Overactive Bladder/Incontinence, Protocols

Do your Kegels – The Right Way!

Kegel exercises are one of the main treatment options for urinary incontinence (specifically for ‘stress incontinence’).  Kegels were first introduced by the American gynaecologist Arnold Kegel in 1948 and since then have been supported as being effective in several studies.

Why do we leak?

Stress incontinence, i.e. the leaking of urine when strain is put on the bladder through exercise, sneezing, coughing or laughing, is the most prevalent type of incontinence.

It is often due to a weakened bladder neck or a ‘dropped’ bladder as the result of childbirth, age, obesity and poor pelvic muscle tone.

In stress incontinence, the urethra (bladder opening) is weakened and therefore added pressure from coughing etc. can cause it to open spontaneously.

Improving pelvic muscle tone can help to exert enough external pressure on the urethra to help keeping it closed under pressure.

How do Kegels work?

The pelvic floor muscle is the muscle responsible for closing your bladder after you finish passing urine.

It comprises of around 70% slow-twitch and 30% fast-twitch muscle fibres. The slow-twitch muscles have less force but provide muscle endurance, whereas the fast-twitch fibres can exert quick and forceful contractions.

Kegels can strengthen both muscles, providing better endurance for the urethra over time and the ability to contract and close the urethra quickly when added pressure is put on the bladder.

Kegels consist of repeated, high intensity contractions of the pelvic floor muscle.

Biofeedback and Kegels

Biofeedback is a popular addition to Kegels.

In women, a probe is inserted into the vagina which then translates the patient’s pelvic floor muscle activity onto a screen, helping the patient to better understand which muscles to twitch.

However, some studies have shown no benefit of this additional procedure over Kegel exercises alone.

I’d recommend trying the easiest and cheapest solution first, which is Kegels! But how?

The right way to do your Kegels – Vaginal Kung-Fu

When Arnold Kegel first developed his pelvic floor exercises, he managed to eliminate urinary incontinence in 93% of his patients. To achieve this, he inserted a device called ‘perineometer’ into the vagina of his patients and had the women contract different areas of the pelvic floor muscle.

Just like weight-lifting, this device provided resistance and feedback for the pelvic floor muscle.

But here’s the problem: the way we are taught to do our Kegels today is by simply contracting the pelvic floor muscle – without using any form of resistance!

According to ‘vaginal weight lifter’ Kim Anami this is the ‘equivalent to me going to the gym, staring at the weight rack, and waving my arms and legs wildly in the air. Then I wipe the imaginary sweat off my brow, congratulate myself on a “Great workout!” and go home.’ [1] – and this is a woman who can lift surfboards with her vagina (or pelvic floor muscles), so she does know a thing or two about Kegels.

Unsurprisingly, with the modern Kegel technique the success rate only lies by around 50% (which is still better than nothing!).

So what is the correct way of doing Kegels? Kim Anami recommends the following steps:

  1. Insert a resistance device into the vagina. This can be a jade egg (her preferred method), a dildo, a special Kegel device or even just your fingers.
  2. Start with twitching only the right side of the vaginal wall 5 times
  3. Now repeat on the left side
  4. Now pull on the device and try to hold it in the vagina by squeezing the muscle.

I am a big fan of high intensity, low frequency exercise (aka HIT). According to proponents of this form of exercise, the muscles quickly adapt if intensity is kept at the same level each time and therefore minimal gain is achieved. Therefore, intensity needs to be increased over time.

  • Therefore, I’d add that intensity of the Kegels should be increased over time (e.g. start with just 5 on each side and once you can do that comfortably do 10 etc).
  • You may also want to give your muscles time to grow for at least a day in between exercises, especially once higher intensity is reached.

Many women might be unsure if they are contracting the right muscles. There is a helpful exercise for this called ‘vaginetics’:

  1. Lie down on the floor on your back and bend your legs (feet flat on the ground).
  2. Have your arms on your sides, palm down, also flat on the floor.
  3. Raise your pelvis, using your hands as a counterbalance – this tightens your back and stomach muscles
  4. Pull up and inward with your vagina – the only muscles you can contract now are the pelvic floor muscles.

I’d recommend doing vaginetics at the same time as your Kegels when you are first starting off. After a while you should be comfortable identifying the right muscles.

By implementing these exercises regularly into your routine your incontinence could become a thing of the past.

Now I’d like to hear from you: Have you had success using regular Kegels? Or have you been trying Kegels for a while without relief of your symptoms? Let me know in the comments.

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  1. Anami, Kim Don’t do your F**king Kegels! http://kimanami.com/dont-do-your-fking-kegels/

Wikipedia Arnold Kegel 2016 https://en.wikipedia.org/wiki/Arnold_Kegel

Anami, Kim Don’t do your F**king Kegels! http://kimanami.com/dont-do-your-fking-kegels/

Gillespie, Larrian You Don’t Have to Live with Cystitis (New York: Avon Books, 1996), p.154-155

McGuff, Doug Body by Science (New York: The McGraw-Hill Companies, 2009)

Bo, K. Urinary incontinence, pelvic floor dysfunction, exercise and sport. Sports Med. 2004 [34 (7): 451-464] available at: http://www.ncbi.nlm.nih.gov/pubmed/15233598

Rovner, Eric et al Treatment Options for Stress Urinary Incontinence Rev Urol. 2004 [6 (Suppl. 3): 29-47] available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472859/

Barbosa, Leila et al The effectiveness of biofeedback in treatment of women with stress urinary incontinence: a systematic review Rev. Bras. Saude Mater. Infant. [vol.11 no.3 Recife July/Sept. 2011] available at: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1519-38292011000300002

B&B F Biofeedback https://www.bladderandbowelfoundation.org/bladder/bladder-treatments/conservative-treatments/biofeedback/

B&B F Pelvic Floor Muscle Exercises https://www.bladderandbowelfoundation.org/bladder/bladder-treatments/conservative-treatments/pelvic-floor-muscle-exercises/

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