Recommended Method for Performing Kegel (Pelvic Floor) Exercises
Kegel exercises should be performed daily with proper technique instruction from trained healthcare personnel, involving isolated pelvic floor muscle contractions held for 6-8 seconds with 6-second rest periods between contractions, performed twice daily for 15 minutes per session, for a minimum duration of 3 months. 1, 2
Essential Technique Components
Proper Muscle Isolation and Contraction
- Contract the pelvic floor muscles (puborectalis, pubococcygeus, iliococcygeus) for 6-8 seconds, followed by 6 seconds of rest between each contraction 2, 3
- Maintain normal breathing throughout—never hold your breath or strain to avoid Valsalva maneuver 4
- Focus on isolating the pelvic floor muscles without contracting abdominal, gluteal, or thigh muscles 3
Training Schedule and Duration
- Perform exercises twice daily for 15 minutes each session 2
- Continue training for at least 3 months to achieve clinically meaningful benefits 5
- Daily performance is encouraged for optimal results 1
Importance of Professional Instruction
Instruction on proper technique by trained healthcare personnel (specialist physiotherapists or continence nurses) is essential to obtain optimal benefits 1, 5. This is a critical point because:
- Women perform significantly better with supervised programs compared to unsupervised or leaflet-based care 5
- Up to 70% improvement in stress incontinence symptoms can be achieved with appropriately performed exercises under supervision 5
- Proper technique instruction maximizes effectiveness and prevents incorrect muscle activation 1, 3
Evidence-Based Effectiveness
For Stress Urinary Incontinence
- Pelvic floor muscle training is first-line treatment for stress urinary incontinence 1, 3
- Achieves up to 70% improvement in symptoms across all age groups 5
- Increases continence rates and improves quality of life 1
For Other Conditions
- Bladder training alone is recommended for urgency incontinence 1
- Combined pelvic floor muscle training with bladder training is recommended for mixed incontinence 1
- May reduce risk of urinary incontinence when performed during pregnancy, though evidence quality is lower 1
Optional Adjuncts
Biofeedback Enhancement
- Biofeedback using perineal EMG surface electrodes can enhance training by teaching proper muscle isolation 4, 6
- Helps patients visualize muscle contraction and relaxation in real-time 6
- Particularly useful for patients who have difficulty isolating pelvic floor muscles 6
Resistance Devices
- Resistance devices (such as Kegelmaster) show no additional benefit over standard Kegel exercises alone 2
- Both methods with and without devices produce equivalent improvements in muscle strength, quality of life, and incontinence severity 2
Common Pitfalls to Avoid
- Avoid breath-holding or straining during contractions, which creates Valsalva and defeats the purpose 4
- Avoid unsupervised training without initial professional instruction, which significantly reduces effectiveness 5
- Avoid premature discontinuation before 3 months, as benefits require sustained training 5
- Avoid contracting wrong muscle groups (abdomen, buttocks, thighs) instead of isolated pelvic floor muscles 3