Up to 35% of women experience stress urinary incontinence, and it can get worse as we get older or with certain exercises.
Pelvic floor exercise is the recommended first-line treatment for women with SUI. A pelvic floor physical therapist will evaluate strength, coordination, and muscular tone and prescribe appropriate therapy. Since there are different types of incontinence, including stress (coughing, sneezing, jumping), urge (a strong “I gotta go!” feeling), and mixed (both types), therapies vary. “Kegels are just one piece of the puzzle,” Crystal Liang, D.P.T., a physical therapist with Sloane Stecker Physical Therapy in New York, says. Other treatments include regaining muscle coordination, urge-suppression techniques, and healthy bladder and bowel habits, including diet and timing voiding intervals.
While Liang recommends that symptomatic individuals consult with a pelvic floor physical therapist before starting rehabilitation techniques, most people can benefit from strengthening the pelvic floor, like any other muscle group. Kegels remain the gold standard of pelvic floor training. (See “The Right Way to Kegel,” below.)
Just as with your strength routine, you can break your Kegels into sets and reps, says Liang. Work up to three sets of 10 reps a day.
The Right Way to Kegel
1. ID Your Target
Kegels strengthen the pelvic floor muscles, which extend from inside the pubic bone to the anus and around the vagina, urethra, and rectum like a hammock. They tighten and relax to control the flow of urine—so one easy way to find them is to try to stop your pee midstream. The exercises should feel the same way.
2. Rep It Right
Start by engaging these muscles for three seconds, then relax them fully for four seconds. Build up to 10 to 15 reps and up to a 10-second contraction as the shorter contractions become easier. Make sure you’re fully relaxing between reps. “If you’re in a constant state of contraction, you won’t be able to generate as much muscle power, and you could potentially worsen your symptoms,” Liang says.
3. Vary Your Time Under Tension
Once you get the hang of it, alternate sets of quick reps, which work the fast-twitch muscles, and sets of slow reps, which are more endurance-focused, says Anna Ribaudo, D.P.T., a physical therapist at the Hospital for Special Surgery in New York.
4. Change Your Position
“Switch up your body stance when you do the Kegels,” Ribaudo recommends. The beauty of Kegels, she notes, is that you can do them anywhere—waiting for a light to cross the street, sitting at your desk, standing in line at the store, or lying on the couch watching TV. “Doing your Kegels in different positions puts varying forces on the muscles to increase the challenge.”
5. Get With the Program
Once you get the hang of the Kegel, incorporate them into other muscle strengtheners like bridges, clamshells, and even squats to get an even deeper benefit, says Liang. It’s also important to engage your deep abdominals like the transverse abdominis, or TA, muscles, adds Ribaudo. “When you get your TA to turn on, it makes the pelvic floor stronger.”