What are Pelvic Floor Muscle (Kegel) Exercises?

Parts of the bladder control system
Parts of the bladder control system
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health

Front view of bladder.  Weak pelvic muscles allow urine leakage (left).  Strong pelvic muscles keep the urethra closed (right)
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health

Bladder control depends on muscles working together when the bladder is filling with urine. The bladder muscle should be relaxed and the muscles around the urethra (the tube that urine passes through), called the pelvic floor muscles, should be tight. Exercises that strengthen the pelvic floor muscles can help hold urine inside the bladder, preventing leakage. These pelvic floor muscle exercises are commonly called "Kegel" exercises, named after the doctor who developed them.

Getting Started: How Do You Find Your Pelvic Floor Muscles?

Strengthen Your Pelvic Floor Muscles
Parts of the bladder control system
Image © 2003 Fairman Studios, LLC.

There are several ways to find your pelvic floor muscles. When using the pelvic floor muscles, women will feel a slight pulling in the rectum and vagina. Men will feel a pulling in of the anus and movement of the penis. Every person is unique, and different techniques work for different people.

General Technique

Everyone at one time or another has been in a crowded room and felt as if he or she were going to pass gas. Imagine that this is happening to you. Most of us will try to squeeze the muscles of the anus to prevent the passing of gas. In fact, the muscles being squeezed are the pelvic floor muscles. If you feel a "pulling" sensation at the anus, you are using the right muscles. In most of our patients, we have found this to be the most successful technique.

Technique for Women

Lie down and insert a finger into your vagina. Try to squeeze around your finger with your vaginal muscles. You should be able to feel the sensation in your vagina, and you may also be able to feel the pressure on your finger. If you can feel this, you are using the right muscles. If you cannot detect any movement with 1 finger, try 2 fingers.

Technique for Men

Stand in front of a mirror and watch your penis. Try to make your penis move up and down without moving the rest of your body. If you can do this, you are using the right muscles.

You may not find your pelvic floor muscles immediately. Many people have to take their time with this.

Don't Exercise the Wrong Muscles

One of the most common mistakes is exercising the wrong muscle(s). When trying to find a new muscle, especially a weak one, most people tighten other muscles too. Some people clench their fists or teeth, hold their breath, or make a face. None of these help. It is very tempting to use other muscles, especially stronger ones, to support smaller, weaker muscles such as the pelvic floor muscles. However, using other muscles interferes with learning how to use the right ones. It is best just to relax your body as much as possible and concentrate on your pelvic floor muscles.

Not Your Abdominal Muscles

To avoid using your stomach muscles, rest your hand lightly on your belly as you are squeezing your pelvic floor muscles. Do you feel your belly tightening? If you do, relax and try again. Be sure that you do not feel any movement of your stomach.

Not Your Chest Muscles

If you find yourself holding your breath then you are probably using your chest muscles. To avoid this, relax completely and notice how you are breathing for a few moments. Then squeeze your pelvic floor muscles while you continue to breathe normally. This will help to make sure that you are not using your chest muscles because these are usually relaxed when you breathe.

Not Your Buttock Muscles

The other set of "wrong muscles" are the muscles of the buttocks (bottom). To test whether you are tightening your buttock muscles by mistake, squeeze your pelvic floor muscles while sitting in front of a mirror. If you see that your body is moving up and down slightly, you are also using your buttock muscles.

Not Your Thigh Muscles

Another set of muscles to avoid using is the thigh muscles. If you see your upper legs moving while you are sitting, causing your entire body to lift, you are contracting the wrong muscles. When done properly, no one should be able to tell that you are squeezing your pelvic floor muscles except for you.

Why Strengthen Your Pelvic Floor Muscles?

Once you have located your pelvic floor muscles and you are able to squeeze them without using your other, stronger muscles, you are ready to begin your daily exercise program.

The reason for daily exercise is twofold:

  1. Exercise increases the strength of your pelvic floor muscles so that they will be strong enough to prevent urine leakage.
  2. Through repeated practice you gain control over these muscles. Then you can use them quickly to prevent urine loss or to decrease the urge feeling.

Each exercise consists of squeezing and then relaxing your pelvic floor muscles. Squeeze the muscles for 3 seconds and then relax the muscles for 3 seconds. It is common for most people not to take the time to relax between squeezes. You must allow the muscles to relax between squeezes so that they can rest before squeezing again.

Using Your Pelvic Muscles to Control the "Urge"

Many people think that the only way to relieve the uncomfortable sudden feeling of urgency is to empty the bladder, but this is not so. Urges can come and go without you emptying the bladder. They are simply messages telling you that eventually you will need to urinate. In someone with overactive bladder, the urges are often false messages that you need to go now. Urges, however, should not be commands. They should function as an early warning system, getting you ready to find a place to urinate----after you have relaxed and suppressed the urge.

To reduce or eliminate the urge to urinate, you will use your pelvic floor muscles. Remember to squeeze your pelvic floor muscles quickly several times when you get the urge feeling. To do this, tighten/squeeze and relax the pelvic muscle as rapidly as possible. Do not relax fully in between squeezes. Try this now. Squeezing your pelvic floor muscles in this way sends a message to your nervous system and back to your bladder to stop contracting. As your bladder stops contracting and starts relaxing, the urge feeling will subside. Then, once the urge to urinate has subsided, you have a safe period when the bladder is calm. This "calm period" is the best time to go to the bathroom.

These Exercises Cannot Harm You

These exercises are not harmful. You should find them easy and relaxing. If you get back pain or stomach pain after you exercise, you are probably trying too hard and using your stomach muscles. If you experience headaches, then you are also tensing your chest muscles and probably holding your breath. We do not recommend practicing these exercises during urination by starting and stopping the flow of urine.

What are the Exercise Routines?

You should complete at least 2 exercise sessions a day. Generally, do 1 set in the morning when you get up and one at night. Do 60 pelvic floor muscles exercises every day, divided into 2 sessions of 30 exercises each. Remember, each squeeze and relaxation counts as 1 exercise. Do the exercises in each position of sitting and standing every day; 10 exercises lying down, 10 sitting, and 10 standing. The exact time of day is not crucial. What is crucial is that you develop the habit of doing the exercises every day.

In the beginning, you will need to set aside time to concentrate while you do the exercises. Each time should be associated with a cue that will remind you to practice. For example, you may want to exercise just before you get up in the morning and before you fall asleep at night. Any activity that you perform regularly on a daily basis can be used as a cue.

Sample Exercise Schedule

  • Lying down, squeeze for 5 seconds and relax for 5 seconds, 15 times
  • Sitting down, squeeze for 5 seconds and relax for 5 seconds, 15 times
  • Standing up, squeeze for 5 seconds and relax for 5 seconds, 15 times

You should build to 10 second contractions. Remember to squeeze and count slowly "1-2-3-4-5-6-7-8-9-10" and relax the muscle and count "1-2-3-4-5-6-7-8-9-10." Continue with 45 exercises twice a day.

Pelvic floor muscle support usually improves within 6 weeks after starting the exercises, and 3 months should bring significant changes. However, symptoms improve slowly, so tracking symptom improvement is essential

Making These Exercises Part of Your Life

Make the exercises part of your daily life so that exercising becomes a habit, almost like a reflex action. After 6 weeks of practice, the exercises will require less effort, and you will no longer need to set aside special times to concentrate on them. Tighten the muscle when you walk, before you cough, as you stand up, and on the way to the bathroom. Try to tighten the muscle when you get a strong urge that you cannot control.

Do your exercises when:

  • standing at the sink and brushing your teeth
  • getting up in the morning
  • washing dishes
  • putting on your makeup
  • sitting in the car at a stoplight
  • sitting and having dinner
  • reading a book in bed
  • watching TV - during each commercial
  • going for a walk
  • talking on the phone
  • having sex

Do your exercises during your daily activities or routines. You do not have to keep a formal count of the number of times you do each exercise. Just do it several times in a row. Do them often enough to make them a habit.