Pelvic Floor Exercises And Stress Incontinence
Pelvic floor exercises, also known as Kegel exercises, have numerous benefits and may help cure stress incontinence. Pelvic floor exercises are also useful to prevent incontinence for women who have had children. In addition, some people feel that having strong pelvic floor muscles heightens the pleasure when having sex.
Reviewed byDr Hannah Gronow
New Guidelines Recommend Kegels Other Lifestyle Treatments For Urinary Incontinence In Women
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The expression I laughed so hard I wet my pants is used in a lighthearted way. But theres nothing funny about it for the millions of women who leak urine when they laugh, cough, or sneeze. Women are embarrassed by the condition. And some women live with it because they believe theres nothing they can do about it, says Dr. May Wakamatsu, Director of Female Pelvic Medicine and Reconstructive Surgery at Massachusetts General Hospital and co-editor of the Harvard special report Better Bladder and Bowel Control.
Fortunately, theres plenty a woman can do to rein in urinary incontinence, and most solutions dont require medication. In fact, new guidelines on urinary incontinence from the American College of Physicians urge doctors to recommend pill-free treatments first. These include Kegel exercises, bladder training, and weight loss and exercise.
Indications You May Have Urinary Incontinence
After urinating do you sometimes feel you havent emptied your bladder completely?
- Do you get sudden urges to use the toilet?
- Do you sometimes worry about losing control of your bladder?
- Do you need to get up twice or more at night to use the toilet?
- Do you sometimes experience leakage before you get to the toilet?
- Do you sometimes leak when lifting, sneezing, laughing or coughing?
- Do you sometimes leak when exercising or playing sport?
If you answered Yes to any of these questions you may have a bladder control problem.
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Stop Stress Urinary Incontinence With 5 Easy Exercises
Dr. Jen, a pelvic floor physical therapist, shows ways to help reduce & prevent stress urinary incontinence in women & men. This can be caused by coughing, laughing, sneezing, or impact exercises. Buy a worksheet with these exercises: https://www.askdoctorjo.com/stress-urinary-incontinence-worksheet
See more Dr. Jen videos: https://www.youtube.com/playlist?list=PLPS8D21t0eO_tBS1ZA2utq86LexPYADF1
One of the most common issues pelvic floor physical therapists see is stress urinary incontinence. Basically, this is when there is involuntary bladder leakage due to a combination of increased pressure or tension in the abdominal area and weak core muscles.
The main muscles to focus on are the true core muscles which are the respiratory diaphragm, pelvic floor, deep transversus abdominis , and the multifidus muscles in your back. They work together to help stabilize the core, support our organs, and help prevent leakage.
Starting off with proper breathing is the most important part. Holding our breaths during activities increase the pressure which can cause the leaking. Diaphragmatic breathing is not only a great strengthening exercise, but it also helps relax the body as well.
Progressing from there, continue with the diaphragmatic breathing and now add in TA exercises by contracting those muscles as you continue to breathe. Next, adding a gluteus bridge helps progress the movement.
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How Often Should I Exercise
Do your exercises often enough to make them a habit but at a minimum of 30 repetitions twice a day. Pelvic floor muscle support usually improves within 6 weeks after starting the exercises. Strengthening your pelvic floor is one step you can take to control your bladder. While incontinence and frequent sudden urges to go may be embarrassing to talk about, your health care provider can offer other treatment options that may provide further relief.
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Urinary Incontinence Hampers Normal Life May Cause Depression
Urinary incontinence can be brought on due to physical changes like menopause or childbirth in women. And while women make up the majority of those with incontinence in the United States, men too may develop the problem.1 An enlarged prostate, neurological problems, chronic coughing, obesity, and old age are some of the possible causes of incontinence in men.2
This problem can affect your self-esteem as well as your ability to function normally at home or in the workplace. It can also hamper your activity levels and mobility in general and take its toll on your sexual activity. It isnt surprising that it is also a trigger for depression in many people. Thankfully, some simple, nonsurgical ways can improve your condition and gain control over this otherwise potentially debilitating problem.3 What follows are some exercises you can do anytime, anywhere to help strengthen your pelvic floor muscles and regain proper control.
Pelvic Floor Exercise Tips
If you are not used to doing pelvic floor exercises then perhaps do the exercises as often as described above for the first three months or so. This will strengthen up the pelvic floor muscles. Thereafter, a five-minute spell of pelvic floor exercises once or twice a day should keep the muscles strong and toned up which may help to prevent incontinence from developing in later life.
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Is Incontinence More Common In Women
Incontinence is much more commonly seen in women than in men. A large part of this is because of pregnancy, childbirth and menopause. Each of these events in a womans life can lead to bladder control issues. Pregnancy can be a short-term cause of incontinence and the bladder control issues typically get better after the baby is born. Some women experience incontinence after delivery because of the strain childbirth takes on the pelvic floor muscles. When these muscles are weakened, youre more likely to experience leakage issues. Menopause causes your body to go through a lot of change. Your hormones change during menopause and this can alter your bladder control.
Men can also experience incontinence, but it isnt as common as it is in women.
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Exercise Your Pelvic Floor
Pelvic floor exercises help strengthen the muscles of the pelvic floor, which support the bladder and urethra and control the flow of urine. These are the muscles you use to hold it in when you have to urinate.
NYU Langone doctors recommend daily Kegel exercises, in which you tighten and release pelvic floor muscles. Your doctor can teach you how to identify these muscles and perform the exercises correctly. He or she can refer you to physical therapists at NYU Langones Rusk Rehabilitation for additional support.
Pelvic floor exercises are recommended for both stress and urgency incontinence.
How To Find The Right Muscles
A Kegel exercise is like pretending you have to urinate and then holding it. You relax and tighten the muscles that control urine flow. It is important to find the right muscles to tighten.
If you still are not sure you are tightening the right muscles:
- Imagine that you are trying to keep yourself from passing gas.
- Men: Insert a finger into your rectum. Tighten the muscles as if you are holding in your urine, then let go. You should feel the muscles tighten and move up and down.
The Squeeze & Release
The squeeze and release is your secret weapon when it comes to getting your pelvic muscles to respond quickly. This can be very helpful for stopping leaks in a pinch!
To squeeze and release:
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Strengthen Your Pelvic Floor Muscles
Once you locate your pelvic floor muscles you are ready to begin. The exercise involves squeezing then relaxing your pelvic floor muscles. Squeeze the muscles for five seconds and then relax the muscles for five seconds. Be sure to take the time to relax between squeezes so that your muscles can rest before squeezing again. Each squeeze and relax counts as one repetition.
Each set of exercises should include three different positions: 10 repetitions lying down, 10 sitting, and 10 standing. Do one set in the morning and one set at night .
Hip Bridge With Pilates Ball
A variation of the glute bridge, this exercise uses the aid of the pilates ball as in the previous exercise.10
- Lie on your back with a ball held between the knees as before.
- Gently squeeze the ball and feel your pelvic floor muscles contract as you do this.Now move your arms above your head, palm side up.
- Exhale as you raise your hips off the ground to create the bridge position. At the same time, move your arms up to the ceiling and bring them to rest on either side of your body, on the mat.
- Breathe in, bringing your torso back down followed by your hips. As you do this, lift your arms up and reach overhead with them.
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Pelvic Floor Muscles Exercise For Men
Male stress urinary incontinence is reported to occur in 1%60% of patients following radical prostatectomy. To date, artificial urinary sphincter implantation has been the standard treatment . However, the PFME is the most recommended initial conservative treatment for urinary incontinence after radical prostatectomy . Trials of PFME for post-prostatectomy urinary incontinence show that PFME reduces urinary incontinence in the first 3 months after surgery . Some reviews demonstrated that PFME is better than no treatment, because it can reduce urinary incontinence episodes. Another study showed that an early PFME after radical prostatectomy significantly reduces continence recovery time . The rationale of PFME is that pelvic floor muscle contraction may improve the strength of the external urethral sphincter during the raises of intra-abdominal pressure. In pelvic floor muscle electrical stimulation therapy, less work has been done examining electrical stimulation in men, and there is little evidence to suggest that electrical stimulation improves outcomes of PFME, with or without biofeedback, but it may promote the improvement of urinary incontinence after prostatectomy .
Why Do Pelvic Floor Exercises
Regular pelvic floor muscle training can help with urinary incontinence, improve the quality of sex , and may make you feel better about yourself.
This means you may be able to hold on a little longer before goingwhich could reduce leakage, relax affected muscles that are tense or tight, improve coordination between the muscle groups in the pelvic floor area, make it easier for your body to get rid of urine and unused waste products.
Training the pelvic floor muscle groups will also give you more control over when you pass solid bowel movements , which may reduce the need to strain.
This can help you avoid straining during sex or just sitting down for long periods of time, which puts pressure on your bottom and pelvic muscles.
Pelvic floor muscle training may also help with dyspareunia by increasing your control over when you pass urine and eliminate solid waste products, which will reduce pressure on the pelvis, making it easier for your uterus to move in different directions during sex reducing stress or anxiety about having sex, which can make your pelvic floor muscles tense up.
Pelvic floor exercises can also help you feel more in control of yourself and give you more confidence in yourself.
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Clinical Trials Of Pfme
Most samples were drawn from community-dwelling populations. Most trials involved 12 weeks of intervention , but some were of 6 weeks or 8 weeks duration . Most involved supervised PFME accompanied by a regimen of home-based exercises by a physiotherapist or nurse. In several trials, PFME was delivered on an individual basis , while others were conducted in a group class . Some trials were restricted to PFME with or without functional pelvic floor muscle contraction to prevent stress urinary incontinence episodes , while in others, PFME was embedded in a multicomponent program with other behavioral or exercise components. One trial included PFME in a broader program of general physical exercise .
PFME is effective as a stand-alone therapy, as part of multicomponent therapies embedding PFME with concomitant behavioral strategies, lifestyle changes, and as part of more general physical exercise programs to improve physical function in older women. Results expand the evidence base to include PFME implemented by mobile technology, with a potentially broader reach, cost savings, and impact on rural health. Benefits are shown across age cohorts and urinary incontinence type, in various cultural contexts, using several different training regimens, and assessed by multiple outcome measures.
Forms Of Urinary Incontinence
Urinary incontinence is frequently associated with pregnancy and childbirth, menopause or a range of chronic conditions such as asthma, diabetes or arthritis. Its severity can range from an occasional leak when you cough, laugh, lift or exercise to an inability to control your bladder, which may cause you to wet yourself.
Today, four primary forms of incontinence are recognized, each with several potential causes:
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Strengthening Your Pelvic Floor Muscles
Millions who suffer with urinary incontinence feel like their bladder controls their lives. Control depends on muscles working together. This simple step can control your bladder!
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health
When the bladder fills, the bladder muscles should be relaxed and the muscles around the urethra , called the pelvic floor muscles, should be tight. Exercises that strengthen these muscles can help prevent leakage and calm the urge to go. These are commonly called “Kegel” exercises, named after the doctor who developed them. They can help keep your pelvic floor muscles toned and may reduce your problems with leakage or frequent urges to urinate.
Avoid High Impact Exercise: It Can Make Leakage Worse
If youre looking at losing weight or exercising to help your urinary incontinence, be aware that high impact exercise can actually make things worse by putting pressure on the pelvic floor muscles. Even sit-ups may prove problematic. So skip the aerobics classes and trade in your running shoes for some yoga or pilates. This will help you build core strength, stretch your body, and get a good workout without taking a toll on your pelvic floor muscles. Plus, as we saw, yoga has some asanas that are actually beneficial for the pelvic region.16
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Preventing Stress Urinary Incontinence
The goal of behavioral treatment for stress urinary incontinence is to teach patients how to prevent urine loss in daily life by occluding the urethra using active contraction of pelvic floor muscles . A careful medical history or examination of frequency volume chart can alert the provider and patient of the circumstances during which each individual patient commonly experiences urine loss. Patients then learn to anticipate these activities and prevent leakage by a volitional contraction of the pelvic floor muscle to occlude the urethra before and during coughing, lifting, or any other physical activities that has precipitated urine leakage. When an anticipatory pelvic floor muscle contraction technique was used, immediate reduction in the volume of urine leakage with a cough was demonstrated . If initial PFME treatments are not sufficient for patients with stress urinary incontinence, patients should be referred for additional treatment options including surgery. For women who desire more rapid and definitive treatment who are willing to accept risks of surgery, the mid-urethral sling offers higher success rates than conservative therapy .
Physiotherapist Session To Teach Correct Pfmt Contraction
There was consensus that generally women do not know how to do a pelvic floor contraction and therefore, were unsure if they were doing a correct contraction when they tried to engage in PFMT. Some participants suggested a physiotherapist check should replace the GP check at 6weeks post-birth, as they felt a recommendation and sign posting to physical activity and teaching a PFMT contraction would be better than the current GP service.
…I saw a GP who did nothing, you know that would be far more beneficial just to check, I dunno like your muscles are healing and everything correctly and have some sort of antenatal maternity check. I feel like they totally didnt have anything at all.
And another participant paid privately for this service:
…with both of them, after I got to the point of being able to exercise, I went for a full postnatal check-up with the physio, cos I think like when, you know, youre worried about your back, I think that gave me reassurance that everything was okay to exercise and that back problems are normal until you build up your core, ehm, I think that helped me be more confident in doing it and not so worried that something was going to happen to me.
Some participants felt 6 weeks was too soon for a health check:
Others felt 6 to 8weeks was an appropriate time
I think maybe six/eight weeks after is maybe a good time.
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