What is Kegel exercise

Kegel exercises also called pelvic floor muscle training exercises, are exercises to make your pelvic floor muscles stronger. The pelvic floor are the muscles that hold up your bladder, rectum and uterus (womb) and help keep them from prolapsing (a condition where organs fall down or slip out of place), resulting in urinary or fecal leakage (incontinence).

Kegel exercises (pelvic floor muscle training exercises) can help both men and women who have problems with urine leakage or bowel control. Kegel exercises (pelvic floor muscle training exercises) can also make sex better.

Building up your pelvic muscles with Kegel exercises (pelvic floor muscle training exercises) can help with your bladder and bowel control. Kegel exercises strengthen the pelvic muscles — the muscles under the uterus, bladder, and bowel (large intestine) and don’t require any equipment. Once you learn how to do “Kegel exercises” you can Kegel anywhere. You can do Kegel exercises while lying down, sitting at a desk, or standing up.

The trick is finding the right muscles to squeeze (see Figures 1 and 2 for reference). Your doctor or nurse can help make sure you are squeezing the right muscles. Your doctor may refer you to a specially trained physical therapist who will teach you to find and strengthen the sphincter muscles. Learning when to squeeze these muscles can also help stop the bladder spasms that cause urge incontinence. After about 6 to 8 weeks, you should notice that you have fewer leaks and more bladder control.

To do Kegel exercises, you just squeeze your pelvic floor muscles. The part of your body including your hip bones is the pelvic area. At the bottom of the pelvis, several layers of muscle stretch between your legs. The muscles attach to the front, back, and sides of the pelvic bone (see Figures 1 and 2).

The pelvic floor has several functions:

• it supports your pelvic and abdominal organs, especially when you are standing or straining;
• it helps your urethra stay closed when you cough, sneeze or strain;
• it controls leakage of wind or motions from your lower bowel;
• it helps to heighten sexual awareness by tightening during intercourse.

A weak pelvic floor gives you less control so that you may have urinary stress incontinence (urine leakage) or fecal incontinence (fecal leakage) when you exercise, lift, cough, laugh hard or sneeze.

Often women leak urine when they are pregnant or after they have given birth.

Female athletes of all ages sometimes have urine leakage during strenuous sports activities.

A man’s pelvic floor muscles support the bladder and bowel and affect sexual function. Kegel exercises can help strengthen these muscles.

The pelvic floor muscles can be weakened by:

• operations on your prostate gland (in men);
• pregnancy and childbirth (in women);
• operations on other organs within the pelvis (e.g. the bowel);
• damage to the nerves of your pelvic floor muscles (by disease, injury, surgery or radiotherapy);
• repeated straining to empty your bowels, usually due to constipation;
• a chronic cough such as a smoker’s cough, chronic bronchitis or asthma;
• being overweight;
• lack of general fitness;
• ageing;
• lack of exercise and the menopause.

Muscles of the pelvic floor

The pelvic floor also called the pelvic diaphragm (Figures 1 and 2), is a complex layer of muscles and ligaments which stretches like a hammock from the pubic bone at the front of your pelvis to the coccyx at the bottom your spine.

The pelvic floor is a sheet consisting of two muscles, the levator ani and the small coccygeus (ischiococcygeus). The pelvic floor supports the pelvic organs, seals the inferior opening of the bony pelvis, and lifts superiorly to help release feces during defecation. The pelvic floor is pierced by the rectum and urethra (the tube for urine) and (in females) by the vagina.

The muscles of the pelvic floor are the levator ani and ischiococcygeus. Along with the fascia covering their internal and external surfaces, these muscles are referred to as the pelvic diaphragm, which stretches from the pubis anteriorly to the coccyx posteriorly, and from one lateral wall of the pelvis to the other. This arrangement gives the pelvic diaphragm the appearance of a funnel suspended from its attachments. The pelvic diaphragm separates the pelvic cavity above from the perineum below. The anal canal and urethra pierce the pelvic diaphragm in both sexes, and the vagina also goes through it in females. The three components of the levator ani muscle are the pubococcygeus, puborectalis, and iliococcygeus. Figure 1 shows these muscles in the female and Figure 2 illustrates them in the male. The levator ani is the largest and most important muscle of the pelvic floor. It supports the pelvic viscera and resists the inferior thrust that accompanies increases in intraabdominal pressure during functions such as forced exhalation, coughing, vomiting, urination, and defecation. The muscle also functions as a sphincter at the anorectal junction, urethra, and vagina. In addition to assisting the levator ani, the ischiococcygeus pulls the coccyx anteriorly after it has been pushed posteriorly during defecation or childbirth.

The body region inferior to the pelvic floor is the perineum. In the anterior half of the perineum is a triangular sheet of muscle called the urogenital diaphragm. It contains the external urethral sphincter muscle, which surrounds the urethra. You use this muscle voluntarily to prevent urination. Just inferior to the urogenital diaphragm is the superficial perineal space, which contains muscles (bulbospongiosus, ischiocavernosus) that help maintain erection of the penis and clitoris. In the posterior half of the perineum, circling the anus, lies the external anal sphincter. This muscle is used voluntarily to prevent defecation. Just anterior to this sphincter, at the exact midpoint of the perineum, is the central tendon. Many perineal muscles insert on this strong tendon and, in so doing, are able to support the heavy organs in the pelvis.

Figure 1. Pelvic floor female

Figure 2. Pelvic floor male

Figure 3. Urinary bladder anatomy

Figure 4. Urinary bladder anatomy

Benefits of Kegel exercises

Kegel exercises are designed to make your pelvic floor muscles stronger. These are the muscles that hold up your bladder and rectum help keep them from leaking. Building up your pelvic muscles with Kegel exercises can help with your bladder and bowel control.

You might benefit from doing Kegel exercises if you:

• Leak a few drops of urine while sneezing, laughing or coughing (stress incontinence)
• Have a strong, sudden urge to urinate just before losing a large amount of urine (urinary incontinence)
• Leak stool (fecal incontinence)

If you do Kegel exercises regularly, you can expect results — such as less frequent urine leakage — within about a few weeks to a few months. For continued benefits, make Kegel exercises a permanent part of your daily routine.

Kegel exercises can be done during pregnancy or after childbirth to try to prevent urinary incontinence.

Keep in mind that Kegel exercises are less helpful for women who have severe urine leakage when they sneeze, cough or laugh. Also, Kegel exercises aren’t helpful for women who unexpectedly leak small amounts of urine due to a full bladder (overflow incontinence).

How Kegel exercises can help with sex

Strong pelvic floor muscles can also mean increased sensitivity during sex and stronger orgasms for women.

Strengthening and training the pelvic floor muscles can help men reduce the symptoms of erectile dysfunction.

How do you do Kegel exercises

To do Kegel exercises, you just squeeze your pelvic floor muscles. The part of your body including your hip bones is the pelvic area. At the bottom of the pelvis, several layers of muscle stretch between your legs. The muscles attach to the front, back, and sides of the pelvic bone. Kegel exercises are designed to make your pelvic floor muscles stronger. These are the muscles that hold up your bladder and help keep it from leaking.

A pelvic floor muscle training exercise is like pretending that you have to urinate, and then holding it. You relax and tighten the muscles that control urine flow. It is important to find the right muscles to tighten.

Find the right muscles. Try one of the following ways to find the right muscles to squeeze.

1. Imagine that you are trying to stop passing gas. Squeeze the muscles you would use. If you sense a “pulling” feeling, you are squeezing the right muscles for pelvic exercises.
2. Imagine that you are sitting on a marble and want to pick up the marble with your vagina. Imagine “sucking” the marble into your vagina.
3. Lie down and put your finger inside your vagina. Squeeze as if you were trying to stop urine from coming out. If you feel tightness on your finger, you are squeezing the right pelvic muscles.

The next time you have to urinate, start to go and then stop. Feel the muscles in your vagina, bladder, or anus get tight and move up. These are the pelvic floor muscles. If you feel them tighten, you have done the exercise right.

If you are still not sure whether you are tightening the right muscles, keep in mind that all of the muscles of the pelvic floor relax and contract at the same time. Because these muscles control the bladder, rectum, and vagina, the following tips may help:

• Women: Insert a finger into your vagina. Tighten the muscles as if you are holding in your urine, then let go. You should feel the muscles tighten and move up and down.
• Men: Insert a finger into your rectum. Tighten the muscles as if you are holding in your urine, then let go. You should feel the muscles tighten and move up and down. These are the same muscles you would tighten if you were trying to prevent yourself from passing gas.

It is very important that you keep the following muscles relaxed while doing pelvic floor muscle training exercises:

• Abdominal
• Buttocks (the deeper, anal sphincter muscle should contract)
• Thigh

If you’re having trouble doing Kegel exercises, don’t be embarrassed to ask for help. Your doctor or other health care provider can give you important feedback so that you learn to isolate and exercise the correct muscles.

In some cases, vaginal weighted cones or biofeedback might help. A woman can also strengthen these muscles by using a vaginal cone, which is a weighted device that is inserted into the vagina. To use a vaginal cone, you insert it into your vagina and use pelvic muscle contractions to hold it in place during your daily activities. During a biofeedback session, your doctor or other health care provider inserts a pressure sensor into your vagina or rectum. As you relax and contract your pelvic floor muscles, a monitor will measure and display your pelvic floor activity.

If you are unsure whether you are doing the pelvic floor muscle training correctly, you can use biofeedback and electrical stimulation to help find the correct muscle group to work.

• Biofeedback is a method of positive reinforcement. Electrodes are placed on the abdomen and along the anal area. Some therapists place a sensor in the vagina in women or anus in men to monitor the contraction of pelvic floor muscles.
• A monitor will display a graph showing which muscles are contracting and which are at rest. The therapist can help find the right muscles for performing pelvic floor muscle training exercises.

Let your doctor, nurse, or therapist help you. Many people have trouble finding the right muscles. Your doctor, nurse, or therapist can check to make sure you are doing the exercises correctly. You can also exercise by using special weights or biofeedback. Ask your health care team about these exercise aids.

Don’t squeeze other muscles at the same time. Be careful not to tighten your stomach, legs, or other muscles. Squeezing the wrong muscles can put more pressure on your bladder control muscles. Just squeeze the pelvic muscle. Don’t hold your breath.

Repeat, but don’t overdo it. At first, find a quiet spot to practice—your bathroom or bedroom—so you can concentrate. Lie on the floor. Pull in the pelvic muscles and hold for a count of 3. Then relax for a count of 3. Work up to 10 to 15 repeats each time you exercise. Use the Exercise Log below to keep track of your sessions.

Do your pelvic exercises at least three times a day. Every day, use three positions: lying down, sitting, and standing. You can exercise while lying on the floor, sitting at a desk, or standing in the kitchen. Using all three positions makes the muscles strongest.

Be patient. Don’t give up. It’s just 5 minutes, three times a day. You may not feel your bladder control improve until after 3 to 6 weeks. Still, most women do notice an improvement after a few weeks.

Performing Kegel Exercises/Pelvic Floor Exercises

1. Begin by emptying your bladder.
2. Tighten the pelvic floor muscles and hold for a count of 10.
3. Relax the muscles completely for a count of 10.
4. Do 10 repetitions, 3 to 5 times a day (morning, afternoon, and night).

You can do these exercises at any time and place. Most people prefer to do the exercises while lying down or sitting in a chair. After 4 to 6 weeks, most people notice some improvement. It may take as long as 3 months to see a major change.

After a couple of weeks, you can also try doing a single pelvic floor contraction at times when you are likely to leak (for example, while getting out of a chair).

A word of caution: Some people feel that they can speed up the progress by increasing the number of repetitions and the frequency of exercises. However, over-exercising can instead cause muscle fatigue and increase urine leakage.

If you feel any discomfort in your abdomen or back while doing these exercises, you are probably doing them wrong. Breathe deeply and relax your body when you do these exercises. Make sure you are not tightening your stomach, thigh, buttock, or chest muscles.

When done the right way, pelvic floor muscle exercises have been shown to be very effective at improving urinary continence.

There are physical therapists specially trained in pelvic floor muscle training. Many people benefit from formal physical therapy.

Kegel Exercise Log

Week: ______________

My Pelvic Muscle Exercise Log

Sunday

• I exercised my pelvic muscles ____ times.
• I spent ____ minutes exercising.
• At each exercise session, I squeezed my pelvic muscles ____ times.

Monday

• I exercised my pelvic muscles ____ times.
• I spent ____ minutes exercising.
• At each exercise session, I squeezed my pelvic muscles ____ times.

Tuesday

• I exercised my pelvic muscles ____ times.
• I spent ____ minutes exercising.
• At each exercise session, I squeezed my pelvic muscles ____ times.

Wednesday

• I exercised my pelvic muscles ____ times.
• I spent ____ minutes exercising.
• At each exercise session, I squeezed my pelvic muscles ____ times.

Thursday

• I exercised my pelvic muscles ____ times.
• I spent ____ minutes exercising.
• At each exercise session, I squeezed my pelvic muscles ____ times.

Friday

• I exercised my pelvic muscles ____ times.
• I spent ____ minutes exercising.
• At each exercise session, I squeezed my pelvic muscles ____ times.

Saturday

• I exercised my pelvic muscles ____ times.
• I spent ____ minutes exercising.
• At each exercise session, I squeezed my pelvic muscles ____ times.

Use this sheet as a master for making copies that you can use to record your exercises week after week.

Kegel exercises for men

Pelvic floor exercises are an important part of preparation before surgery for removal of your prostate for cancer (radical prostatectomy) ¹. They ensure that the pelvic floor muscles are in good condition and can help reduce urine leakage after the operation.

How do I contract the pelvic floor muscles?

The first thing you need to do is to identify the muscles to exercise. You can do this by sitting or lying comfortably with the muscles of your thighs, buttock and abdomen relaxed.

Step 1

Tighten the ring of muscle around the back passage as if you are trying to control diarrhea or wind. Relax the muscle again. Practice this movement several times until you are sure you are exercising the correct muscles. Try not to squeeze your buttocks, thighs or abdominal (tummy) muscles

Step 2

Imagine you are trying to pass urine, stop the flow in mid-stream and then re-start it. If your technique is correct, you will feel the base of your penis move upwards slightly towards your tummy. You can check this “for real” while passing urine, but no more than once a week, in case it interferes with normal bladder emptying

How do I do pelvic floor exercises?

Learning how to do these exercises can take a little time but, with practice, you should be able to learn the technique:

• tighten and draw in the muscles around the anus (back passage) and the urethra (water pipe) all at once. Lift them up inside you and hold this position as you count to five. Release the muscles slowly and relax for a few seconds
• repeat the contraction and relax again. Once you find it easy to hold the contraction for a count of five, try to hold it for longer (up to ten seconds)
• repeat this for a maximum of eight to ten squeezes. Try to make each contraction strong, slow and controlled
• do the same thing again but, this time, using ten short, fast contractions, pulling up rapidly and immediately letting go
• repeat this whole exercise routine at least four to five times every day. You can do it in a variety of positions – lying, sitting, standing and walking
• try to avoid holding your breath, pushing down (instead of squeezing) and tightening your abdominal muscles, buttocks or thighs
• the exercises can be performed standing, sitting or lying down but you may find it easier at first to do them sitting down

Other things that help

Once you have learnt how to do these exercises, they should be done regularly, giving each set your full attention. Find at least five regular times during the day to do them e.g. after going to the toilet, when having a drink, when lying in bed. Tightening the pelvic floor before you cough, lift anything heavy or get up from a chair will also help.

You will probably not notice an improvement for several weeks. It may take a few months before you get maximum benefit. Once you have recovered control over your bowel and bladder, continue doing the exercises twice a day for life, to keep the pelvic floor muscles strong.

When to do your Kegel exercises

Make Kegel exercises part of your daily routine. For example:

• Fit in a set of Kegel exercises every time you do a routine task, such as brushing your teeth.
• Do another set after you urinate, to get rid of the last few drops of urine.
• Contract your pelvic floor muscles just before and during any activity that puts pressure on your abdomen, such as sneezing, coughing, laughing or heavy lifting.

Other things to do include:

• Share the lifting of heavy loads;
• Avoid constipation and straining when opening your bowels;
• Seek medical advice for hay fever, asthma or bronchitis to reduce sneezing and coughing;
• Keep your weight within the correct range for your height and age; and
• Other methods which have been shown to help some men include biofeedback and electrical stimulation.

If you would like to explore other methods or you are not sure whether you are performing the exercises correctly, ask your urologist or specialist nurse. They will be able to give you more advice or put you in touch with a continence advisor or physiotherapist.

When you’re having trouble

If you’re having trouble doing Kegel exercises, don’t be embarrassed to ask for help. Your doctor or other health care provider can give you important feedback so that you learn to isolate and strengthen the correct muscles.

In some cases, biofeedback training might help. In a biofeedback session, your doctor or other health care provider inserts a small probe into your rectum. As you relax and contract your pelvic floor muscles, a monitor will measure and display your pelvic floor activity. Research suggests that biofeedback training is more effective in treating fecal incontinence.

When to expect results

If you do your Kegel exercises regularly, you can expect results — such as less frequent urine leakage — within about a few weeks to a few months. For continued benefits, make Kegel exercises a permanent part of your daily routine.

Kegel exercise for women and pregnant mothers

If you’re pregnant or planning to get pregnant, you can start doing pelvic floor exercises straight away. Kegel exercises will lower your risk of experiencing incontinence after having your baby. The more active and fit you are during pregnancy, the easier it will be for you to adapt to your changing shape and weight gain. It will also help you to cope with labor and get back into shape after the birth. Exercise is not dangerous for your baby – there is some evidence that active women are less likely to experience problems in later pregnancy and labor.

Kegel exercises help to strengthen the muscles of the pelvic floor, which come under great strain in pregnancy and childbirth. The pelvic floor consists of layers of muscles that stretch like a supportive hammock from the pubic bone (in front) to the end of the backbone (see Figure 1 above).

If your pelvic floor muscles are weak, you may find that you leak urine when you cough, sneeze, laugh or strain. This is quite common and you needn’t feel embarrassed. It’s known as stress incontinence and it can continue after pregnancy.

You can strengthen the muscles by doing pelvic floor exercises. This helps to reduce or avoid stress incontinence after pregnancy. All pregnant women should do Kegel exercises, even if you’re young and not suffering from stress incontinence now.

It is not easy to identify your pelvic floor muscles. Exercising them should not be visible from the outside. Read the section above on “How do you do Kegel exercises.” The steps are essentially the same because doing Kegel exercise (pelvic floor muscle training exercise) is simple. However, if you’re still unsure about what to do, let your doctor, nurse, or therapist help you. Many people have trouble finding the right muscles. Your doctor, nurse, or therapist can check to make sure you are doing the exercises correctly. You can also exercise by using special weights or biofeedback. Ask your health care team about these exercise aids.

Don’t squeeze other muscles at the same time. Be careful not to tighten your stomach, legs, or other muscles. Squeezing the wrong muscles can put more pressure on your bladder control muscles. Just squeeze the pelvic muscle. Don’t hold your breath.

Here is what to do ²:

Step 1

Sit comfortably with your knees slightly apart. Imagine that you are trying to stop yourself passing wind from your bowel. To do this, you must squeeze the muscle around the back passage. Try lifting and squeezing the muscle as if you have wind. If you sense a “pulling” feeling, you are squeezing the right muscles for pelvic exercises. You should be able to feel the muscle move and your buttocks or legs should not move at all. You should notice that the skin around your back passage tightens up and creates the sensation of lifting you from your chair.

Step 2

Imagine that you are sitting on the toilet to pass urine and try to stop yourself from producing a stream of urine. You should be using the same group of muscles that you used before but you will find this a little more difficult. Do not try to stop the urinary stream when you are actually passing water because it can cause problems with bladder emptying.

Or you can lie down and put your finger inside your vagina. Squeeze as if you were trying to stop urine from coming out. If you feel tightness on your finger, you are squeezing the right pelvic muscles.

Step 3

Try to tighten the muscles around your back passage and vagina, by lifting up inside as if you are trying to stop passing wind and urine at the same time. Do not tense your abdomen, squeeze your legs together, tighten your buttocks or hold your breath. If you can master this, most of the muscle contraction should be coming from the pelvic floor.

How do you practice the exercises?

You need to develop two types of muscle activity, slow and fast.

• to practice slow contractions
  • do the exercises above and try to hold the pelvic floor tight for up to ten seconds. Rest for four seconds and then repeat the contraction as many times as you can, up to a maximum of ten
• to practice quick contractions
  • draw the pelvic floor rapidly upwards and hold this for one second. Repeat up to a maximum of ten times. This will protect you against sudden leakage during coughing, laughing or exercise
  • Aim to do one set of slow contractions followed by one set of fast contractions up to six times a day. Do not over-do it or the muscles will get tired. The exercises can be performed standing, sitting or lying down but you may find it easier at first to do them sitting down.
• Don’t make a habit of using Kegel exercises to start and stop your urine stream. Doing Kegel exercises while emptying your bladder can actually lead to incomplete emptying of the bladder — which increases the risk of a urinary tract infection.

Other things that help

• Get into the habit of doing your exercises regularly and linking them to everyday activities e.g. do them after emptying your bladder, while answering the telephone, standing in a queue or whenever you turn on a tap. Do your pelvic exercises at least three times a day. Every day, use three positions: lying down, sitting, and standing. You can exercise while lying on the floor, sitting at a desk, or standing in the kitchen. Using all three positions makes the muscles strongest.
• At first, find a quiet spot to practice—your bathroom or bedroom—so you can concentrate. Lie on the floor. Pull in the pelvic muscles and hold for a count of 3. Then relax for a count of 3. Work up to 10 to 15 repeats each time you exercise.
• If you are not sure you are doing the exercises correctly, insert a thumb or two fingers into the vagina and try the exercises; you should feel a gentle squeeze as the muscles contract
• Use the pelvic floor exercises to prevent leakage before you do anything which might make you leak; this way, your control will gradually improve
• Drink normally – six to eight cups (two litres) per day – avoiding caffeine and alcohol if you can
• Avoid going to the toilet “just in case”; go only when you feel that your bladder is full
• Watch your weight; extra weight puts more strain on your pelvic floor muscles and your bladder
• Avoid constipation. Straining can put excessive pressure on your bladder and bowels
• Pelvic floor exercises take three to six months to produce maximum benefit, but you should continue them for life to prevent problems recurring or worsening; you should seek help from a health professional there is little or no change in your symptoms after exercising for three months
• Other methods which help some women include weighted vaginal cones, biofeedback and electrical stimulation; consult your doctor, urologist or specialist nurse for more details

Be patient. Don’t give up. It’s just 5 minutes, three times a day. You may not feel your bladder control improve until after 3 to 6 weeks. Still, most women do notice an improvement after a few weeks.

When to do your Kegel exercises

Make Kegel exercises part of your daily routine. You can do Kegel exercises discreetly just about anytime, whether you’re sitting at your desk or relaxing on the couch.

When you’re having trouble

If you’re having trouble doing Kegel exercises, don’t be embarrassed to ask for help. Your doctor or other health care provider can give you important feedback so that you learn to isolate and exercise the correct muscles.

In some cases, vaginal weighted cones or biofeedback might help. To use a vaginal cone, you insert it into your vagina and use pelvic muscle contractions to hold it in place during your daily activities. During a biofeedback session, your doctor or other health care provider inserts a pressure sensor into your vagina or rectum. As you relax and contract your pelvic floor muscles, a monitor will measure and display your pelvic floor activity.

When to expect results

If you do Kegel exercises regularly, you can expect results — such as less frequent urine leakage — within about a few weeks to a few months. For continued benefits, make Kegel exercises a permanent part of your daily routine.

1. http://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Pelvic%20floor%20XS%20male.pdf[↩]
2. http://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Pelvic%20floor%20XS%20female.pdf[↩]