Urinary incontinence is a prevalent, costly, yet ignored problem among elderly. Kegel exercise is an effective, non-harmful, of very low complication rates, and a very highly successful treatment for urinary incontinence. Objective: To determine the effect of Kegel exercise on urinary incontinence among institutionalized elderly in Lattakia, Syria. Setting: The study was carried out in the three available residential homes for elderly people in Lattakia, Syria. These were Dar Al Raha, Dar Al Mowasat, and Dar Al Ber. Subjects: The study comprised 30 elderly persons with urinary incontinence. They were divided randomly to two equal groups (group -1-: experimental group and group -2-: control group. Elders in group -1- performed the Kegel exercise for three months in four sessions per day for fifty contractions (5 seconds for each contraction) followed by fifty resting phases (10 seconds for each one) in each session with a total of 200 contractions per day. Elders in group -2- were left to their routine treatment. Tools: Participants were interviewed individually to collect the necessary data using a structured interview sheet and the revised urinary incontinence scale (RUIS) which was repeated after 3 months for both the control group and those who performed Kegel exercise to evaluate its effect on the urinary incontinence status. Results: The Kegel exercise had a positive effect on the urinary incontinence status of elders who practiced it. Four of the 15 (26.7%) elders in group 1 were cured completely and five (35.7%) showed improvement in their symptoms. Among the control group the condition of four elders worsened (26.7%) while for the rest the condition did not change. This improvement was related significantly with age, gender, duration of stay in the home, and incontinence duration. Conclusion: The Kegel exercise improved urinary incontinence status significantly. Recommendations: Early identification of elders with urinary incontinence. Educate and motivate elders with urinary incontinence to perform Kegel exercise regularly in order to improve their condition.