What is the proper progression of Kegel exercises? I’m seeing different things in different texts. Starting Supine vs. Sitting? Starting with just contractions or with holding urine flow while sitting on toilet?

Kegel exercises strengthen the pelvic floor muscles which support the uterus, bladder, small intestine and rectum. They help prevent or control urinary incontinence and other pelvic floor problems. Many factors can weaken pelvic floor muscles including pregnancy, childbirth, surgery, aging, excessive straining from constipation or chronic coughing and being overweight. A patient may benefit from doing Kegel exercises if S/he leaks a few drops of urine while sneezing, laughing or coughing (stress incontinence), has a strong, sudden urge to urinate just before losing a large amount of urine (urinary incontinence) or leaks stool (fecal incontinence).

Kegel exercises can also be done during pregnancy or after childbirth to try to prevent urinary incontinence. However, they are less helpful for women with severe stress incontinence or overflow incontinence.

A general guideline to get started is to:

• Find the right muscles. To identify the pelvic floor muscles, ask the subject to stop urination in midstream. Success often means  that the right muscles have been identified. Once identified, the exercises may be done in any position, although most subjects find it easier doing them lying down at first.
• Perfect the technique. Tighten the pelvic floor muscles, have the subject hold the contraction for five seconds, and then relax for five seconds. Repeat about four or five times in a row. Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions.
• Maintain focus. For best results, focus on tightening only the pelvic floor muscles. The subject should be careful not to flex the muscles in the abdomen, thighs or buttocks. S/he should also avoid holding their breath. Instead, the subject should breathe freely during the exercises.
• Repeat thrice daily. Aim for at least three sets of 10 repetitions a day.

Avoid using Kegel exercises to start and stop the urine stream because doing the exercises while emptying the bladder can actually lead to incomplete emptying of the bladder — which increases the risk of an urinary tract infection.

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