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After the strain of carrying a baby for nine months, and the rigours of giving birth, it is not surprising that some moms will be left with weakened pelvic floor muscles and poor control over their bladder.


Kegel exercises strengthen the muscles of the pelvic floor to improve urethral and rectal sphincter function. The success of Kegel exercises depends on proper technique and sticking to a regular exercise program.


womenMethod of Use
The set includes two sizes of vaginal cones. The normal progression for home exercising is to start with Size 2 (the larger size) and then progress to Size 1 (the smaller size). At the start, the small cone could tend to fall out, even with a low weight. By beginning with the larger cone, this problem is avoided. To remove the cone, the patient relaxes her pelvic muscles and the cone falls out. Alternately, she can use the flexible plastic cord to remove the cone. Very soon, the patient will find that she does not need to consciously squeeze her pelvic floor to keep the cone in place. The main reason that unassisted Kegel exercises often fail is that the patient is not doing them correctly. When the patient uses the Aquaflex cones correctly and masters the technique, she will be recruiting the right muscles. In one clinic, the therapist found that it took approximately 45 minutes to properly instruct a patient to do Kegel exercises correctly. In contrast, Aquaflex typically took only 15 minutes of instruction.


To use kegel weights in the clinic, it is helpful to start by finding the patient’s active level. This is the weight that the patient can retain while contracting her pelvic muscles for one minute. Instruct the patient to squeeze and lift the pelvic floor. Verify by palpation that she is not contracting the abdominal, thigh or gluteal muscles. Then reduce the weight by 10 g. This is a good starting weight to find the resting level. The resting level is the maximum weight that the patient can retain for one minute while walking about and without contracting.


When used without weights, the cones are also helpful at the start of therapy as a teaching aid for showing the patient how to find and contract the right muscles. Almost all patients will benefit from Aquaflex therapy.

Aquaflex is complementary to biofeedback therapy. It is very useful to have an Aquaflex set available in the clinic. At the beginning of a series of treatment sessions, you could introduce the cones to the patient as part of a home exercise plan. She will quickly become familiar with the concept. If suited to her interest and goals, you can prescribe the exercise cones as the primary exercise aid, or, you can use them to augment other methods, such as FemiScan EMG biofeedback and E-Stim. Aquaflex will help your patient to increase her resting muscle tone more quickly than by Kegels alone.

The Aquaflex cone is designed with the optimum slope and shape for maximum muscle response during exercise. The starting weights are located mainly in the pointed portion of the cone to avoid any problems of the cone tipping sideways while in place, which would decrease effectiveness.

Detailed self-teaching instructions are included. Aquaflex vaginal weights will encourage the patient to exercise correctly between sessions in the clinic.

Many patients who otherwise might have difficulty in keeping up with unaided pelvic exercises find that the cones are an easy-to-use confidence builder and an ideal exercise aid. The Aquaflex system, can help your patients to

achieve overall better outcomes by encouraging home exercise.


After a successful program, you can suggest a lifetime plan to maintain pelvic fitness. At least once per month, between periods, and at the same time during the day, she can exercise with Aquaflex. If she can no longer hold the same weight, then daily exercise is needed to restore muscle tone.

Patients tend to remember what they see. Two videos are available from Biomation for you to show your patients:

1. Aquaflex Instructional Video
2. Treating Urinary Incontinence - A Guide to Behavioral Methods


Prescribing Information

vaginal conesAquaflex is especially effective when prescribed for daily use at home. The method appeals especially to the busy and active patient who is aware of the importance of physical fitness and preferably exercises regularly.

A typical exercise plan is 15 to 20 minutes, twice per day. To start, you can recommend a shorter exercise period of one to five minutes depending on the patient’s endurance and level of muscle tone. When Aquaflex is the primary treatment, the exercises should be performed once or twice daily for eight to twelve weeks.

You will need to tailor the exercise plan to fit your patient’s situation and daily routine. The patient will likely need to decrease the weight level in the evening. This will illustrate the amount of fatigue developing in the pelvic muscles during the day. Very little extra time is needed each day because she can do other light activities while using the cone. Your guidance will be important to encourage slow steady progress because this will give the best results. Increases in the resting level correlate with improvements in continence.

Adding Aquaflex therapy into the patient’s daily morning and evening routine is recommended. As in other forms of exercise therapy, the patient should not attempt to advance to the heavier weights too quickly.


You can also prescribe active exercise to increase effectiveness. Increase the weight by about 10 g over the resting level. The patient uses the squeeze and lift technique to hold the weight in place for about one minute. Repeat three times. Increase up to two minutes.

After using Aquaflex successfully, you can add Kegel exercises. These could consist of flicks, strength, incremental steps and endurance exercises, working up to 50 repetitions per cycle and four cycles per day.

For some patients, there can be faster progress with an exercise progression:

• Three weeks of Aquaflex th.erapy to help find, recruit and strengthen the correct muscles
• three weeks of active Kegel exercises.
• three weeks of Aquaflex therapy to further develop the postural muscles.

In general, you can suggest that she should work to a target increase of 20 g over her starting weight. By this time there should be total dryness or at least a significant improvement. Lifestyle changes can also be important. Each patient is different, and perhaps she will advance all the way to 55 g, but, on average, a 20 g increase is a reasonable objective.

Aquaflex does not need a lubricant, but a small dab of water-soluble lubricant such as K-Y™ or Muko® or wetting the surface of the cone with water can help insertion and exercising. If needed, a lubricant can make the exercise more intense and effective.

The patient will need to disassemble and wash the cone after each use.

Post menopausal women can use Aquaflex with the aid of estrogen cream, if required, when there is vaginal dryness.

You should stress that the objective is to achieve full bladder control. Otherwise the patient might tend to stop exercising before the full benefits are realized.

The Aquaflex vaginal weights should not interfere with a pessary, provided that the pessary is placed high up.

Falling within the category of a physiotherapy aid, and being used for a diagnosed medical condition, the cost of Aquaflex is covered by many extended-health insurance plans that cover physical therapy, continence products or medical equipment, when supported by a prescription.


Indications for Use:

1. Diagnosed urinary stress incontinence.
2. First stages of mild stress incontinence, to counteract progression to more severe incontinence.
3. First degree prolapse.
4. Weakness and improper recruitment of the pubococcygeus muscle due to childbirth or menopause.
5. Pelvic therapy for patients awaiting corrective surgery to correct stress incontinence.
6. Post operative physical therapy to reduce the incidence of a relapse.


Contraindications for Use:

1. Severe prolapse of the bladder or uterus. kegel
2. Dementia or inability to follow instructions.
3. Pregnancy.
4. Within six weeks of birth, where grazing or incisions have not yet healed.
5. Within six weeks of vaginal corrective surgery.
6. Vaginal infection or inflammation.
7. Cervical or uterine cancer.


Beneficial Effects:

1. Reduction or elimination of involuntary urine leakage.
2. Increased pelvic muscle tone.
3. Increased energy level, reduced feeling of tiredness.
4. Resumption of a normal active lifestyle.
5. Increased mobility and higher fluid intake produces significant overall health benefits.
6. Decreased fear and anxiety about future long-term incontinence problems.
7. Tendency for an increase in the libido, sexual response and sexual intensity.
8. Savings on expenditures for pads and protective clothing.


Problem Solving

1. The patient reports that the cone falls out even when using the large cone with no weight.

This is OK, but she is likely using the wrong muscles. She is bearing down with the abdominal muscles instead of lifting up with the pubococcygeus muscle. This is a learned response; success can be expected after a few more exercise sessions. More instruction is needed.
2. In a new patient, the cone stays in even with all weights.
The patient has inserted the cone too far and it has tipped over. It will not be very effective in this position. She should not insert is so far, as described in the instructions. Use a water-soluble lubricant.
3. The cone stays in easily and the patient does not think it is helping very much.
Use a lubricant, use the smaller cone and increase the weight to give a more intense exercise level.



It is intended that each patient should have her own personal Aquaflex set. However, as well as the patients' personal Aquaflex sets, you should have additional sets available for use in the office. After use, the set must be disassembled, washed, rinsed and then subjected to a high-level disinfection protocol by chemical soaking or by ETO gas.
Clean and disinfect the cone shells and the weights. To disassemble an Aquaflex cone, unscrew the two parts of the plastic cone shell, remove the vaginal weights and remove the plastic spindle.

Wash with soap or detergent. An enzymatic detergent such as Empower or Klenzyme, is preferable, if available, because it cleans away any protein material more quickly and effectively.

After cleaning, you can easily disinfect the set by chemical soaking such as in activated 2% glutaraldehyde (available as Metricide) or Cidex OPA. Soak for 20 minutes; then rinse and dry, or follow the recommendations of your facility’s infection control guidelines.