How to build pelvic floor strength

By 1948 Dr Arnold Kegel, assistant professor of gynaecology at the University of Southern California School of Medicine in the US, had spent almost two decades pondering the incontinence that many of his patients experienced in the months after giving birth.

The problem was usually treated with drugs or even surgery. But Kegel concluded that the weakness of a particular pelvic-floor muscle—the pubococcygeus, about which little was known—was the undoubted cause. This hammock-like muscle, which supports the pelvic organs, extends from the pubic bone at the front of the pelvis to the spine.

In his revolutionary 1948 paper, Dr Kegel outlined exercises that would treat incontinence by strengthening the pubococcygeus, which he described as "the most versatile muscle in the entire human body".

Various factors, besides childbirth, can weaken pelvic floor muscles, including weight gain and diabetes, and, in men, removal of the prostate gland. Dr Kegel’s brilliance was recognising that these muscles could be exercised and strengthened like any others in the body. Doctors across the world now recommend his exercises. 

A number of medical trials, recorded in the prestigious Cochrane Database, have confirmed the efficacy of Kegel exercises for helping to prevent and reduce incontinence. One small British study of men with an average age of 59 found that practising the exercises regularly was as effective for combating erectile dysfunction as taking Viagra. To summarise, Kegel exercises can:

To keep your pelvic floor in good shape, give it a daily workout. First, you need to locate your pelvic floor muscles by stopping the flow while passing urine. To avoid exercising the wrong ones, do not:

Repeat 10–15 times, breathing freely. After some weeks, hold each squeeze for five seconds, building up to at least three sets of exercises a day. When you find this easy, move up to holding each squeeze for 10 seconds.

Exercise at the same time as a regular activity—while working in the kitchen, stuck in traffic or watching TV. If you exercise when going to the toilet, wait until you have fully emptied your bladder: do not stop and start the urine flow as an exercise, since this can irritate the bladder.

If you suffer from incontinence, aim to exercise six to ten times a day.

Whether you have stress incontinence, in which activities such as coughing or laughing may lead to leakage due to weakness in the pelvic floor muscle, or urge incontinence, in which your bladder contracts before you can reach the toilet, there are various options as well as exercises. Talk to your doctor, who may refer you to a continence advisor. 

If you have urge incontinence, it’s possible to "re-educate" your bladder. Bladder retraining programmes involve learning to distract yourself when you feel the urge and only going to the toilet at planned times. As you regain control, you’ll find you can gradually increase the gap between toilet visits until you go only when your bladder is full. Ask your doctor if a training programme of this type is available in your area.

Vaginal cones: This equipment comprises a cone with an adjustable weight or separate cones of different weights. You insert a cone in your vagina and use your pelvic floor muscles to grip it for one minute. Start with the lightest weight; over time, graduate to the next weight up. Once you can hold the heaviest weight for 20 minutes, your pelvic floor will be in good shape.