Kegel Exercises for Urinary Incontinence: How to Do Them Right

What are Kegel exercises and how do they help with bladder control?

Kegel exercises involve repeatedly contracting and releasing the pelvic floor muscles — the group of muscles that support the bladder, bowel, and uterus (or prostate in men) from below. Strengthening these muscles improves their ability to support the urethra and resist sudden increases in abdominal pressure (like coughing, sneezing, laughing, or lifting). For urge incontinence, trained pelvic floor muscles can help override the involuntary bladder contractions that create sudden urgency.

The AUA/SUFU guideline for overactive bladder identifies pelvic floor muscle training as a first-line behavioral intervention 1Ref 1Lightner DJ, Gomelsky A, Souter L, Vasavada SP (2019).Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline Amendment 2019.Pelvic floor muscle training as first-line behavioral treatment for overactive bladder; behavioral therapy by trained therapist as high-value initial intervention. For women with stress urinary incontinence, the AUA/SUFU guideline recommends pelvic floor muscle training before surgical options are considered 2Ref 2Kobashi KC, Albo ME, Dmochowski RR, Ginsberg DA, Goldman HB, Gomelsky A, Kraus SR, Sandhu JS, Shepler T, Treadwell JR, Vasavada S, Lemack GE (2017).Surgical Treatment of Female Stress Urinary Incontinence: AUA/SUFU Guideline.Pelvic floor muscle training as a first-line behavioral option for stress urinary incontinence in women before surgical consideration. A 2018 Cochrane systematic review found that women who do PFMT are up to 8 times more likely to report cure of urinary leakage compared with no treatment 3Ref 3Dumoulin C, Cacciari LP, Hay-Smith EJC (2018).Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women.Pelvic floor muscle training is better than no treatment for urinary incontinence in women; women doing PFMT are up to 8x more likely to report cure of all leakage.

How do I find the right muscles?

The most common instruction is to contract the muscles you would use to stop urine flow mid-stream or to prevent passing gas. You should feel a tightening and upward lift in the pelvic area — not a tightening of the buttocks, thighs, or abdomen. Those surrounding muscles should stay relaxed.

A practical check: try briefly stopping urination midstream once to identify the muscle. Do not make a habit of stopping mid-flow during urination, as that can disrupt normal bladder emptying patterns — just use it once for identification purposes.

What is the correct technique for Kegel exercises?

Once you have identified the pelvic floor muscles:

1. Contract (squeeze) the muscles and hold for 3–5 seconds. As your strength improves, work toward holding for 10 seconds. 2. Fully relax the muscles for an equal amount of time (3–10 seconds). The relaxation phase is as important as the contraction — incomplete relaxation leads to muscle tension that can worsen symptoms. 3. Repeat 10–15 times per set. 4. Aim for 3 sets per day.

Kegels can be done in any position — lying down is easiest for beginners, progressing to sitting and standing. They require no equipment and can be done anywhere, discreetly.

How long does it take to see results?

Most people begin to notice improvement in leakage episodes within 4–6 weeks of consistent daily practice. Significant strengthening — and maximum benefit — typically takes 12 weeks or longer. Consistency matters more than intensity; daily practice at moderate effort is more effective than intense occasional sessions.

Who benefits from Kegels, and are they the same for men and women?

Kegel exercises are recommended for:

• Women: stress urinary incontinence (leaking with exertion), urge incontinence (OAB), and mixed incontinence. They are also recommended during pregnancy and postpartum recovery to prevent pelvic floor weakness 2Ref 2Kobashi KC, Albo ME, Dmochowski RR, Ginsberg DA, Goldman HB, Gomelsky A, Kraus SR, Sandhu JS, Shepler T, Treadwell JR, Vasavada S, Lemack GE (2017).Surgical Treatment of Female Stress Urinary Incontinence: AUA/SUFU Guideline.Pelvic floor muscle training as a first-line behavioral option for stress urinary incontinence in women before surgical consideration.
• Men: particularly men who have had radical prostatectomy (prostate cancer surgery), in whom pelvic floor muscle training during recovery significantly improves continence outcomes 1Ref 1Lightner DJ, Gomelsky A, Souter L, Vasavada SP (2019).Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline Amendment 2019.Pelvic floor muscle training as first-line behavioral treatment for overactive bladder; behavioral therapy by trained therapist as high-value initial intervention. Also helpful for men with mild stress or urge incontinence.

The technique is essentially the same for both, although a pelvic floor physical therapist can tailor the program to your specific anatomy and goals.

Is a pelvic floor physical therapist necessary?

For many people, self-directed Kegel practice works well. However, studies show that 30–40% of people cannot correctly identify and contract the pelvic floor muscles from verbal instruction alone — some push down (bearing down) instead of lifting up, which can worsen leakage. A pelvic floor physical therapist uses biofeedback or internal examination to confirm correct muscle activation and progression at an appropriate rate 3Ref 3Dumoulin C, Cacciari LP, Hay-Smith EJC (2018).Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women.Pelvic floor muscle training is better than no treatment for urinary incontinence in women; women doing PFMT are up to 8x more likely to report cure of all leakage. The AUA guideline for overactive bladder endorses behavioral training by a trained therapist as a high-value first-line option 1Ref 1Lightner DJ, Gomelsky A, Souter L, Vasavada SP (2019).Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline Amendment 2019.Pelvic floor muscle training as first-line behavioral treatment for overactive bladder; behavioral therapy by trained therapist as high-value initial intervention. If self-directed practice for 6–8 weeks has not improved symptoms, or if symptoms are moderate to severe, a referral to pelvic floor physical therapy is worthwhile.