vaginal cones and weights explained by a physiotherapist

Vaginal cones: a modern girl’s guide to the ancient art of pelvic floor weights

Vaginal cones and weights; relatively cheap and a good way to progress your pelvic floor training

Vaginal cones and weights are a very different concept to electronic devices, cheaper and more accessible for most people.  There is a bit of a knack to using them correctly.   They are particularly good for building the endurance qualities of the pelvic floor – which we need for holding babies, carrying shopping and going for a run.

 Did you know that vaginal cones are modern versions  of Chinese Ming Balls?  Once only available in sex shops and more associated with ancient “boudoir” skills than bladder control.  But good things last the test of time and vaginal cones are now even available on NHS prescription!   

The electronic devices monitor whether you are squeezing correctly and give  you feedback on that action as well as ‘games’ to keep you occupied.  However, because they are technically advanced, they are clever and also expensive.  Cones are a much cheaper, non-electric alternative (£25 – £30 with one type available on prescription).  

There are several choices on the market: –

the Neen Aquaflex Cones  Pelvic Floor Exercises System (boots.com, stressnomore.com), you put little weights inside a plastic cone and add more inside the plastic shell as you progress.  

Aquaflext vaginal cones have stood the test of time

Aquaflex vaginal cones

With the Kegel8 Vaginal Cones (www.stressnomore.com) you have 3 different cones of lighter to heavier weight.  

Kegel8 vaginal cones are available on prescription now

Kegel8 Vaginal Cones

There are also several others such as the Lelo Luna Beads which are more obviously modern takes on the original Ming Ball concept (www.stressnomore.com carry a comprehensive range)

Lelo luna balls vaginal weights based on Ming Balls

Lelo Luna Balls

 

 

Aquaflex vs Kegel8?

I have had many clients use both the Aquaflex or Kegel8  system – they do exactly the same job – Kegel8 a bit prettier and more touchy-feely with a nice pointer to help you see how far in to put it in (and now available on prescription) .  The Aquaflex cones have a finer retrieval cord, which appears from online reviews to make some people nervous  (though I’ve never had anyone have any trouble) but this does let you put your knickers back on giving you more options of where you might use them!   Have a look at them both online and read the customer reviews – but I would say it is just a personal preference thing.

Cones and weights are a progression from the basic exercise

You do need to have a good foundation pelvic floor contraction first or they are just going to fall straight out the minute you stand up, which is most disheartening.  If this happens to you, I would recommend you get your pelvic floor technique checked by a specialist physiotherapist first.    It is not uncommon for people to think they are squeezing quite perfectly only to find on proper vaginal examination that there is really not much going on at all.  Don’t panic if this is you – it is all sortable but cones are not for you (yet!). 

It’s like adding hand weights to your pilates routine

Good ol’ basic pelvic floor exercises come first (see the Pelvic Floor School videos).  The vaginal cones are to your pelvic floor exercises, as adding handweights would be to your yoga or pilates routine.  It takes the normal unloaded task and makes it more challenging by adding a resistance to work against.  Adding “load” to a muscle encourages it to work harder and grow more.    In the gym you can hold handweights for your arm exercises or push against a piece of gym equipment for more resistance challenge for your legs.  The cones allow you to add some weight directly onto the pelvic floor. 

How to use them

Though I said earlier it is like adding hand weights to arm exercises – it’s not quite like you might think.  When you are exercising with the vaginal weights you are not trying to squeeze and contract, on and off like with traditional pelvic floor/kegel exercises. Now you are rather trying to hold the weight of the cone in place while you do another activity.   You really are holding it to stop it falling out.  This style of holding exercise promotes the development of the slow twitch/endurance qualities of the muscle – think of channelling Mo Farah (for 2 hours on your feet at playgroup) rather than Hussein Bolt (though we need his power for The Knack when we cough or sneeze).    We need to develop this endurance muscle skill for when we are lugging shopping or carrying toddlers or trying to enjoy prolonged exercise.

First find the right weight

 If the vaginal weight is too heavy you will feel the cone slip out of position within 30 seconds.  If it is too light you might find you have completely forgotten all about it and practically gone out shopping with it.  It will have just been sitting in the vagina like a plastic tampon.  The right weight should feel like you are not doing anything terribly exciting for a minute or so and then you start to feel that it is slipping towards the vagina opening and needs a little push to reposition it.  This means that your muscles were holding it well, in an endurance hold, but as you started to fatigue, the muscles loosened and it started to move down the vagina with gravity.

 When inserting the cone it can help to use a tiny dab of personal lubricant on the end to help entry to the vagina but beware anything more than a dab or you will never hold it in.  Think more cork fully in a bottle than tampon position.  The Kegel8 has a marker on the “tail” to guide position, or with the Aquaflex you should have to reach inside about a knuckles depth to feel the base of the cone.

Then choose your venue

I don’t recommend wearing them out of the house as some adverts suggest. That just seems like asking for trouble to me.  I suggest that you stay securely at home and start by putting the cone in for a relatively still activity and then increasing the challenge. 

A customer favorite is to use the cones when you are going to wash your hair in the shower – based on the principle that this is about every second or third day and you don’t forget to wash your hair.   I also like that you are going to be naked anyway and its a naturally clean environment.   You can keep the cone you are using hidden discreetly in the bathroom, ideally somewhere close enough to the shower that you can reach it even if you’ve already got in and got wet before you remember the cone.

First skill – just stand still!

First goal is to just stand still and wash your hair as normal.  You will find yourself more conscious of your underneaths (!) and if it’s the right weight you will feel the need to reposition it a couple of times as soon as your muscles tire.  About the 4th time you come to wash your hair you should be noticing that it slips less easily and then very soon it doesn’t feel like a challenge at all. 

Progress to complex activities…

Now put your shampoo & toiletries on the floor while you shower to make yourself have to bend up and down a few times mid-hair wash.  When this is easy, progress by extending the showering session to include standing on the bath mat and over-dramatically rubbing dry, add in a little jog on the spot and then the ultimate tests are a bit of jumping up and down – and a pretend cough. The thought that you could shoot the cone across the bathroom if you don’t hold on will certainly activate the right muscles.    Once you can do all these things with your first weight time to progress.  If you are using the Kegel8 cones move to the next weight up, if you are using Aquaflex, unscrew the cone to add another weight inside.  Now, with your heavier weight in place go back to standing still and just hairwashing, progressing through the stages as before.

And maintain weekly….

Once you feel you have improved your muscle strength, endurance and co-ordination vaginal cones are neat to establish a “maintenance drill”  Pick one of your hair washes a week (say the weekend wash) to be the “cones-wash” and as long as week on week you are still as masterful at your washing, jumping and coughing routine you know the muscles are keeping strong.

Other popular activities

ironing – progress from simple tea-towels to complex men’s shirts and put the basket of laundry on the floor so you have to bend more

emptying the dishwasher – takes longer if you are multi-tasking with the cones but a nice bit of bending/stretching and few steps about the kitchen required

childcare – my sister’s mantra was never doing anything when you child is asleep that you could have done when they were awake.  Under 5’s are not going to remotely notice what you are up to.  Put some music on!  Start with some  sedate wafting about  to gentle nursery rhymes and build up to a good stomping rendition of the Grand Old Duke of York or a bit of Justin Bieber (no judgements here).

Let’s grow this list.  Have you tried vaginal cones or weights?  When (Where???!)  do you do yours?  Do share (photos optional).

What's the difference between pelvic floor biofeedback and stimulation units?

What’s the difference between a pelvic floor biofeedback device and a stimulation machine?

*denotes an affiliate link

There are two types of units you can use to help improve your internal muscles –  pelvic floor biofeedback devices and muscle stimulation units.

Pelvic floor Muscle Stimulation Units

These units are designed to be used at home to artificially stimulate the pelvic floor muscles to work. Electrical impulses are sent from the machine directly to the pelvic floor to mimic the messages that your brain is supposed to send. These units are ideal for people who really don’t know where their muscles are or what they are supposed to do. They are also good to use for very weak muscles that can only contract a few times before they fatigue or can only muster a very tiny amount of strength.

  • the sensations (a sort of tingly feeling) created by the electrical impulses help your brain to correctly identify the location of your pelvic floor muscles.
  • the machine will stimulate the muscles to work (contract). It is possible to change the settings to favour different parts of the muscle.
  • you can practice joining in with the machine to learn how to contract your muscles without help
  • the machine can help you to ‘hold’ a muscle contraction while you concentrate on learning to breathe and/or move at the same time
  • we usually recommend that you wait until 3 months postnatally before using a stimulation machine.

Examples of stimulation units:

To be professional, I cannot recommend a single specific product or supplier but I have aimed to narrow down the list of options for  you.  Please do read customer reviews to help you make your decision.  Remember that a specialist physiotherapist like myself has units in clinic for you to try out and borrow if you prefer to try before you buy.

  • Neurotrac Continence is a simple classic pelvic floor stimulation unit which we  have used inNeurotrac Continence is easy to use our clinic for many years.  The buttons are large and few!  It has pre-set programmes for both stress and urgency or your physiotherapist can customise it for you.  Available from Physio & Medical .  Stella is really helpful, you can phone her at 01629 735894.  She has arranged free p&p and a discount for readers £89.59 (includes periform probe) – QUOTE AS-2017 for when placing your order on the phone or use coupon code Conti2 for an online order.
  • Neen Pericalm was recently brought in by a customer.  I also found this one very easy to follow Neen Pericalm is discreet and easy to usethe instructions and set the programmes.  It is also very small and discreet.  Available from Physio & Medical .  Stella is really helpful, you can phone her at 01629 735894.  She has arranged free p&p and a discount for readers  £78.38 (includes periform probe) – QUOTE AS-2017 for when placing your order on the phone or use coupon code Neen3 for an online order.
  • Kegel 8 Mother Nuture (even though it is the cheapest one that Kegel8 offer it has all the Kegel8 Mother Nuture is also a TENS machineprogrammes you will need, plus doubles up as a TENS machine if you anticipate another delivery) £79.99. The kegel 8 Tight & Tone Electronic Pelvic Toner £98.99 looks like a re-package of the Neurotrac Continence which I have used in my clinic for many years (see above).
  • Nu-tek Levator mini continence stimulator.   Win-health  supplies our practice.  It is a Nu-tek levator minigood stimulator though the buttons and set up are a little fiddly until you understand how it works. I recommend you select the Periform probe (which has a hole in the middle rather than solid, most clients find it more comfortable).

Pelvic floor Biofeedback devices

Generally we advise that if you can already contract your pelvic floor muscles then you don’t need to do passive stimulation. The majority of women are ready to jump straight in with a biofeedback unit. Muscles develop quicker by doing ‘active’ exercises where the brain initiates the activity. When you use a biofeedback device to enhance your practice your brain is learning the skill-set that your muscles need to perform in every day life even when you are not plugged in to a machine:

  • With these units the action of your muscles contracting is relayed to a machine which “shows” you what you are doing.  There are several different ways this can be done.  Some machines pick up the electrical signal from your muscles while some respond to pressure.  Some give you a visual picture of what you are doing, others vibrate in response to your contraction.
  • These are great to correctly identify your pelvic floor muscles in different positions and ensure you are contracting correctly and also to help you focus on relaxing fully between contractions
  • to see how well your muscles contract and relax and give you targets to aim for to improve strength, endurance and co-ordination.
  • to practice more complicated tasks (mimic real life tasks)
  • to make exercising a bit more fun and interesting to help you to keep up long-term practice and awareness for your PF muscles (rather like a piece of gym-kit for your pelvic floor!)

 Examples of pelvic floor biofeedback devices:

To be professional, I cannot recommend a single specific product or supplier but I have aimed to narrow down the list of options for  you.  Please do read customer reviews to help you make your decision.  Remember that a specialist physiotherapist like myself has units in clinic for you to try out and borrow if you prefer to try before you buy.

Electrical biofeedback devices:

  • Peritone EMG biofeedback unit and Simplex EMG biofeedback unit are  the ones we have used in our clinic for many years (same device in different packaging).  They are effectively two parts.  You place a small internal electrode (called a Periform, £20, which is single person use,  into the vagina, put your clothes back on, and then link your internal device by a cable to the handheld Pelvitone or Simplex unit (we can loan one of these to you).  When you contract your pelvic floor muscles their electrical activity registers on the screen making the  lights change from orange to green and giving an audible beep.  You can practice your quick maximum power squeezes seeing how high you can make the lights go, practice keeping the lights green while you cough or try moving your arms or legs and there is also a work/rest function which ‘counts’ the endurance holds for you and tells you your average squeeze score at the end.

These devices are widely available from lots of online sellers +/- £160 (including the Periform).  Our practice is supplied by WinHealth –and  Physio & Medical (use code pelvi5 for a small additional discount) both of whom can offer a VAT exemption if the unit if for personal use for a medical problem.

Peritone Biofeedback unit

Peritone EMG biofeedback unit

Neurotrac Simplex

Neurotrac Simplex Biofeedback unit

 

Periform + is very comfortable

Periform internal device

 

 

 

 

 

  •  ELVIE.   * affiliate link    The Elvie is a new release last year and updates the design of the traditional units above. It is becoming very popular as it has modern smart phone visuals, easy charting and they are developing a sense of community amongst users.   I have one I can show you in clinic but the internal device (the pebble) is the expensive part, and understandably single use only, so I’m afraid you can’t try before you buy.
Elvie pelvic floor tracker and app

Elvie pelvic floor tracker and app

It is a discreet, attractive, wireless bluetooth pebble
shaped device to go inside the vagina and then an app to turn your phone into the biofeedback monitor/exercise tracker.  No cables between you and the phone but you can’t put knickers back on or the bluetooth can’t connect. It is beautifully packaged and well designed by women. It can be used in the second trimester of pregnancy but is not recommended for the 1st and 3rd trimesters.   Available directly from  Elvie £150 for the pepple device,  the phone app is free.  Enter PHYSIO at the checkout for a 10% discount *.

Pressure Biofeedback devices

Kegel8 pressure biofeedback

  • Kegel 8 Biofeedback Pelvic Trainer Kegel8 are not offering an electrical biofeedback unit in their products any more. They have a product  which uses a pressure system where you squeeze on a larger tube which moves a dial on the hand held unit.  Relatively unsophisticated but an inexpensive option at £79.99 including VAT.

 

  • Epi-No Delphine Plus £89.99 This is another non-electrical device, which monitors the amount of squeeze pressure you
Epi-no Delphine Plus pressure biofeedback can be used in pregnancy

Epi-no pressure biofeedback

are creating with your muscle contraction.  Though, as with the Kegel 8 Trainer, this is less sensitive than the electrical one the advantage of the Epi-No is that it is  certified for use through your whole pregnancy. It can also be used in the latter part of pregnancy (after 37 weeks) to help to stretch the vaginal opening.  Though a recent study ^ did not show evidence of a protective effect of the Epi-No device on birth trauma, anecdotally many women feel it has helped with their confidence to relax the vaginal opening in preparation for birth.

^Kamisan Atan I, et al. BJOG 2016  Does the Epi_No birth trainer prevent vaginal birth-related pelvic floor trauma? A multicentre prospective randomised controlled trial.

 

  • The Vibrance Pelvic Trainer  was released in the UK this January, though it has been available in Asia and USA for several years.  It is a petite internal device which vibrates when you correctly contract your pelvic floor muscles.  The device is  discreet and easy to position correctly. There are no wires and you don’t need a handheld device as the vibration is felt in the device itself.

    Vibrance personal trainer

My instinct is that this device could also be useful as a ‘bridge’ back to penetrative sex  if you were a bit nervous of what things will feel like or having trouble relaxing.  You could practice inserting the trainer at your own pace and might find the vibration element helpful to re-sensitise your tissues.   We have one available to try in our clinic (using a condom cover protocol).  They are available directly from  www.vibrancepelvictrainer.co.uk  £140.83 with VAT exemption.

This links to a digitally annotated instructional video for Vibrance PFT on youtube:https://www.youtube.com/watch?v=n8IoqefRzTU

 

Note about VAT exemption

If you have had a problem for more than 3 months you can declare yourself as having a ‘chronic medical condition’ and do not have to pay VAT. There will be a form to complete. This does not apply to the Elvie which is registered as an exercise tracker not a medical device. Not all the online suppliers can offer this service.

Combined Stim & Biofeedback Machines

You can also buy combined units which do both functions but these are surprisingly expensive (and a bit fiddly) so if you feel you need both systems I usually suggest you buy two separate simpler units and switch between them.

Lubricating gel

You will need a water-based lubricating gel to help the insertion of the devices and it is essential to help the electrical devices to operate correctly. A simple, in-expensive, chemist-own or basic brand name  is all you need unless you  have concerns about ingredients and prefer an organic version.   Do read my posts about the difference between water-based and oil-based lubricating products.

Where to start?  

If you are not too sure how good your muscles are then my role at physiotherapy is to do an internal assessment of your pelvic floor muscles to check how well they are working and teach you how to get the best from them. We can loan you both muscle stimulation and biofeedback units to try out at home to see how well they work for you before you consider buying your own. It is particularly important to consider an individual assessment by a specialist physiotherapist if you are at all worried that your pelvic floor muscles might be too tight rather than too weak.

I can also teach you exercises , which require no equipment at all (!) to get your muscles to the best possible condition. I usually combine pelvic floor exercises with appropriate abdominal muscle work as these two areas need to work well together for best support of our internal organs.

Please don’t hesitate to be in touch if you have further questions.

3 Great Pelvic Floor Exercise Apps

If you have a smart phone you may enjoy one of the new pelvic floor exercise apps.  These are great innovations.  This week I have  tried out a couple of  reminder apps (Squeezy & my pff), a tracking app (Elvie) and an exercise workout to watch on your phone (Pelvic Floor First)

Road-testing has had entertaining moments with  my phone  beeping and buzzing.    I have done a LOT of pelvic floor exercises this week.  Perk of the job.

TIP (obvious, to everyone else I’m sure, but I did it by accident):  When you are looking at them the first time and organising your settings you might find it easier to view the app on your iPad/tablet so all the buttons and instructions are bigger.

Sadly there is no app that actually does the exercises for you.    Though they all have similar sounding descriptions on the app stores,  I would categorise them into ‘reminder’ apps, ‘ exercise tracking’ apps (with wearable device) and ‘portable exercise workouts’ to follow on your smart device.

REMINDER APPS

Pelvic floor exercise apps - Squeezy NHS

Squeezy NHS app gives regular reminders and lovely visual prompts to follow

  Squeezy – the NHS Physiotherapy App for Pelvic Floor Muscle Exercises, Propagator Ltd £2.99.  Also offers the Apple Watch App for iphone. 

This has been designed by one of my specialist physiotherapy colleagues, Myra Robson, using all her NHS experience and hundreds of clients feedback to develop an informative, easy to use, clear and visually pleasing app.  You can change settings easily yourself to chose how many times a day you want to be reminded to do your exercises.  It sends you a (silent!) text message to remind you to do your exercises.   Then you tap on the screen to start a balloon/type bubble moving – you can’t but help start squeezing in response!  Its a great visual prompt (with optional ‘boing’ noises).  There are drills to practice fast contractions or slower ‘holding’ contractions.  You can change the settings to make the exercises a comfortable speed for your ability.  You can record your sessions, as well as how much you have been drinking.   

If you are working with a physiotherapist they can help you set up your programme to fit with their training and check up on your efforts!  

pelvic floor exercise apps - My pff

My pff by tena

My pff – an app sponsored by Lights by TENA.  Free.

This free app is a similar exercise concept, with a screen changing colour up and down to show you how long to hold and relax for, but lacks the helpful information and bespoke settings options of Squeezy.     It was very simple to chose your level (in the settings bar at the base) and then get started.   I liked the very simple interface of this app but similar to the reviewers I had problems with it crashing when trying to set the reminders.  Once I had set them (2 or 3 crashes but it restarted easily each time) it worked fine.  I like that there was a simple button to turn the reminder off (if you finally get a daytime nap you would be hideously cross if it’s an app that wakes you up)

HACK  Use your phone clock function!   Free.

Set your phone’s ordinary timer to alert you every 4 hours through the day to do your exercises

Exercise tracker device with smart phone app

Pelvic floor exercise apps - Elvie

The Elvie is a discreet vaginal device which tracks your pelvic floor exercises on your smartphone

Elvie  feedback/tracker device with free app   £150     www.elvie.com  (for a 10% discount use PHYSIO as a promotion code at the checkout)

Tracking apps  communicate with a wearable device.  You may already have a FitBit worn on your wrist to communicate with your phone?  The Elvie is, as they say, ‘the most intimate’ tracker – a small, pebble shaped unit which you put inside the vagina.  Then it communicates via blue tooth to a phone app.  When you practice your pelvic floor contractions a patented force and motion sensor system detects the strength of the muscle activity and shows up on your phone screen, giving you real time information about how well you are contracting.  There are clever ‘games’ to play by contracting your muscles – think pacman controlled by your pelvic floor? It records your exercise sessions – great for motivation.

Important note – designed for discreet home exercise, unlike a FitBit, not for going out & about!

WORK OUT APPS WITH PELVIC FLOOR FRIENDLY EXERCISES

pelvic floor first app has good workouts

The Pelvic Floor First app has great pelvic floor friendly workouts

Pelvic Floor First – by the Continence Foundation of Australia . Free.

This app is not a ‘reminder-type app’, rather a portable workout regime to copy.  If you like your pelvic floor exercises disguised amongst your other body part exercises then this app may be just right for you.  The app is based on the Continence Foundation of Australia’s Pelvic Floor First website with the workouts designed by a physiotherapist and fitness professional to be ‘pelvic floor safe’.

There are 3 levels of workouts, using light hand weights and a gymball as props.  The exercises are very clearly presented as just stills, audio or audio & video together.  It has a nice feature to count down a daily workout but you do have to keep starting each new exercise by pressing the arrow on the screen.

 Have you tried a pelvic floor exercise app?  Did you like it?  Please share your recommendations in the comments below and let me know which one I should road-test next?!