A worldwide row is brewing following recommendations by the American College of Physicians that Kegel exercises, bladder training and, in some cases, weight loss are the most effective ways to treat urinary incontinence in women, and should be tried before the use of drug treatments.
This appears to fly in the face of the recent review of the UK NICE Guidelines that focussed entirely on surgical and pharmacological intervention and totally ignored developments in non-surgical, lifestyle and non-invasive physical therapies.
Lauren Streicher, MD, a leading US commentator, succinctly raises the key issue: ”Face it, if Kegel exercises worked, the adult diaper (nappy) industry would not be advertising on prime time television and would not be a gazillion dollar a year industry.” . This echoes the core argument made by British author Barry Fowler in The Kegel Legacy (ebook gbp1.99) published in 2013.
Streicher goes on to say: “It’s true that Kegel exercises are commonly recommended. And almost as commonly, they fail. Multiple studies show that few women do them correctly or consistently.”
Barry Fowler totally agrees with the sentiment of Streicher’s comments but points out that the core problem is not pelvic floor exercises per se, but the fact that the Kegel exercises that are taught around the world bear no resemblance to the clinically proven techniques developed by Arnold Kegel. He says they ignore the key principles that Kegel deemed to be necessary for his exercises to work: namely confirmation and confidence that the correct muscles are engaged; rigour; progressive resistance; and positive feedback for motivation.
Fowler says: “Kegel demonstrated in the largest clinical trial of its kind that 85% of women with stress incontinence could achieve an objective cure in two weeks. Today women are wasting their time with a totally useless ‘exercise’ and face a life time of embarrassment and suffering.”
“In researching The Kegel Legacy I studied the medical literature going back 50 years and I cannot find one clinical trial that supports the methods taught today and demonstrates that they are as effective, or more effective, than the methods proposed by Kegel”.
There is hope for women in the UK. The highly effective PelvicToner™ exercise programme is based on Kegel’s principles and has been available on prescription for over three and a half years. It is clinically proven to be as effective as the NICE recommended three month programme of physiotherapy yet it costs one tenth as much and does not take up scarce physiotherapy resources. However, many women are denied access to The PelvicToner by local prescription policies.
For further information contact Barry Fowler
0117 974 3534
07768 233 670
An estimated 7 million women in the UK suffer the embarrassment of Urinary Stress Incontinence (USI).
5000 new mothers each week will develop serious long term health problems because of the poor post-natal advice and guidance that they receive. Published data shows that there are around 60,000 births per month in the UK, and it is widely acknowledged that a third of these new mothers with develop long term health problems such as stress incontinence and prolapse because they are not encouraged to follow an effective post-natal rehabilitation pelvic floor exercise programme and are not given sound advice or offered effective treatment.
Author Barry Fowler says: “Our research shows that the best that most women presenting with bladder or prolapse problems can expect is a suggestion that they ‘do’ pelvic floor or Kegel exercises. Some may be offered a locally produced leaflet. I cannot find one clinical trial that demonstrates that giving out leaflets confers any benefits. It is just not a clinically proven treatment.”
The new Clinical Practice Guideline for the Nonsurgical Management of Urinary Incontinence in Women by (http://annals.org/article.aspx?articleid=1905131) published by the ACP makes a number of recommendations:
Recommendation 1: ACP recommends first-line treatment with pelvic floor muscle training in women with stress UI. (Grade: strong recommendation, high-quality evidence)
Recommendation 4: ACP recommends against treatment with systemic pharmacologic therapy for stress UI. (Grade: strong recommendation, low-quality evidence)
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