Pelvic toners and pelvic floor exercisers

We are often asked "What style of pelvic toner or pelvic floor exerciser would suit me best?"

The answer usually depends on a woman's existing symptoms and pelvic floor strength, what level of pelvic floor fitness she is aiming to achieve, and on lifestyle factors too.

This summary of the four main types of pelvic exercisers, and how they work, is designed to help you choose what's right for you. However everyone's needs are different. If you are still unsure after reading this guide, we suggest that you read our 5 Step Guide to making a decision and talk to your health practitioner to discuss your specific needs.  

There are four principle types of pelvic floor exercisers, or pelvic toners: weights exercisers, feedback exercisers, electrical stimulation devices and spring exercisers. Even products which look and function quite differently usually fit into one of these main categories.

WEIGHTS EXERCISERS: There are three main types of weights exercisers: Vaginal Cones (also know as vaginal weights), Vaginal Balls and Vaginal Barbells.

Weight exercisers all work on the principle that by challenging the pelvic floor muscles with weight, muscle strength is gained, just the same as using weights for other parts of the body. Some vaginal weights have built-in progression, where extra weight is added to create greater challenge. Others use a fixed weight, but suggest you can increase the muscle challenge by adjusting your body position or your exercise technique.

•  Vaginal cones or weights sets (such as Aquaflex and Luna Beads, which although shaped like balls are actually another form of progressive weights) consist of a series of cones of increasing weight, and provide sufficient challenge to beat stress incontinence for a very large number of women. They are often the most popular choice for women who are experiencing mild stress incontinence, and who want to overcome or reduce their symptoms to more manageable levels . They are recommended by the expert body, the International Consultation on Incontinence, as a first-line therapy for the treatment of stress incontinence.

Cones strengthen the pelvic floor muscles simply by their presence. They are used progressively over a period of weeks, starting with the lightest cone and building to the heaviest. The presence of a cone in the vagina naturally causes a contraction of the pelvic muscles to hold the cone in place. Cones must be used standing up, as they rely on gravity to work.

Cones are used for 15-20 mins a day while undertaking normal day-to-day activities (at least once you've started to get used to them), with no need to set aside dedicated exercise time.

Cones work to strengthen the pelvic floor without the need for "squeeze and lift" exercises, so are often the choice of women who are not sure whether they are able to contract their pelvic floor correctly, or who do not want to give the time to an exercise program. The maximum weight in most cone sets is 50-55gm, so there is a limit on the "challenge" that cones present to the pelvic floor muscles. Women who are seeking a high level of pelvic floor fitness, beyond the level required to overcome their stress incontinence, may find that they need to use add-on weights or an additional exerciser to achieve their goals.

The Fourth International Consultation on Incontinence, Paris, July 2008 recommended vaginal cones for the treatment of stress incontinence, as a stand-alone alternative for women who do not exercise.

Cones or weights are not suitable for women who have a prolapse as the prolapse can preclude the correct positioning of the cone. Some women with a wider vaginal vault may find that the cones do not sit correctly in the vagina and may therefore find the wider vaginal balls suit them better. You can easily test whether this applies to you.

•  Vaginal balls (such as Smartballs, Smartballs Original and Luna Beads)
are usually wider than cones or weights and therefore are much easier for some women to hold in place. Although they aren't generally as widely recommended by health professionals as vaginal weights, research has shown that they are effective and some practitioners prefer them to narrower cones.

They are flexible enought to be used in a variety of ways:

Luna Beads, although designed as vaginal balls, offer weight progression just like vaginal cones. Vaginal balls are also available in single and duo designs, which can be combined to create similar weight progression.

Vaginal balls used alone can be a useful choice for women who are seeking to overcome mild to moderate stress incontinence. When used as a resistance device for a woman who is committed to a pelvic floor exercise programme, they can assist in developing stronger muscles, and when used with external added weights, such as PelviWeights, they offer virtually unlimited opportunities for building pelvic floor strength.

•  Vaginal barbells (such as PelviBar, Juno and Energie) are available in a range of designs, weights and materials. The shapes usually provide increasing challenge to the pelvic floor muscles, using the principle that it becomes harder to hold a heavy object in the vagina as the object becomes smaller (narrower). Therefore most barbells are shaped so that one end is narrower than the other, and progression is therefore possible by:

By exercising in front of a mirror, it's possible to get visual feedback when using a barbell, as the pelvic floor muscles "lift" it.

Barbells are available up to 390g in weight, representing a very serious challenge to pelvic floor muscles. Generally this level of weight is more than would be necessary to overcome incontinence and other pelvic floor muscle disorders. It is more likely to appeal to women who want to improve their sexual response and ability to reach orgasm.

FEEDBACK EXERCISERS (also called perineometers). These include the PFX2, PX-IQ and PFXA, which all work via air pressure and the Peritone, which is powered by a 9v battery.

Feedback exercisers have a vaginal (or anal) sensor attached to a device that incorporates a read-out gauge. When the user contracts her pelvic floor, with the sensor in place, the strength, speed and duration of the contraction is demonstrated on the gauge.

Some feedback exercisers are most suitable for women who can already achieve a pelvic floor contraction (even if it's an extremely weak or very short one) and who want to build up muscle strength and tone. The PFX2 and Peritone in particular are so sensitive that even a minimal weak contraction "registers" so they are generally an excellent choice for beginners. The PX-IQ, with its wider readout gauge and adjustable, hard silicone sensors, appeals more to women who can already produce a measurable contraction but want to push themselves further.

Since it is possible to register a reading on the gauge of an air pressure perineometer through abdominal pressure, rather than through a pelvic floor contraction, exercise technique is important, and users must ensure they adhere to instructions, especially when they first begin exercising. Every customer buying a perineometer from Pelvic Floor Exercise is provided with our Information Sheet 1: Using a perineometer.

Even women who can achieve a strong contraction are often surprised when the perineometer demonstrates how much time it takes to achieve the full contraction and even more surprised at how quickly the power of the contraction begins to fade, and how hard it is to hold.

Generally, a perineometer enables the user to achieve stronger muscles than is achieved using the lighter weight devices. This is important for women seeking solutions for problems other than mild stress incontinence, or women who are seeking to prevent pelvic floor weakness from developing. Women who want to improve their "grip" and their sexual response will also usually prefer a feedback exerciser. A feedback exerciser with a soft sensor (eg the PFX2) is usually also the product of choice for women with a prolapse.

Perineometers require dedicated exercise time, usually in the region of 15-20 mins a day.

Our simplest feedback device, the Pelvic Floor Educator, doesn't provide a read-out gauge, but simply gives feedback on correct technique via an indicator stick.

ELECTRICAL STIMULATORS (also called ES, EMS or NMES devices) like the Pericalm, the InControl Micro Battery-Operated and the Incontrol Micro: Rechargeable work by sending a small electrical impulse via an electrode that is placed in contact with the area of the body that's being treated. The electrical impulses cause the muscles to contract, and by repeating the impulse over the course of a preset program, the muscles "learn" how to contract correctly. Repetition over time through repeated contractions builds muscle strength.

Electrical stimulators are generally used to stimulate muscles or nerves that are not able to respond optimally without help. They are often recommended for use by women who are unable to contract their pelvic floor muscles at all, or who are only able to achieve a weak contraction.

Electrical stimulation is also considered very useful for helping women who can't "feel" their pelvic floor muscles to get in touch with them again, so that they are eventually able to do pelvic floor contractions without assistance.

ES devices can be used on their own as a starting point for strengthening the pelvic floor, or in conjunction with weights or feedback devices as part of an exercise program.

•  All our electrical devices have programs pre-set to frequencies and rest/work times that are known to help to overcome stress and urge incontinence. The InControl models incorporated a third pre-set program for mixed stress and urge incontinence, whilst the Pericalm incorporates additional pre-set programs for Frequency/Urge, Pelvic Pain and an all around pelvic floor workout, as well as three blank customisable programs for the user or the therapist to set as they wish.

•  Electrical stimulators are used with vaginal (or anal) electrodes, attached by wires to the stimulation device. The electrodes are used internally in the vagina (or anus) and the user has complete control over the intensity of the stimulation. Manufacturers usually recommend ES devices are used for 15-30 mins per day (depending on device and program), and since the placement of the electrode is important (to ensure it is in contact with the correct muscle area), they must generally be used in a still position.

•  Although the concept of electrical stimulation can be daunting, the Pericalm and InControl models are very user-friendly, with pre-set programs and easy-to-use controls.

•  Electrodes of different designs are available. Generally most women using electrical stimulation at home, find it easier to use a vaginal electrode with vertical plates, such as the Periform, which is designed to accompany the Pericalm. Vertical plates are easier to position correctly in contact with the pelvic floor muscles than circular plates. The two InControl models both come with a Veriprobe included.

SPRING EXERCISERS (such as the Pelvic Toner and the Kegelmaster) feature two "arms" separated by springs that force the arms apart. The arms are squeezed together and inserted in the vagina, the springs cause the arms to open and the user is able to squeeze against the resistance offered by the springs.

Generally these are the most heavily marketed pelvic floor devices and some women find them very effective, although they are most suitable for women who can already identify and contract their pelvic floor muscles, even weakly. Manufacturer's instructions sometimes emphasise repeated quick contractions, rather than the squeeze and hold contractions that we recognise are necessary to build muscle, but as long as correct current recommendations for pelvic floor exercises are followed, this drawback can be overcome. We supply our spring exercisers with a FREE copy of Women's Waterworks to assist our customers in developing correct technique and exercise regimes.

Because women are all built differently, some women report that the arms of some spring exercisers do not open sufficiently when a device is in place in the vagina, and therefore the device doesn't offer spring resistance, although it continues to offer the passive resistance of a hard object.

Spring exercisers offer very little visual feedback, although it is possible to glimpse the opening and closing movement if you are fairly flexible when using it. Alternatively some women may prefer to use a mirror.