Kegel exercises work by increasing the bulk and strength of the one remaining sphincter muscle. There are disagreements about what is the “proper” way. I like to have patients do Kegel exercises by imagining that they are urinating and then contracting the muscles to “cut off” the stream. They should hold for only a second or two. Then they should let the muscle rest for 5-10 seconds and repeat the contraction. I advise patients to do a set of 10 contractions four times a day – usually at breakfast, lunch, dinner, and bedtime. This schedule allows the muscles to rest between exercise periods so the muscles do not remain in a fatigued state. In addition, I like patients to actually stop the urinary stream once or twice when urinating to determine whether they are contracting the right muscles. If the stream stops, they are contracting the right muscles. Taken together, this schedule leads to about 50 contractions per day. The exercise will strengthen the muscles if done faithfully. More than 50 contractions may be too much and may leave the muscles fatigued – resulting in worse continence.