Kegel (KAY-gul or KEY-gul) exercises are named after Dr.Arnold Kegel who invented the perineometer, an instrument used to assess the strength of a woman's pelvic floor; they are used to strengthen the pelvic floor muscles, which support the uterus, bladder, and bowel. Kegel exercises consist of contracting and relaxing the muscles that form part of the pelvic floor (sometimes called the "Kegel muscles"). If you do Kegel exercises regularly and keep your pelvic floor muscles toned, you may reduce your risk of incontinence and similar problems as you get older.

Who can benefit from Kegel exercises?
Many conditions put stress on your pelvic floor muscles:

• Pregnancy
• Childbirth
• Being overweight
• Aging
• A chronic cough
• A genetic predisposition to weak connective tissue

When your pelvic floor muscles weaken, your pelvic organs descend and bulge into your vagina, a condition known as pelvic organ prolapse. The effects of pelvic organ prolapse range from uncomfortable pelvic pressure to leakage of urine or feces. Fortunately, Kegel exercises can strengthen pelvic muscles and delay or maybe even prevent pelvic organ prolapse.

Kegel exercises are recommended especially during pregnancy. Well-toned pelvic floor muscles may make you more comfortable as your due date approaches. You may be less likely to develop urine leakage — common near the end of pregnancy and prone to persist after you've given birth.

Finally, Kegel exercises — along with counseling and sex therapy — may be helpful to women who have persistent problems reaching orgasm.

How to do Kegel exercises
Learning how to perform Kegel exercises properly can be tricky. How do you know whether you're working the correct muscles? It takes diligence to identify your pelvic floor muscles and learn how to contract and relax them.

Find the right muscles
To make sure you know how to contract your pelvic floor muscles, insert a finger inside your vagina and try to squeeze the surrounding muscles. You should be able to feel your vagina tighten and your pelvic floor moves upward. Then relax your muscles and feel your pelvic floor move down to the starting position. As your muscles become stronger, and you become more experienced with the exercises, the movement will become more pronounced. Or try another technique: try to stop the flow of urine while you're going to the bathroom. If you succeed, you've got the basic move. But don't make a habit of starting and stopping your urine stream. Doing Kegel exercises with a full bladder, or while emptying your bladder, can actually weaken the muscles. It can also lead to incomplete emptying of the bladder, which increases your risk of a urinary tract infection.

If you're having trouble finding the right muscles, don't be embarrassed to ask for help. Your doctor or other health care provider can give you important feedback so that you learn to isolate and exercise the correct muscles.

Perfecting your technique
Once you've identified your pelvic floor muscles, empty your bladder and sit or lie down. Then:

1. Contract your pelvic floor muscles.
2. Hold the contraction for three seconds then relax for three seconds.
3. Repeat 10 times.
4. Once you've perfected three-second muscle contractions, try it for four seconds at a time, alternating muscle contractions with a four-second rest period.
5. Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions.

To get the maximum benefit, focus on tightening only your pelvic floor muscles or isolating your pelvic floor muscles. Be careful not to flex the muscles in your abdomen, thighs or buttocks. Also, try not to hold your breath. Just relax, breathe freely and focus on tightening the muscles around your vagina and rectum.

Repeat three times a day
Perform a set of 10 Kegel exercises three times a day. The exercises will get easier the more often you do them. You might make a practice of fitting in a set every time you do a routine task, such as checking e-mail or commuting to work.

Vary your technique with one of these methods:

• Try sets of mini-Kegels. Count quickly to 10 or 20, contracting and relaxing your pelvic floor muscles each time you say a number.
• Visualize an elevator. Slow down the exercises, gradually contracting and releasing your pelvic floor muscles one at a time. As you contract, visualize an elevator traveling up four floors. At each floor, contract your muscles a little more until you reach maximum contraction at the fourth floor. Hold the contraction and then slowly release the tension as you visualize the elevator returning to the ground floor. Repeat 10 times.

Biofeedback training
If you have trouble doing Kegel exercises, biofeedback training may help. In a biofeedback session, a nurse, therapist or technician will either insert a small monitoring probe into your vagina or place adhesive electrodes on the skin outside your vagina or rectal area. When you contract your pelvic floor muscles, you'll see a measurement on a monitor that lets you know whether you've successfully contracted the right muscles. You'll also be able to see how long you hold the contraction.

Another technique uses electrical stimulation to help you feel the muscles contract. The procedure is painless, although you'll experience a buzzing feeling as a small electrical current is applied to your pelvic floor muscles, making them contract. Once you feel this sensation a few times, you'll probably be able to duplicate the exercise on your own. Because simpler methods work for most women, this technique is rarely used.

When to expect results
If you do your Kegel exercises faithfully, you can expect to see some results, such as less frequent urine leakage, within about eight to 12 weeks. Your improvement may be dramatic — or, at the very least, you may keep your problems from worsening. As with other forms of physical activity, you need to make Kegel exercises a lifelong practice to reap lifelong rewards.