Kegel exercises strengthen the pelvic floor muscles, which are important because they support the uterus, bladder, small intestine and rectum. Strengthening the pelvic floor muscles with Kegel exercises can help to control or prevent urinary incontinence and also protect against other pelvic floor issues such as various forms of prolapse.

It’s hard to give an exact figure but it is quite high, probably 70 per cent. Most women have heard of Kegel exercises and most have tried to do them at some point. Many of my patients think they have been doing Kegel exercises, sometimes for years but when I ask them to demonstrate they are often tensing or clenching the wrong muscles; typically their abdominals or the gluteal muscles of the butt.

I usually start by telling patients what not to do, as I mentioned before you should not be clenching the abdominal or gluteal muscles. The other thing I tell patients not to do is try and stop the flow when urinating. Although that is a good way of initially identifying the correct muscles to contract it is not good to practice that way as it could store up problems for the future.

When learning how to do them, some women find it helpful to insert a finger into their vagina and then tighten the muscles to squeeze the finger as though they were trying to hold back urine. Getting the hang of it might take a few tries but once you have identified the correct set of muscles and learned to isolate them you will know what it feels like and be able to do them anywhere and at any time.

At first, you may only be able to contract the muscles hard for a second or two but like training any muscle they will get stronger and their endurance will improve if you keep exercising them until you can contract them for five or six seconds per repetition. I recommend doing two or three sets of 10 to 20 repetitions, two or three times a day. Try also mixing sets of short two and three second contractions with sets of longer five or six second contractions.

Weak pelvic floor muscles can lead to a variety of problems. Probably the most common, especially for new mothers and menopausal women is stress urinary incontinence (SUI), which is when coughing, sneezing, jumping or lifting heavy objects puts stress of the bladder and causes a small, involuntary leak of urine. Weak pelvic floor muscles can also lead to various types of pelvic organ prolapse, which is when the muscles and tissues of the pelvic floor become so weak or loose that they can no longer properly support the uterus, bladder and rectum.

There are a number of reasons why it is difficult to put an exact figure on the number of women that experience SUI. One of those reasons is that definitions of it vary among the medical professions and from country to country. Another reason is that many women, especially in Asia, are reluctant to raise the topic with their doctors. It is rare in younger women who have not had children; if you are young and have not given birth you should see your doctor if you develop incontinence. It is very common after childbirth, especially vaginal deliveries – probably something like a third of women will experience temporary stress incontinence for a couple of months after giving birth while the muscles and connective tissues of the pelvic floor recover from being stretched during pregnancy and delivery. If it persists beyond three months it’s worth checking it out with your gynaecologist. The chances of having incontinence increase with each pregnancy and birth.

The other group of women that commonly experience it are menopausal and post-menopausal women. Menopause-induced vaginal atrophy is the main reason older women suffer from SUI, because the pelvic floor muscles and tissues that provide support to the pelvic organs depend on estrogen to maintain their strength and elasticity. The decline in the production of estrogen during menopause causes the thinning and weakening of the pelvic support structures making women more susceptible to SUI. The incidence increases with age and it is thought that as many as 40 percent of women over 65 experience some degree of stress incontinence.

Pelvic floor prolapse, also known as pelvic organ prolapse is surprisingly common. Estimates vary but somewhere between a third and half of all women will experience some degree of prolapse in their lifetime. They can vary from mild or small post-delivery prolapses that self-correct, sometimes without the woman even being aware of it, to major prolapses with the uterus descending out of the vaginal opening. Like incontinence, prolapse is most common after vaginal deliveries and then again in post-menopausal women.

Although it is rare, there are some things that can lead to prolapse. Obesity can increase the risk of prolapse as can straining on the toilet and severe coughing.

Some conditions and therapies can mimic or temporarily induce a menopause-like state, which might increase the risk of prolapse. Treatment-induced menopause can result from surgical removal of both ovaries, chemotherapy, radiation therapy to the pelvis, and some hormonal therapies. An under-active thyroid (hypothyroidism) can also cause menopause-like symptoms but all of these are very rare.

One can certainly reduce one’s chances of experiencing incontinence or prolapse by maintaining a health weight, not smoking, exercising regularly and including Kegel exercises in your daily fitness programme.

There are some intravaginal treatments that involved inserting a laser or radio frequency (RF) probe into the vagina to treat the superficial tissues of the vagina wall. Many of these are ablative and can cause some discomfort and soreness post-treatment and patients are usually advised against having sexual intercourse after such treatments for a period of time to allow the tissue to regenerate.

More recently high-intensity focused electromagnetic (HIFEM®) devices have become popular as they offer a non-invasive treatment option that allow the patient to remain fully-clothes throughout the treatment.