Kegel Exercise Technique for Patients
Patients should perform Kegel exercises by contracting the pelvic floor muscles (as if stopping urine flow) for 5-8 seconds, followed by 6 seconds of rest, repeated 10-15 times per session, twice daily for 15 minutes each session, for a minimum of 12 weeks. 1, 2
Identifying the Correct Muscles
- Instruct patients to identify pelvic floor muscles by attempting to stop urine flow mid-stream (though this should only be done once for identification purposes, not as regular practice). 3
- The correct sensation is a "squeeze and lift" feeling in the vaginal/rectal area, without tightening the abdomen, buttocks, or thighs. 3
- Critical caveat: 25% of women perform Kegel exercises incorrectly after verbal instruction alone, with 25% actually performing a Valsalva maneuver (bearing down) that can worsen incontinence. 4
Proper Exercise Technique
- Contract the pelvic floor muscles for 5-8 seconds (squeeze and hold). 2, 5
- Rest for 6 seconds between contractions to allow muscle recovery. 2
- Perform 10-15 repetitions per session (one set). 1, 2
- Complete two sessions daily, each lasting 15 minutes. 2, 6
- Maintain normal breathing throughout—never hold your breath or strain (avoid Valsalva maneuver). 7
Training Duration and Progression
- Continue exercises for a minimum of 12 weeks to achieve therapeutic benefit. 2, 6
- Improvement typically begins at 4 weeks, with maximal benefit by 12 weeks. 6, 5
- Success rates with comprehensive pelvic floor muscle training can reach 90-100% when performed correctly. 1
Key Instructions to Prevent Common Errors
- Do not bear down or push out—this worsens pelvic floor dysfunction. 4
- Do not tighten abdominal, buttock, or thigh muscles—isolate only the pelvic floor. 3
- Do not practice by repeatedly stopping urine flow—this can disrupt normal voiding patterns. 3
- Perform exercises in various positions (lying, sitting, standing) once technique is mastered. 3
When to Seek Professional Guidance
- If uncertain about correct technique, refer for pelvic floor physiotherapy with biofeedback, as this is first-line treatment and ensures proper muscle isolation. 1, 3
- Biofeedback uses perineal EMG surface electrodes to provide real-time feedback, confirming correct muscle contraction. 1
- Approximately 50% of women cannot perform an ideal Kegel contraction after brief verbal instruction alone, making professional assessment valuable. 4
Adjunctive Measures
- Combine with lifestyle modifications including proper toilet posture (buttock support, foot support, comfortable hip abduction). 1
- Address constipation aggressively, as straining worsens pelvic floor dysfunction. 1
- Consider cognitive behavioral therapy for anxiety related to symptoms. 1