A 55-year-old woman complains to a physician because she has been having chronic pelvic discomfo. On fuher questioning, she repos chronic lower back pain, constipation, difficulty with walking, and impaired coitus. Pelvic examination demonstrates that the uterine cervix lies low within the vaginal canal, but does not protrude through the introitus. For minor degrees of this patient's disorder, Kegel exercises are sometimes prescribed. These can be performed by asking the patient to do which of the following?

The Kegel exercises are specifically designed to contract the pubococcygeus muscle, and can be performed by interrupting the flow of urine. Patients with minor degrees of prolapse may also be treated with a pessary, which is a small object placed in the vagina that serves as a mechanical suppo for the uterus. Estrogen therapy is also of some help in some patients. Severe degrees of prolapse may require either hysterectomy or surgical strengthening of the pelvic floor. First choice describes the Valsalva maneuver, which these patients should not do, because it increases intra-abdominal pressure and may worsen the prolapse. (They should also avoid lifting heavy objects for the same reason).