KEGEL EXERCISES

What are Kegel exercises?

Kegel exercises are designed to strengthen the muscles of the pelvic floor that support the bladder and close the sphincters (urethral or anal muscles that contract to stop urine, gas, or stool from coming out).  They were first developed to assist women before and after childbirth.  However, they are useful to improve continence and pelvic organ prolapse by strengthening the pelvic floor muscles.

How do pelvic muscles get weak?

Illustration showing weak bladder control muscles and stong bladder control muscles.

Before exercises:
Weak bladder control muscles

After exercises:
Strong bladder control muscles

Many factors can weaken pelvic muscles, including pregnancy, childbirth and being overweight.   Fortunately, pelvic muscles are just like other muscles – exercises can make them stronger.   Between 50-75% of women with bladder control problems report a substantial improvement in their symptoms as a result of doing Kegel exercises.

Which muscles do I exercise?

Image of organs discussed as seen looking up between the legs.

You can make these pelvic floor muscles stronger with a few minutes of exercise every day.

Your pelvic area is the portion of your body between your hips.  At the bottom of your pelvis are several layers of muscle that stretch between your legs.  These muscles attach to the front, back, and sides of the pelvic bones.  They are the same muscles that the doctor or nurse asked you to contract during your pelvic exam after placing two fingers in your vagina and a hand on your abdomen.  These are the very muscles to exercise. 

You can identify these muscles by trying to stop your urine stream.  Once you have learned how to identify these muscles, do not regularly perform Kegel exercises while urinating because this may eventually weaken the muscles and worsen your symptoms.  You can also place a finger into your vagina, practice a Kegel exercise, and see if you can feel the muscles squeeze your finger.  Some women squeeze the wrong muscles.  Place a hand on your buttock, thighs or abdomen to make sure you are not exercising these muscles instead of the internal muscles of the pelvic floor.   Try squeezing these muscles while lying, sitting and standing to see which position best helps you to isolate these muscles.  Think of pulling up or pulling into your body rather than just squeezing all the muscles of your pelvis.

How do I exercise pelvic muscles?

In the beginning, exercise by quickly contracting and relaxing the pelvic muscles.  You should try to do 4 to 5 sets of 10 contractions each day.  When you are comfortable performing quick pelvic muscle contractions, begin contracting and holding the pelvic floor muscle contraction for 5 seconds before relaxing.  Again, you should try to do 4 to 5 sets of 10 “contraction and hold” exercises each day.  When you are comfortable holding the pelvic muscle contraction for 5 seconds, increase the hold time for 10 seconds before relaxation.  Try to do 4 to 5 sets of 10 “contraction and hold” exercises each day.  Make sure you completely relax your muscles in between each “contract and hold”.  If you are holding for 5 seconds, make sure you relax your muscles for 5 seconds before contracting the muscles again.

Remember, the goal is to improve overall muscle tone.  This may take some time, just as it does with other muscles of your body.  So be patient.  Over-exercise can also tire muscles and cause more leakage.  It may take 6 to 8 weeks for bladder control to improve.  Most women notice an improvement after a few weeks of exercise.  You can exercise almost anywhere and any time – while driving in a car, at your desk or watching TV.  As with other muscle groups, if you stop exercising, they will again relax and you may notice a return of your symptoms.  Doing Kegel exercises isn’t just for a month or two, but should become a routine part of each day.   They are something important women can do for themselves to lessen problems with urine leakage and pelvic organ prolapse.  Remember, pelvic floor exercise training is an effective treatment for incontinence and pelvic organ prolapse, with no side effects.  This can not be said for other therapy like medication or surgery.

The pressure in your abdomen increases when you laugh, sneeze, cough, push, pull, climb stairs, change position, stoop, lift or do other similar activities.  When anticipating any of these activities, or those that cause you to leak urine, tighten the muscles of your pelvic floor during the activity and relax when you are done.  This will help to prevent urine leakage.  For prolonged activities like jogging or playing tennis, squeeze and relax your pelvic floor muscles several times throughout the activity.  Don’t worry if you don’t have great success when you first try this technique. The more diligent you are, the stronger your muscles will become, and the more effective the exercises will be in preventing urine leakage.

A few points to remember

  • Weak pelvic muscles often lead to urine leakage
  • Daily exercises can strengthen pelvic muscles.
  • These exercises often improve bladder control
  • Ask your doctor or nurse if you are squeezing the right muscles
  • Tighten your pelvic muscle before sneezing, lifting or jumping.  This can prevent pelvic muscle weakness from disuse and improve urine leakage.
  • Continue to exercise.  If the exercises work, continue to do them, just like any other exercises.

See NIH Publication No. 02-4188; April 2002.  The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health under the U.S. Department of Health and Human Services.

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