Urinary Incontinence

Catherine E. DuBeau, MD

I’m trying to do Kegel exercises, but I’m not sure I’m doing them right. How do I know?

Kegel exercises follow the same principles as exercises to strengthen other muscles in the body. The first step is making sure that you are contracting the right muscles. Your health care provider can check this in the office during a pelvic exam, by inserting their fingers in the vagina, feeling for the muscle contraction when you squeeze, and making sure you are not contracting the wrong muscles -- your abdomen, buttocks, or thighs. You can also try this yourself at home, if you wish.

Next, to build muscle strength and stamina you need to use the same approach as when you are trying to build muscle strength by weight training: "high intensity, low reps" -- i.e., contracting the muscle as tightly and for as long as possible, relaxing, and repeating a set but low number of contractions/relaxations. You don’t need to do hundreds of contractions a day, unless you are training for the Kegel Olympics!

Instead, the recommended schedule is to do three sets of 10 contractions/relaxations starting at 3 times a week. Over time, you should try to make stronger contractions and hold for longer periods of time. Generally, at the beginning women can hold the contraction only for a second or two, but then can work up to a target of 8 to 10 seconds. You should do Kegels in several positions (sitting, lying, standing). Also, you will want to practice doing some "quick" contractions, to build up the ability for fast contractions for "emergencies" such as a sudden cough or sneeze.

If you still are uncertain if you are doing Kegels correctly, you can try biofeedback training. In biofeedback, a sensor is inserted in the vagina and small patches on placed on the abdomen and buttocks which are connected to a computer. The screen displays whether you are contracting your pelvic floor or other muscles, and the intensity and duration of the contractions. Biofeedback is available through urologists, gynecologists, and specialist nurses and physical therapists. Ask your insurer whether they will cover biofeedback. For older women, Medicare will pay for biofeedback if trying Kegels for at least four weeks is not effective.

Catherine E. DuBeau, MD
Director, Geriatric Continence Clinic
University of Chicago
National Association for Continence
American Geriatric Association