How to Do Better Kegels at Any Age

A group of muscles that acts as a hammock, your pelvic floor supports vital organs such as the bladder, rectum and uterus (or, in men, the prostate). And just like many other body parts, it needs to be maintained to function properly.

"If you don't exercise [the pelvic floor] on a regular basis, it's probably going to get weak," says Jennifer Shifferd, M.S.P.T., C.L.T., W.C.S., a physical therapist and pelvic floor clinical specialist who works with patients with pelvic floor disorders at the University of Michigan Health System.

"Your pelvic floor muscle is like a hammock that supports your pelvic organs. When that muscle is strong and has good tone, it keeps all those openings closed so you stay continent," she says.

Beyond the risk of urinary or bowel leakage, a weak pelvic floor might also lead to pelvic organ prolapse, a condition in which the pelvic organs can drop into the vagina or even through the vaginal opening. The risks aren't just with weak muscles: If your pelvic floor is too tight or in spasm, you may experience abdominal pain, back pain, constipation or pain with sexual intercourse.

A key way to keep your pelvic floor in shape: clench-and-release motions known as Kegel exercises. The motions are designed to squeeze the muscles you would use to stop urinating or passing gas and strengthen them over time.

The namesake routine, first described in 1948 by American gynecologist Arnold Kegel, requires no equipment — which means Kegels can be completed anywhere.

"The beauty is, no one knows you're doing them," says Shifferd, who recommends Kegels to men and women of all ages. "If people were more aware of these muscles early on, they will most likely have less dysfunction later in life."

Such issues, though, aren't always a result of self-neglect: Pelvic floor disorders can result from childbirth, chronic medical conditions such as constipation or coughing, certain medications, surgeries or radiation treatments.

That's why Kegels are as crucial to recovery as they are for preventive maintenance.

Although many people might have a working knowledge of the exercises, they might have dismissed the idea — either because they don't think they'll work or they don't think they can do them right.

The truth? Doing Kegels right makes a difference, and they aren't that hard. You just have to know how.

Shifferd, in her own words, offered tips for optimal Kegels:

Squeeze from both ends

When I tell a patient to contract their pelvic floor muscle, it's not only about "pulling up" from the anal area. You also have to think about a vaginal contraction — squeezing the labia together like you're trying to pick up a marble. Those actions together help to compress the urethra and get deep inner muscles working.

You shouldn't be feeling it in your gluteals or thigh muscles ("butt muscles"); it needs to be deeper inside. Remember that no one should be able to see you doing these — so if you are visibly rising upward while sitting in a chair, try again with different muscles.

For men, beyond rectal contraction, they have to retract the penis inward ... pull the turtle head back in the shell. All of my male patients know exactly what I mean.

Stick to a routine

A typical regimen would be 10 repetitions — a 10-second hold with a 10-second rest in between each one — two to three times a day.

If you feel the contraction let go, however, that's where you stop. This means your muscles are fatiguing. You may need to gradually work up to 10 repetitions of a 10-second hold.

You can also practice Kegels in different positions: lying on your side, back, sitting, standing, etc. You may find certain positions are easier to generate a contraction in than others. That is the position you should practice them in initially.

Performing quick muscle contractions is important as well. What we're trying to do is retrain the body to contract during those times so we don't have leakage. So practicing quick contractions with coughing and sneezing will help to retrain your body and have less leakage by improving your muscle coordination.

Many women try their Kegels when urinating — they know if the stream stops, the Kegel muscle is working. This is fine to do once or twice, but once you learn the right muscles to use, stop Kegeling when you're urinating. Doing this regularly can confuse the muscles and permanently alter your urinating patterns.

Consider weights

Patients can gain better strength using vaginal or rectal weights (a cone held in place by the pelvic floor muscles during contractions). You're going to gain the strength twice as fast with that resistance.

This only works when you already can feel a good contraction. I will have patients put a finger in their vagina or rectum — if they can squeeze and feel a little lift, that's a good time to try a weight.

Seek help if needed

Keep at it — if you've had a pelvic floor problem such as incontinence or prolapse for 10 years, it's not going to go away in two weeks. Give yourself two to three months of trying (Kegels) on your own.

If you're not having success and getting frustrated, absolutely get a referral to see a pelvic floor physical therapist. Ask your primary care doctor, gynecologist or urologist if you need help or have questions. Similarly, if you are experiencing pelvic pain you should see a physician before starting or continuing any kegel routine.

The takeaway

Shifferd often reminds patients that the exercises take work and commitment to see results. Just like starting any exercise program, it takes time.

But she also stresses an important point: The pelvic floor can, in fact, be rehabilitated.

For patients with pelvic prolapse or whose pelvic floor conditions aren't relieved through physical therapy, a physician certified in female pelvic medicine and reconstructive surgery (sometimes called a urogynecologist) can offer the next step in treatment options.

"Pain is not normal. Incontinence is not normal," she says. "People shouldn't rest on that and say, 'It's an aging thing; I've got to live with this.' We can do something about it."