Pelvic floor exercises for stress incontinence

Many women suffer from stress incontinence and are helped by following this exercise programme. However, there arc several different types of incontinence which may not be helped by exercises, so it is a good idea to see your family doctor who may refer you to a gynaecologist or urologist, or to a specialist physiotherapist.

"Stress incontinence" means that the bladder leaks urine when put under sudden pressure, e.g. coughing, sneezing or playing a sport. Weak pelvic floor muscles are one of the main causes of this type of leaking.

The pelvic floor muscles form a broad muscular sling across the floor of the pelvis; they support the pelvic organs arid control the outlets from them. Weakness of these muscles is usually due to childbirth (maybe many years ago) but constipation, a chronic cough or being overweight can also weaken then. The muscles work by closing and drawing up the back and front passages. Even if you persevere faithfully with pelvic flor exercises, improvement is slow and may take 3 - 6 months. However., it's worth it!

Many women have found it difficult to remember the exercises every hour at first - these are some of the ideas they have had which may help you.

Set an alarm, kitchen timer or the bleeper on your watch.
If you listen to the radio for long periods, exercise with every news bulletin.
Put a sticker in a place which will catch your eye e.g. typewriter, telephone or steering wheel.
Wear your watch on the "wrong" wrist.
Exercise every time you use the telephone.

Decide on your reminder and do the exercises carefully.

The exercises

Sit on a chair, feet wide apart, knees wide apart. Lean over to rest your forearms on your knees. Relax - let your head drop - hands loose - muscles of your tummy and bottom relaxed. Think about the three holes "down below" on the seat of the chair.

Now think about the pelvic floor muscles an inch or two above the seat of the chair, across the inside of you.

STEP ONE Front passage.

Think about where you spend a penny - squeeze the tube tight up inside you. There will be some movement on the outside but concentrate and squeeze the tube up inside (Do Not pull in your tummy muscles). Relax - relax some more - let ALL the squeeze go. Repeat step one slowly. Be sure you've mastered it.

STEP TWO Back passage.

This is usually easier than the front. Squeeze the tube up inside your bottom. Squeeze tighter. Again the outside will move a bit but make sure the squeeze is right up inside you (DO Not tighten all the seat muscles). Relax - relax some more - let ALL the squeeze go. Tighten the back passage again to make sure you've mastered it.

NOW FOR THE REAL EXERCISE

Tighten the front passage and hold it tight.

Tighten the back passage and hold it tight.

Between the two is the birth canal - squeeze around the middle passage. You should get a lifting feeling inside as the floor lifts up into the abdomen. It is not a flat floor, more like a sling or hammock. Relax - relax some more - just let go - take your time and let it all relax - front, back and middle.

And that is it.

Do five pelvic floor contractions (tightening around all three passages) at a session. Have a session before you get out of bed each morning and as soon as you get to bed each night. Every time you spend a penny stay on the loo to do five more contractions. They can be done standing at the sink, watching TV, wailing in a shop or for a bus, sitting in the car, in fact anywhere, any time. Make sure the squeeze is really, really tight and hold the squeeze much longer as the muscles get stronger. Bully yourself. Then having formed the habit keep it up – CONTRACT YOUR PELVIS!

Avoid the following:

Being overweight - gives the muscles extra work to d6. Getting down to your correct weight can make a considerable improvement in your symptoms. If you know you need to lose weight, start today.
Constipation - straining to force the bowels open; this stretches the pelvic floor muscles down. It is most important that you do not do this - diet is the best way to cope with it and you may need to consult your General Practitioner.
Heavy lifting - puts a strain on the pelvic floor so repeated heavy lifting should be avoided when possible. If you do need to lift something heavy remember to tighten the pelvic floor muscles before you lift and hold them tight until you have put down the load.
Strenuous tummy exercises - such as sit ups and double leg lifts (lying down and lifting up both legs together) put severe pressure on the pelvic floor muscles and must not be done.

Liquid intake

You should drink at least 2 pints of liquid a day - do not restrict your intake, it will not make you leak less and your bladder will be irritated by the small volume of strong urine which could make things worse. Some women are very sensitive to coffee and/or tea. If you are a coffee or tea drinker try to stop drinking them for a few days to see if this helps you.

Frequency of bladder emptying

Try not to get into the habit of emptying your bladder too frequently as this can reduce its capacity. If you feel that you need to go more often than once every 2 hours (frequency) train your bladder to wait longer.

When you feel the urge to empty your bladder, tighten your pelvic floor muscles and try to wait a few more minutes before going to empty your bladder. This will stretch the bladder so that it can hold more urine and so lengthen the time between one bladder emptying and the next.

Bladder emptying

It is important to completely empty the bladder each time you go to the toilet without straining. Any small amount of urine left inside may irritate the bladder lining and cause inflammation.

Sudden movements

Try to contract and hold the pelvic floor muscles tight before coughing, sneezing etc., this will improve your control and reduce leaking.

Test

Once you feel you have regained good control, test the muscles like this:

Ensure your bladder is nearly full (about 3 hours from last empty). Stand - feet apart - jump or bounce tip and down on the spot and cough deeply twice. If no leakage of urine occurs continue tile exercise for one more month, and then at least once or twice daily forever.
If this test still causes leaking, continue the exercises for 2 - 3 months and be prepared to seek further expert medical advice.

For further information write to:

The Hon. Secretary
The Association of Chartered Physiotherapists in Obstetrics and Gynaecology
C/o The Chartered Society of Physiotherapy
14 Bedford Row
London WCIR 4ED