November 01, 2014
Woman lying down doing exercises

Kegel Exercise Know-How

by Berkeley Wellness  |  

Kegel exercises were developed by Arnold Kegel, M.D., in the 1940s to help women regain bladder control after childbirth and menopause. But the exercises, which consist of repeatedly tightening and releasing the muscles of the “pelvic floor” to strengthen them, may be useful for more than that. They can help some men, too, and may also improve sexual function.

Pelvic floor muscles, which support the bladder and bowel, help you urinate, move your bowels and have intercourse. The muscles weaken as you get older, if you are overweight, and after childbirth—and this can lead to incontinence and premature ejaculation. Men who have had prostate surgery may also suffer from incontinence. It makes sense to think that exercising these muscles can then help these conditions, and much research is encouraging.

For incontinence: Pelvic floor muscle exercises can help treat women with stress incontinence (the leakage of urine that occurs with coughing, laughing, sneezing or other exertion) or urge incontinence (when you can’t make it to the bathroom in time), according to a 2009 review by the Cochrane Collaboration, which evaluates scientific research. A Norwegian review of several studies, published in the World Journal of Urology in 2012, found convincing evidence that pelvic floor exercises can help with both stress incontinence and pelvic organ prolapse (when a pelvic organ such as the uterus slips out of place), which can lead to urinary incontinence.

Research has also shown that pelvic floor exercises can be valuable for preventing pregnancy-related incontinence. For example, a Cochrane review a few years ago concluded that, in women having their first baby, they can help prevent incontinence in late pregnancy and after birth. Most recently, a 2012 Cochrane review found that women who do Kegel exercises during and after pregnancy have a lower risk of postpartum incontinence. It also found that the exercises may be useful for women at high risk of postpartum leaks, such as those who give birth to large babies or think they may need to have a forceps delivery.

For the prostate: Research on pelvic floor muscle exercises as a way to reduce incontinence after prostate surgery has produced mixed results. A review of studies in BJU International a few years ago concluded that the exercises helped men regain bladder control within one to two months of surgery, compared to three to four months in men who did not do them. But another review by the Cochrane Collaboration found no benefits in six out of seven studies. Still, many urologists recommend Kegels before and after prostate surgery—they can’t hurt and may help.

For sexual dysfunction: In a small 2012 study published in the International Journal of Andrology, 12 weeks of training pelvic floor exercises helped more than half (11 out of 19) of men with lifelong premature ejaculation. Areview by Israeli researchers in 2007 found some benefit for men with either premature ejaculation or erectile dysfunction, as well as a benefit in both men and women with low sexual arousal, which can be affected by factors such as incontinence and urinary tract surgery. How such exercises could help sexual function is not entirely clear, but anything that makes people more aware of sexual response and improves their sense of control may also enhance performance and increase pleasure. However, a 2011 study from Brazil did not find that the exercises improved sexual function in a group of postmenopausal women.

How to Kegel

You must first learn where the pelvic floor muscles are. One way to do this is to note the muscles you use to stop or decrease the flow of urine. You can do the exercises in different ways, while you’re lying down (the easiest position initially), seated or standing. Contract the pelvic floor muscles for three seconds and then relax them for an equal time; repeat this 10 to 12 times. Gradually work up to 10-second contractions. Another way is to contract and relax the muscles quickly. Or you can slowly contract the muscles until you reach a maximal contraction and then slowly release them. Be sure not to use other muscles—like your abdominal, buttock or thigh muscles—as this can put more stress on the pelvic floor muscles and increase the risk of incontinence. Don’t hold your breath. Repeat these sessions several times throughout the day. It may take a few months to notice improvement. And note that researchers are still trying to determine the optimal program for maintaining muscle strength once you do see some improvement.

Many people have trouble isolating the proper muscles and can benefit from instruction by a gynecologist, urologist, physical therapist or nurse. If you still have difficulty, biofeedback training may helpthough results have not been positive across the board. An electrode is placed on your skin between your rectum and vagina or scrotum (for women, a probe may be inserted into the vagina instead), then attached to a monitor that will let you know when you’ve contracted the right muscles.