You’ve probably heard a hundred times that Kegel exercises are key to halting urinary incontinence. But did you know that there are different ways to Kegel — and that the right way depends on which type of incontinence you have? Or that other exercises also help prevent bothersome leaks? This could be the information you need to put the problem behind you.
Of course, you should alert your doctor if you’re experiencing incontinence. But chances are good that you won’t need drugs or surgery if you practice the exercises below, recommended by urologist Larissa V. Rodríguez, of the David Geffen School of Medicine at the University of California, Los Angeles. What to do…
Identify your problem. If a little urine escapes when you exercise, sneeze, cough or laugh, you have stress incontinence. It occurs when weakness develops in the muscles of the pelvic floor (the hammock-like structure that supports the uterus and bladder) and the sphincter of the urethra (the tube that carries urine out of the bladder), causing the bladder’s position to drop and preventing the urethra from closing properly.
If you experience a sudden, urgent need to urinate in response to a trigger (such as sipping a drink or hearing running water) or at random, you have urge incontinence. This occurs when abnormal nerve signals cause the bladder to contract involuntarily.
Pick the correct Kegel. With either type of incontinence, step one is to identify your pelvic floor muscles. Insert a finger into your vagina and try to contract the muscles that allow you to feel the squeeze on your finger… or instead, try to stop your urine midstream. The muscles you use to accomplish these tasks are the ones that need strengthening. (Note: Do not make a habit of interrupting your urine stream — try it just once or twice to isolate the correct muscles.)
For stress incontinence: Squeeze your pelvic floor muscles and hold for five seconds… relax… repeat 10 times. Throughout the day, do 10 sets of 10 squeezes each — for a total of 100 squeezes daily. Also squeeze those muscles whenever you cough or sneeze.
For urge incontinence: Do a chain of 10 Kegels very quickly, holding for one second and then releasing for one second. Do this 10 times daily. Also do it whenever you feel a sudden urge to go — fast Kegels activate nerves that tell the bladder to relax.
Try weighted vaginal cones. These exercise aids, which further strengthen the pelvic floor, are especially helpful with stress incontinence. A set of cones typically includes several softly tapered cones weighing from about 0.7 ounce to about 2.5 ounces. [Editor’s note: Vaginal cones are readily available online (for instance, see www.VaginalWeights.org) starting at about $60.] To use: Gently insert the lightest cone into the vagina… then, using your pelvic floor muscles, try to keep the cone inside for at least one minute as you walk around. Practice daily — as your muscles get stronger, try a heavier cone.
Practice timed voiding. This exercise retrains your bladder, helping mostly with urge incontinence. The idea is to urinate on a schedule — for instance, starting at intervals of every two hours. If you feel an urge to go sooner, try to wait until the end of the two hours… or decrease your starting interval to whatever amount of time allows you to void without urgency or incontinence. Once you can easily manage the starting interval, gradually lengthen the time between bathroom trips — for example, to every three hours. As your bladder adjusts, you gain more control over its contractions… and are less likely to leak.
Keep it up. Rodríguez said, “With daily practice, both types of incontinence typically improve significantly within three to six weeks — but to keep muscles strong, you must make a lifetime commitment to pelvic floor exercise.”