What Are Kegel Exercises
Kegel exercises, also called Kegels or pelvic floor muscle training, are exercises for your pelvic floor muscles to help prevent or reduce stress urinary incontinence. Your pelvic floor muscles support your uterus, bladder, small intestine, and rectum.
Four in 10 women improved their symptoms after trying Kegels.9 Kegels can be done daily and may be especially helpful during pregnancy. They can help prevent the weakening of pelvic floor muscles, which often happens during pregnancy and childbirth. Your pelvic floor muscles may also weaken with age and less physical activity.
Some women have urinary symptoms because the pelvic floor muscles are always tightened. In this situation, Kegel exercises will not help your urinary symptoms and may cause more problems. Talk to your doctor or nurse about your urinary symptoms before doing Kegel exercises.
Treatment For Urge Incontinence
There are several different types of treatment for urge incontinence.
- Bladder training. This is usually the first treatment. Youll be asked to do it for six weeks to see if it works. The training includes lengthening the time between planned visits to the toilet. Distraction and relaxation techniques help you control the urge to pee.
- Medicines. Your doctor may offer medicines called anticholinergics . These help to stop the muscle in your bladder from tightening when it shouldnt. They can take about a month to work and can cause a dry mouth and constipation. But these can be signs that the medicine is working.
If these treatments dont work, there are other options.
- Botulinum toxin A. This is injected into the wall of your bladder. It helps to stop the muscle in your bladder being overactive.
- Nerve stimulation. This involves sending electrical signals to the nerves that control your bladder.
- Surgery. There are two main types of surgery for urge incontinence. One involves making your bladder bigger . The other redirects urine away from your bladder into a bag . Both are major operations and only used if other treatments havent worked.
Each treatment comes with risks and benefits. Talk to your doctor about your treatment options. Make sure you have all the information you need to decide whats best for you.
Treating And Managing Urinary Incontinence
Today, there are more treatments and ways to manage urinary incontinence than ever before. The choice of treatment depends on the type of bladder control problem you have, how serious it is, and what best fits your lifestyle. As a general rule, the simplest and safest treatments should be tried first.
A combination of treatments may help you get better control of your bladder. Your doctor may suggest you try the following:
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How Is Urinary Incontinence Diagnosed
For people with urinary incontinence, it is important to consult a health care provider. In many cases, patients will then be referred to an urogynecologist or urologist, a doctor who specializes in diseases of the urinary tract. Urinary incontinence is diagnosed with a complete physical examination that focuses on the urinary and nervous systems, reproductive organs, and urine samples.
How Is Incontinence Treated
There are many different factors that your healthcare provider will consider when creating a treatment plan for your incontinence. The type of incontinence and the ways it affects your life are both big considerations. Your provider will also talk to you about the type of treatment you are most comfortable with. There are three main types of treatment you can explore for incontinence medications, lifestyle changes and surgery. Each option has pros and cons that your provider will discuss with you.
Medications to treat incontinence
There are quite a few medications that can reduce leakage. Some of these drugs stabilize the muscle contractions that cause problems with an overactive bladder. Other medications actually do the opposite thing relaxing muscles to allow your bladder to empty completely. Hormone replacement therapies can often involving replacing estrogen thats decreased during menopause may also help restore normal bladder function.
In many cases, medications can work very well to return normal function to the bladder. Your provider will carefully select a medication that matches your specific needs. Often, your provider will start you on a low dose of the medication and then increase it slowly. This is done to try and reduce your risks of side effects and to keep track of how well the medication is working to treat your incontinence.
Common medications that can be used to treat incontinence include:
Lifestyle changes to manage incontinence
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Demonstration Of Stress Incontinence: Cough Stress Test
Stress urinary incontinence should be objectively demonstrated before any anti-incontinence surgery is performed 101113. Visualization of fluid loss from the urethra simultaneous with a cough is diagnostic of SUI. Delayed fluid loss is considered a negative cough stress test result and suggests cough-induced detrusor overactivity. The cough stress test can be performed with the patient in the supine position during the physical examination. However, if urine leakage is not observed, the cough stress test needs to be repeated with the patient standing and with a full bladder to maximize test sensitivity. Health care providers often ask patients to come to the office with a full bladder during an initial evaluation so that the cough stress test can be performed before bladder emptying 12.
Treatment Of Urge Incontinence
There are a number of treatment options available for people who suffer from urge incontinence. One common treatment is Kegel exercises, which involve repeatedly contracting and relaxing the muscles that control urination.
Medications such as oxybutynin and tolterodine can also be effective in treating urge incontinence by reducing muscle spasms. In some cases, surgery may be necessary to treat the underlying condition causing urge incontinence.
Whatever the treatment, it is important to seek medical advice to ensure that the most appropriate treatment is selected.
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Conducting The Systematic Review
Searching for the Evidence: Literature Search Strategies for Identification of Relevant Studies to Answer the Key Questions
To identify new primary research studies meeting our criteria we will conduct literature searches of studies in PubMed, the Cochrane Central Trials Registry, the Cochrane Database of Systematic Reviews, and EMBASE databases. We will also search the FDA Web site , ClinicalTrials.gov, and the International Clinical Trials Registry Platform. We will also review reference lists of existing systematic reviews for additional studies.
To the extent possible, the current search will replicate the search reported by the 2012 AHRQ review. However, we will add terms for any listed eligible interventions that were omitted from the 2012 AHRQ review search strategies. We will use the search strategies in Appendix A. Since the terms being added to the 2012 AHRQ review primarily cover interventions that were included in that review , we will not search for older studies with the newly added terms.
With the exception of studies in the 2012 AHRQ review, studies found from existing systematic reviews will be extracted de novo. For studies included in the 2012 AHRQ review, to the extent feasible, we will rely on their extraction and summary data for study level data, including risk of bias assessment.
Data Extraction and Data Management
Assessment of Methodological Risk of Bias of Individual Studies
Grading the Strength of Evidence
Will I Have Incontinence For My Entire Life
Sometimes incontinence is a short-term issue that will go away once the cause ends. This is often the case when you have a condition like a urinary tract infection . Once treated, frequent urination and leakage problems caused by a UTI typically end. This is also true for some women who experience bladder control issues during pregnancy. For many, the issues end in the weeks after delivery. However, other causes of incontinence are long-term and related to conditions that are managed throughout your life. If you have a chronic condition like diabetes or multiple sclerosis, you may have incontinence for a long period of time. In those cases, its important to talk to your provider about the best ways to manage your incontinence so that it doesnt interfere with your life.
A note from Cleveland Clinic
It can be embarrassing to talk about bathroom habits with your healthcare provider. This embarrassment shouldnt stop you from treating incontinence, though. Often, your healthcare provider can help figure out the cause of your bladder control issue and help make it better. You dont need to deal with it alone. Talk to your healthcare provider about the best ways to treat incontinence so that you can lead a full and active life without worrying about leakage.
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Urinary Incontinence In Women
Expert reviewer, Emma Mitchell, Physiotherapist at Bupa UK and Dr Elizabeth Rogers, Associate Clinical Director, Bupa Health Clinics Next review due October 2024
Urinary incontinence is when you pass urine without meaning to. Its common in women, particularly as you get older. If you have urinary incontinence, it can be embarrassing and may affect every area of your life. If you find yourself just putting up with it, youre not alone. But theres actually a lot of help available and incontinence can often be treated.
Pelvic Floor Muscle Training
Your pelvic floor muscles surround the bladder and urethra and control the flow of urine as you pee.
Weak or damaged pelvic floor muscles can cause urinary incontinence, so exercising these muscles is often recommended.
A GP may refer you to a specialist to start a programme of pelvic floor muscle training.
The specialist will assess whether you’re able to squeeze your pelvic floor muscles and by how much.
If you can contract your pelvic floor muscles, you’ll be given an exercise programme based on your assessment.
Your programme should include a minimum of 8 muscle contractions at least 3 times a day and last for at least 3 months. If the exercises are helping after this time, you can keep on doing them.
Research has shown that pelvic floor muscle training can benefit everyone with urinary incontinence.
Find out more about pelvic floor exercises.
Do Pelvic Floor Muscle Exercises
Strong pelvic floor muscles hold in urine better than weak muscles. You can strengthen your pelvic floor muscles by doing Kegel exercises. These exercises involve tightening and relaxing the muscles that control urine flow. Researchers found that women who received pelvic floor muscle training had fewer leaks per day than women who didnt receive training.6 You should not do pelvic floor exercises while youre urinating.
Men can also benefit from pelvic floor muscle exercises. Strengthening these muscles may help a man leak urine less often, especially dribbling after urination.
A health care professional, such as a physical therapist trained in pelvic floor therapy, can help you get the most out of your Kegel exercises by helping you improve your core muscle strength. Your core includes your torso muscles, especially the lower back, pelvic floor muscles, and abdomen. These muscles keep your pelvis lined up with your spine, which helps with good posture and balance. Your physical therapist can show you how to do some exercises during daily activities, such as riding in a car or sitting at a desk.
You dont need special equipment for Kegel exercises. However, if you are unsure whether you are doing the exercises correctly, you can learn how to perform Kegel exercises properly by using biofeedback, electrical stimulation, or both. Biofeedback uses special sensors to measure muscle contractions that control urination.
How Does Overflow Incontinence Occur
Overflow incontinence is a type of urinary incontinence that can be caused by several factors. One cause is an overflow of urine due to weak muscles in the bladder.
This can be due to various conditions such as stroke, multiple sclerosis, or spinal cord injury. Another cause is an obstruction in the urinary tract, such as an enlarged prostate or bladder stones.
Overflow incontinence can also be a side effect of certain medications, such as diuretics or sedatives. If you are experiencing overflow incontinence, it is important to consult with a doctor to determine the cause and find the most effective treatment.
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How Do I Do Kegel Exercises
Kegel exercises are a simple way to build strength in your pelvic floor muscles. These exercises are done by lifting, holding and then relaxing your pelvic floor muscles. You can find these muscles by stopping the flow of urine mid-stream while youre urinating. Only do this until you learn how to find the muscles stopping the flow of urine mid-stream isnt healthy over a long period of time.
When youre doing Kegel exercises, start small. Only hold it for a few second. Over time you can slowly work your way up to longer and longer stretches of holding the muscles tight.
Unlike other types of workouts, no one can tell when youre doing Kegel exercises. Aim to do several sets of Kegel exercises twice a day.
When Should I See A Doctor About Incontinence
Its important to know that incontinence can be treated. Many people believe that its something that just goes along with aging and is an unavoidable issue. If you find that incontinence is disturbing your daily activities and causing you to miss out on things you typically enjoy, talk to your healthcare provider. There are a wide range of options to treat incontinence.
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When To See A Health Care Provider And What To Expect
Talk to your health care provider if you have urinary incontinence or any signs of a bladder problem, such as:
- Needing to urinate more frequently or suddenly
- Cloudy urine
- Urinating eight or more times in one day
- Passing only small amounts of urine after strong urges to urinate
- Trouble starting or having a weak stream while urinating
Your doctor may recommend urodynamic testing and perform the following to try to figure out what might be causing your bladder problem:
- Give you a physical exam and take your medical history.
- Ask about your symptoms and the medications you take.
- Take urine and blood samples.
- Examine the inside of your bladder using a cystoscope a long, thin tube that slides up into the bladder through the urethra. This is usually done by a urinary specialist.
- Fill the bladder with warm fluid and use a cystoscope to check how much fluid your bladder can hold before leaking.
- Order or perform a bladder ultrasound to see if you are fully emptying your bladder with each void.
- Ask you to keep a daily diary of when you urinate and when you leak urine. Your primary care doctor may also send you to a urologist, a doctor who specializes in urinary tract problems.
Keeping A Bathroom Journal
You may be asked to keep a bathroom journal before or after your appointment. In your journal, youll log all your bathroom trips and bladder leakage or issues. It can also be helpful to record what you eat and drink in your bladder journal. This record will help your doctor get a more accurate idea of your symptoms and how often they occur. Keeping a journal can also determine what triggers your need to pee or any accidents.
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Vi Definition Of Terms
Biofeedback: Training to gain awareness of one’s own physiological function, which may help to train the patient to better control her symptoms.
Electrical and magnetic stimulation: Electrical or magnetic pulses used to stimulate, and thus exercise and strengthen, the lower pelvis muscles.
Mixed urinary Incontinence: UI with features of both stress and urge UI.
Pessaries: Medical devices inserted into the vagina, most commonly ring shaped, to compress the urethra against the symphysis pubis and to elevate the bladder neck.
Stress Urinary Incontinence: UI that occurs with episodes of increased intraabdominal pressure, such as when coughing, sneezing, or laughing. Stress UI is caused primarily by poor support of the urethra which results in leakage when the urethra is forced downward.
Urethral bulking: Bulking agents injected around the urethra to give structural support to the urethra.
Urethral plugs/patches: Disposable or reusable adhesive plugs or patches to temporarily seal the urethral opening and thus prevent urinary leakage.
Urge urinary Incontinence: UI associated with a frequent feeling of the need to urinate with loss of bladder control associated with overactive bladder.
Urinary Incontinence : Leakage of urine, by definition involuntary.
Vaginal cones/weights: Weighted cones inserted into the vagina that are used to exercise the pelvic floor muscles.
How To Get Help For Female Urinary Incontinence
Still feeling unsure about your first step? Remember, incontinence doesnt have to stop you from enjoying daily life on your terms. Getting the right diagnosis and treatment can be a life changer.
If you think that you might have urinary incontinence, reach out to one of our primary care doctors. Well answer any questions you may have and guide you to treatment that will work for you. If specialty care is needed, well refer you to our team of compassionate urogynecology specialists.
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How Is Female Incontinence Diagnosed
Because there are many different factors that can contribute to urinary incontinence, a doctor will first take a take a detailed medical history and conduct a physical exam. A qualified nurse practitioner will also perform a test for involuntary urine loss by inserting a small catheter to empty the bladder completely and then fill it with water. With a bladder full of water, you will be asked to cough and bear down, and the nurse will measure the amount of water that escapes
This evaluation will help determine if the condition is severe enough to warrant a urodynamic study, which measures the activity of the bladder as it fills and empties. This will help determine the cause and severity of the problem and guide the best treatment.
Urge Incontinence Treatment Options
Urge incontinence or urine leakage that comes with a strong sense of urgency is a widespread problem. Many of our patients seem to just chalk it up to growing older or being part of what it means to be a woman. However, it doesnt have to be true. We have so many minimally invasive options for treatment with very few side effects.
Behavioral changes. In terms of management, we start with behavioral changes. Many women think that they have to drink six to eight glasses a day. However, even though its always healthier to drink, some people dont need that much fluid. They dont notice that all the liquid that theyre taking in has to go somewhere. And it might be associated with some sense of urgency.
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