Kegel exercises
The standard advice is to pretend as if you are passing gas. Women are sometimes advised to imagine that they are tightening the vagina around a tampon. In general, you should feel like you are pulling in the anal area.
It can be difficult to isolate the pelvic floor muscles. People contract their leg and abdominal muscles instead. It can help to put your hand on your belly so you can sense when you are contracting your abdominal muscles when you shouldn’t be.
The advice to practice pelvic muscle exercises during urination has been discarded. An article on urinary stress incontinence in women in the March 6, 2008, New England Journal of Medicine said this:
“Performance of pelvic floor exercises is not recommended during voiding, because frequent interruptions of voiding may cause voiding dysfunction, and the ability to stop the flow of urine intermittently does not confirm that the exercises are performed correctly.”
The second part of that statement seems especially important. An article on treatment of urinary incontinence in Uptodate, an online publisher of in-depth review articles on medical topics, has this to say:
“Instructions to interrupt urination on regular basis or do [Kegel] exercises ‘one hundred times per day’ are unphysiologic and doomed to failure.”
Biofeedback
Both men and women can sometimes learn to do Kegels more effectively with biofeedback. Monitors are placed inside the vagina or rectum (or both, if you are a woman). As you attempt to do Kegels, you watch a computer screen to see if you are activating the correct muscles. Just one session of biofeedback can help people learn to perform Kegels correctly. Others may need five or six biofeedback sessions.
Electrical stimulation
If you are unable to activate your pelvic floor muscles, electrical stimulation therapy can help. A small electrode is placed inside the vagina or rectum. That electrode is used to deliver an electric current that causes the pelvic muscles to contract. The current can be set at different strengths and time intervals. Electrical stimulation therapy can be done with at-home machines or in a doctor’s office.
Sacral nerve stimulation is another form of electrical stimulation therapy. A wire with a small electrode tip is implanted inside the body so the tip is near the sacral nerve in the lower spine. There’s a device at the end of the wire that generates small electrical impulses. Those impulses activate the sacral nerve, which controls bladder function.
Magnetic stimulation
Magnetic stimulation is similar, conceptually, to electric stimulation, but a pulsed magnetic field is used to activate pelvic floor muscles instead of an electric current. Treatment with a magnetic stimulation device called Neocontrol involves sitting in a chair that sends magnetic pulses into the body. Magnetic stimulation can also be delivered by magnets applied externally near the sacral nerve roots. Uptodate sounds a cautionary note:
“Trials of these devices have been uniformly small, included heterogeneous patient groups, and may have been incompletely blinded or had no control group.”
Vaginal cones
These small, plastic cones are placed in the vagina. They come in different shapes and weights, and women are usually instructed to begin with the lightest one first. The idea is to use the pelvic floor muscles to keep the cone in place. Vaginal cones are, in effect, a sort of low-tech biofeedback device.
Pessaries
Pessaries are inserted into the vagina and positioned so they support the urethra. They come in various shapes, but are basically circular with a knob that pushes gently against the urethra. Strictly speaking, the purpose of a pessary isn’t to strengthen the pelvic floor or activate its muscles. The notion is to provide additional physical support to the urethra.
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