Kegel exercises are a series of pelvic muscle exercises designed to strengthen the muscles of the pelvic floor.

Dr. Arnold Kegel developed Kegel exercises in 1948 as a method of controlling incontinence in women after childbirth. These exercises are now recommended for:

• Women with urinary stress incontinence
• Some men who have urinary incontinence after prostate surgery
• People who have fecal incontinence

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.

Some people have trouble finding and isolating the muscles of the pelvic floor. It's important to learn how to tighten (contract) the correct muscles. Most people contract the abdominal or thigh muscles, and don't work the pelvic floor muscles. These incorrect contractions can worsen pelvic floor tone and incontinence.

Several techniques can help you find the right muscles. One approach is to sit on the toilet and start to urinate. Try to stop the flow of urine midstream by tightening your pelvic floor muscles. Repeat this action several times until you learn the feel of contracting the right group of muscles. Do not contract your abdominal, thigh, or buttocks muscles while doing the exercise.

Another approach to help you find the correct muscle group is to insert a finger into the vagina (in women), or rectum (in men). Try to tighten the muscles around your finger as if holding back urine. The abdominal and thigh muscles should stay relaxed.

A woman can also strengthen these muscles by using a vaginal cone, which is a weighted device that is inserted into the vagina. Then try to contract the pelvic floor muscles to hold the device in place.

If you are unsure whether you are doing the Kegel 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 Kegel exercises.

Electrical stimulation involves using low-voltage electric current to stimulate the correct group of muscles. The current may be delivered using an anal or vaginal probe. The electrical stimulation therapy can be done in the clinic or at home.

Treatment sessions usually last 20 minutes and may be done every 1 - 4 days. Some studies have shown that electrical stimulation might help in treating stress and urge incontinence.

PERFORMING 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 muscle completely for a count of 10.

4. Do 10 exercises, 3 times a day (morning, afternoon, and night).

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

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, overexercising 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. Some people hold their breath or tighten their chest while trying to contract the pelvic floor muscles. Relax and concentrate on contracting just the pelvic floor muscles.

When done the right way, Kegel exercises have been shown to be very effective in improving urinary continence.

Holroyd-Leduc JM, Tannenbaum C, Thorpe KE, Straus SE. What type of urinary incontinence does this woman have? JAMA. 2008;299:1446-1456.

Rogers RG. Clinical practice. Urinary stress incontinence in women. N Engl J Med. 2008;358:1029-1036.