In Brief: Kegels hold up as urinary continence treatment

Content provided by the Faculty of the Harvard Medical School

In Brief: Kegels hold up as urinary continence treatment

In Brief

Kegels hold up as urinary continence treatment

A review of studies confirms that women with urinary incontinence can benefit from pelvic floor muscle training, better known as Kegel exercises. The review appeared in The Cochrane Library (2006, issue 1), published by The Cochrane Collaboration, an international organization that evaluates medical research. The authors examined randomized trials comparing pelvic floor exercises with no treatment, a placebo, a sham treatment, or some other type of control treatment. Women who did the exercises were more likely to report being cured or improved compared with the women who did not. The Cochrane review also suggests that receiving training in how to identify and exercise the right muscles boosts the effectiveness of a Kegel regimen.

Urinary incontinence — the involuntary loss of urine — is a problem for as many as 30% of women in the United States. The most common type is stress incontinence, which can occur with coughing, sneezing, laughing, and physical activities such as jumping. Another form, urge incontinence, is the inability to hold back urine after feeling the urge to urinate. Some women have both types. Kegel exercises (named for Arnold Kegel, the physician who first described them) are usually recommended for stress incontinence but only sometimes for urge and mixed incontinence. The Cochrane review found that they helped with all three types of incontinence. Trials of women with stress urinary incontinence suggested greater benefit for those in their 40s and 50s who were in a supervised program lasting at least three months. But further study is needed to explore these factors.

Pelvic floor muscles run from the pubic bone to the tailbone, with openings for the urethra, vagina, and anus. They’re the muscles you use to hold back urination and thus are important in maintaining continence. They may weaken due to age and, possibly, the loss of estrogen at menopause. Many experts believe that damage during vaginal childbirth also places a woman at risk for urinary incontinence. But not all studies support this idea. For example, in a study of pairs of postmenopausal sisters — in each pair, one sister had given birth vaginally and the other had never given birth — researchers found no difference in the incidence, type, or severity of incontinence (Obstetrics and Gynecology, December 2005).

How to Kegel

To perform Kegel exercises, you first need to find your pelvic floor muscles. Pretend you’re trying to avoid passing gas while simultaneously tightening your vagina around a tampon. You should feel the contraction more in the anal area than the front. Avoid contracting the muscles of your stomach, legs, or buttocks.

Once you’ve located the pelvic floor muscles, practice contracting and relaxing them repeatedly, alternating short contractions and releases (called flicks) with longer ones. Mastering long contractions may take more practice. Start by holding each one for 3–5 seconds, resting the same number of seconds between contractions. Build up to 10-second contractions, with 10 seconds of rest between contractions.

Try to do 30–40 Kegels every day, divided into groups of 10 each. You can start by lying on your back until you get the feel of contracting the pelvic floor muscles. Later, practice in different positions. For example, you might do 10 Kegels before getting out of bed in the morning, 10 standing after lunch, 10 in the evening while sitting, and another 10 before going to sleep.

You can also use Kegels to control symptoms. If you have stress incontinence, tighten your pelvic floor muscles just before lifting, coughing, or whatever usually causes urine leakage. Do the same several times when you have the urge to urinate and doubt you can to make it to the bathroom in time.

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Last updated:	August 21, 2006

Medical content reviewed by the Faculty of the Harvard Medical School. Harvard Health Publications, Copyright © 2007 by President and Fellows of Harvard College. All rights reserved. Used with permission of StayWell.

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