Finding the muscle is the whole first lesson

Most people who "do Kegels" are squeezing a buttock or a thigh and calling it a day. The National Institute of Diabetes and Digestive and Kidney Diseases describes Kegel exercises, also called pelvic floor muscle training, as a squeeze, a hold, and a release of the muscles that support the bladder, rectum, and uterus. Those muscles run like a hammock from the pubic bone to the tailbone. When they work, they help you hold urine, stool, and gas until you choose to let them go.

The same institute says many factors weaken that hammock, including pregnancy, childbirth, surgery, and getting older. Leaking a little urine, stool, or gas is the usual reason someone goes looking for the exercise. NICHD describes the broader group of pelvic floor disorders as urinary incontinence, fecal incontinence, and pelvic organ prolapse, and notes they are more common among older women. Childbirth, age, and some surgeries contribute. Some people with a pelvic floor disorder do not need treatment. Others need exercise, a device, medicine, or surgery. Exercise is one tool, not the whole toolbox.

What the exercise has evidence for

NIDDK says the exercises strengthen the pelvic floor and can help you stop leaks. It points to a 2018 Cochrane review by Dumoulin, Cacciari, and Hay-Smith (Cochrane Database of Systematic Reviews, 2018) comparing pelvic floor muscle training with no treatment or inactive control treatments for urinary incontinence in women, and to a 2020 systematic review on physiotherapy methods for fecal incontinence in women (Mazur-Bialy and colleagues, Journal of Clinical Medicine). NIDDK also says studies suggest pelvic floor training may improve sexual function. That is a "may," attached to the papers NIDDK cites, not a promise of orgasm or of pain-free sex.

Check with a clinician before you start. NIDDK is direct: in some cases these exercises are not a good option. Pain with tightening, a feeling that you cannot relax the pelvic floor, or symptoms that began after surgery are reasons to be examined first. Squeezing an already-too-tight muscle can make pain worse. A pelvic floor therapist can tell the difference. You cannot tell it from a blog.

How to tell you have the right muscle

NIDDK offers three ways to find it:

  • Imagine you are stopping gas from passing. A pulling feeling in the vaginal or rectal area means you are on the right muscle.
  • While urinating, try once to stop the stream. The muscles that do that are the pelvic floor. Use this only to identify them. Do not practice Kegels during urination on a regular basis. Stopping the bladder from emptying fully can raise the risk of a bladder infection.
  • Insert a clean finger into the vagina and squeeze as if holding urine. Tightness on the finger means you found them.

Do not tighten the stomach or the thighs at the same time. NIDDK says squeezing the wrong muscles can put more pressure on the bladder and make leaks easier, which is the opposite of the goal. Breathe. If you are holding your breath, you are probably bearing down.

If you cannot find the muscle, that is common. A doctor, a nurse, or a pelvic floor therapist can check while you squeeze. They may add biofeedback, electrical stimulation, or vaginal weights. Those are clinic tools, not a requirement for everyone.

A basic session, then stop adding more

NIDDK's starter method is deliberately small:

  1. Find and squeeze the pelvic floor.
  2. Try to hold for 3 seconds.
  3. Release and let the muscle go fully slack.
  4. Repeat. Work up to 10 to 15 repetitions.
  5. Do this at least three times a day.

Practice lying down, sitting, and standing. NIDDK says using all three positions makes the muscles stronger. A sample day from the same page: one set while making breakfast, one set while sitting at a desk or in the car, one set lying in bed. Keep a simple tally so the third set actually happens.

Give it time. NIDDK says you may not feel bladder control improve until after 3 to 6 weeks. The daily time cost it cites is about 5 minutes, three times a day. Do not keep adding repetitions because a little helped. Overdoing the exercises can lead to straining when you urinate or move your bowels. If leaks are not better after a couple of months of correct practice, the next step is an exam, not a fourth set.

Quick, one-second squeezes are sometimes taught for the moment you cough or sneeze. NIDDK's public instructions center on the held squeeze and full release, and they tell you to follow the plan your own clinician gives you. Hold times and counts differ. If a therapist gives you a different count, use theirs.

Leaks are not all the same

Stress leaks happen with a cough, laugh, lift, or jump, when abdominal pressure spikes and the pelvic floor does not match it. Urge leaks come with a sudden need to go. Many people have both. The Cochrane review NIDDK cites looked at urinary incontinence as a group. It does not mean every leak is a weak muscle. Infection, constipation, a medicine, a neurologic condition, or a prolapse can sit underneath the same wet underwear. Blood in urine, pain with urination, or leaking that starts suddenly in someone who never leaked before should be checked before a month of exercise.

Pelvic organ prolapse is a descent of the bladder, uterus, or rectum toward or through the vaginal opening. NICHD lists a feeling of heaviness in the vagina among pelvic floor symptoms, along with a frequent urge to urinate and leaking. Exercise is sometimes part of care for mild prolapse. It does not put a significantly descended organ back where it was. A clinician stages prolapse on exam. Bulging tissue you can see or feel, or trouble emptying the bladder or bowel, is an exam, not a new workout.

Pregnancy, birth, and the months after

Pregnancy and vaginal birth are on NIDDK's list of reasons the pelvic floor weakens. Training during pregnancy is widely used, and many obstetric clinicians encourage it when it is comfortable. This page will not invent a week-by-week pregnancy program or a promise that exercise prevents tears or prevents every postpartum leak. Ask the person managing your pregnancy whether to start, pause, or change the exercise, especially if you have preterm-labor risk, pelvic pain, or bleeding.

After a birth, including a cesarean, healing is individual. Abdominal surgery and a vaginal birth stress different tissues, and both can leave the pelvic floor weaker than it was. Wait for your own clinician's clearance rather than a calendar date copied from a forum. If leaks, pressure, or pain with sex are still there at the postpartum visit, ask for a pelvic floor referral. Needing that referral is common. It is not a failure of willpower.

When exercise is the wrong first move

Stop and get care if:

  • Tightening causes pain, and relaxing does not relieve it
  • You cannot start the urine stream, or you strain to finish
  • You see or feel a bulge
  • Leaks include stool you cannot control
  • Symptoms follow pelvic surgery and are getting worse
  • You are pregnant and you have contractions, bleeding, or pelvic pressure that is new

NIDDK's instruction to be patient sits next to its instruction not to overdo it. Both can be true. A short daily practice for several weeks is the experiment. Pain, or no change, ends the experiment and starts a clinical one.

If bladder leaks are the problem you are actually trying to solve, the useful next question is whether you leak with a cough, with a sudden urge, or both, because those two patterns are not treated with the identical plan.

Sources

  • National Institute of Diabetes and Digestive and Kidney Diseases, Kegel Exercises (last reviewed November 2021): niddk.nih.gov/health-information/urologic-diseases/kegel-exercises
  • Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews. 2018;10:CD005654.
  • Mazur-Bialy AI, Kołomańska-Bogucka D, Opławski M, Tim S. Physiotherapy for prevention and treatment of fecal incontinence in women: systematic review of methods. Journal of Clinical Medicine. 2020;9(10):3255.
  • NICHD, Pelvic Floor Disorders: nichd.nih.gov/health/topics/pelvicfloor

Educational only. Pelvic pain, prolapse, and leaks of stool need an exam. A therapist's instructions outrank a generic set of repetitions.