Patient information: Pelvic floor muscle exercises (Beyond the Basics)

INTRODUCTION

The pelvic muscles work to control the release of urine. Like other muscles, they can become weakened over time as a result of childbirth, surgery, and aging. People with bladder control problems can improve urinary control through pelvic muscle exercises (also called Kegel exercises).

If you want to use pelvic muscle exercises, speak to your healthcare provider to determine if the exercises would be helpful, and also to receive instructions about how to perform the exercises correctly.

PELVIC MUSCLE EXERCISE TECHNIQUE

• First, you will need to learn which muscles to tighten. To do this, tighten your pelvic muscles while you are urinating to stop the flow of urine. Tighten and relax your muscles to start and stop your flow of urine several times. That way you will learn which muscles are the ones you should tighten. Do this ONLY a few times while you are learning. Normally, when you do the exercises you should NOT stop the flow of your urine, because this can hurt your bladder.
  
  After you learn which muscles to tighten, you can do the exercises in any position (sitting in a chair or lying down). You do not need to do them while you are in the bathroom.
• Second, hold the pelvic muscle contraction approximately 8 to 10 seconds, and then relax the muscles; relaxing the muscles is as important as contracting. In the beginning, it may not be possible to hold the contraction for more than one second.
  
  Perform 8 to 12 exercises three times per day. Try to do this every day, but no less than three or four times a week. Continue this regimen for at least 15 to 20 weeks.
• Over time, try to hold the contraction harder and for a longer time. You will need to continue these exercises indefinitely to have a lasting effect, similar to other forms of exercise.

Some people benefit from working with a physical therapist or nurse to receive more detailed instructions and to ensure that you use the correct technique. In addition, these providers may use biofeedback to improve your exercise technique and strength. Biofeedback uses a computer monitor to show you as the muscles contract and relax, and also indicates if you use the wrong muscles.

PELVIC MUSCLE EXERCISE RESULTS

Studies have shown that, if done correctly, pelvic muscle exercises can be effective in the following situations:

• If you leak urine with coughing/laughing/sneezing. Contract your muscles when you are about to cough/laugh/sneeze to avoid leaking.
• If you have a sudden urge to run to the bathroom, sit or stand still and contract your pelvic muscles. After the urge diminishes, you can then proceed to the toilet.
• If you have mild fecal leakage (leakage of stool).

These exercises are less helpful for people with severe leakage with laughing/coughing/sneezing. Exercises are not helpful at all for people with other types of urinary incontinence, including overflow incontinence (when the bladder cannot empty completely and leaks when it becomes overly full). (See "Patient information: Urinary incontinence in women (Beyond the Basics)" and "Patient information: Urinary incontinence treatments for women (Beyond the Basics)".)

Most people notice an improvement after three to four months of practicing pelvic muscle exercises. If these exercises are not helpful, please speak with a healthcare provider. Other treatments are available and may be recommended.

WHERE TO GET MORE INFORMATION

Your healthcare provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.

Patient level information — UpToDate offers two types of patient education materials.

The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Patient information: Pelvic muscle (Kegel) exercises (The Basics)
Patient information: Urinary incontinence (The Basics)
Patient information: Urinary incontinence in men (The Basics)
Patient information: Pelvic organ prolapse (The Basics)
Patient information: Treatments for urge incontinence in women (The Basics)

Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.

Patient information: Urinary incontinence in women (Beyond the Basics)
Patient information: Urinary incontinence treatments for women (Beyond the Basics)

Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Nocturia: Clinical presentation, diagnosis, and treatment
Pelvic floor disorders associated with pregnancy and childbirth
Treatment of urinary incontinence

The following organizations also provide reliable health information.

• National Library of Medicine

     (www.nlm.nih.gov/medlineplus/healthtopics.html)

• Mayo Clinic

     (www.mayoclinic.com)

• American Academy of Family Physicians

     (www.familydoctor.org)

• The National Institute of Diabetes and Digestive and Kidney Diseases

     (http://kidney.niddk.nih.gov/kudiseases/a-z.asp)

• National Association for Continence

     1-800-BLADDER
     (www.nafc.org)

• Simon Foundation

     (www.simonfoundation.org)

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