Exercise for bladder incontinence

Kegel Exercises for Urinary Incontinence

You won’t really look like you’re working out. You’ll be watching television, driving in your car, working at your desk, or brushing your teeth. But you’ll also be squeezing and strengthening the pelvic floor muscles through Kegel exercises, a series of muscle contractions that can help control or prevent urinary incontinence.

Dr. Arnold Kegel created these pelvic floor exercises in 1948 as a way to help women who developed stress urinary incontinence following childbirth.

Childbirth or menopause can weaken the pelvic floor muscles that hold the bladder and urethra in place. With those muscles weak, any additional pressure on the bladder caused by a laugh, sneeze, cough, or exercise can cause urine to leak.

Kegel exercises, if done correctly and over an extended period of time, strengthen those muscles to better support your bladder. A review of studies from New Zealand found that women who regularly practiced Kegels were up to 17 times more likely to be cured of incontinence symptoms than women who did not.

Men can benefit, too. Though women make up 75 to 80 percent of the 25 million Americans living with incontinence, men may face similar bladder issues after they’ve had their prostate removed. Kegels are often prescribed for women, but recent research published in the Journal of the American Medical Association suggests more men should be doing them as well. The study found that men who did Kegels over an eight-week period had fewer than half as many weekly incontinence episodes as they had prior to learning the exercises.

Performing Kegel Exercises

Before you start your Kegel regimen, you’ll need to figure out which muscles are the correct ones to focus on. The best way to do that is to sit on the toilet with your legs slightly apart and start to urinate. After a few seconds, try to stop the stream of urine by squeezing without moving your legs. If you stop the urine flow, you’ve likely used the pelvic floor muscles: These are the muscles you will need to strengthen to help control urinary incontinence. It may take more than one try to be sure you have found the right muscle group.

The individual contractions of a Kegel workout require you to squeeze the pelvic floor muscles just as you would if you were trying to stop urine flow. Ideally, Kegel exercises should be done as follows:

  • Empty your bladder before beginning.
  • Contract the pelvic floor muscles and hold for a count of 10.
  • Relax the muscles completely for a count of 10.
  • Stand and perform 10 of these contractions. Repeat 10 times each while sitting, and 10 times while reclining, for a total of 30 contractions in a single exercise routine.
  • Perform your Kegel exercises three times a day, for a total of 90 contractions a day.

Your Kegel Program

Ninety contractions a day may sound daunting, but keep in mind that you can do them anywhere-while waiting on a supermarket line or pumping gas, for example. After all, no one can see you doing them.

You can help make these exercises second nature by performing them during set triggers — for example, whenever you are stopped at a red light or during commercial breaks. After a while, you might find yourself performing Kegel exercises automatically.

Remember that these are like any other exercises in that results are not automatic. Most notice some improvement in their urinary incontinence after four to six weeks, but it could take as long as three months before you experience noticeable results.

And as with other forms of exercise, remember that overdoing it is a bad thing. Some people try to speed up their progress by performing more repetitions or doing their exercises more often. By doing so, they’re running the risk of overtiring or injuring the pelvic floor muscles, which can make urinary incontinence worse.

Strengthening Your Pelvic Floor Muscles

Millions who suffer with urinary incontinence (leakage) 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 (the tube that urine passes through), 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.

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 (or at least twice a day).

Control Your Pelvic Floor Muscles.

It may take some practice to learn to control your pelvic floor muscles. When doing the exercises, relax your body as much as possible and concentrate on your pelvic floor muscles. To avoid using your stomach muscles, rest your hand lightly on your belly as you squeeze your pelvic floor muscles. Be sure that you do not feel any movement of your stomach. Do not hold your breath.

To test whether you are tightening the wrong muscles, squeeze your pelvic floor muscles while sitting in front of a mirror. If you see that your body is moving up and down slightly, you are also using your buttocks or thigh muscles. When done properly, no one should be able to tell that you are squeezing your pelvic floor muscles – except for you.

Image © 2003 Fairman Studios, LLC

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.

Narrator: She’s been America’s sweetheart since the 1984 Games. Only 4 foot, 9 inches, little Mary Lou Retton scored tall—winning gold with a perfect 10 despite a serious knee injury. But that wasn’t the only obstacle she faced.
Mary Lou Retton: I would have that small fear in the back of my mind…oh, my goodness, what happens if I have to go to the bathroom?
Narrator: Like millions of women, Mary Lou Retton has urinary incontinence. The type she has is called urge incontinence or overactive bladder and is caused by involuntary spasms of the bladder muscles.
Mary Lou Retton: During just one day, I went to the bathroom as often as 20 to 25 times.
Narrator: She spoke to WebMD about her overactive bladder during a 2005 audio taping.
Mary Lou Retton: I lived with this condition my entire life without knowing it. I always justified and made excuses for why I had to go to the bathroom so much.
Narrator: Treatments for overactive bladder include: eliminating bladder irritants such as caffeine and alcohol; limiting or timing your daily fluid intake; medications that relax the bladder; bladder training – such as lengthening the times between trips to the bathroom; scheduling toilet trips at regular times during the day; and pelvic strengthening exercises such as Kegels.
Celia Dominguez, MD: The definition of a Kegel for a female is to attempt to hold your urine. And the act of holding your urine increases that muscle tone.
Narrator: A Chinese therapy involving a series of graduated vaginal weights can help hone those muscles even more.
Celia Dominguez, MD: So what the female is trying to do is trying to squeeze that sling, that hammock, that surrounds the vagina and hold up the weight without allowing it to slip through. As the weights get heavier and heavier they will tend to start sliding down and the female, to be able to hold onto that weight, just like holding their urine, will have to clamp down on the weight.
Narrator: For Mary Lou, medication was the answer. Whatever the solution, it can only work when women ask for help.
Mary Lou Retton: So if I can help bring attention or bring down that wall of embarrassment, then I will do what I can to help.
Narrator: For WebMD, I’m Sandee LaMotte

Kegel exercises are one of the best natural ways to control urinary incontinence.

These simple moves can help many women and men, regardless of your age or what’s causing your problem. They strengthen your pelvic floor muscles, which support your bladder. When these muscles are weak, you’re more likely to have leaks.

Here’s what you need to know:

Who benefits from Kegels? Anyone, at any age, who suffers urinary incontinence or leaks urine. While the exercise mainly helps those with stress urinary incontinence, it can also work if you have urge incontinence from overactive bladder. This causes a sudden urge to pee. You might not always make it to the bathroom. Men can do Kegel exercises to control urinary incontinence that can happen after prostate surgery.

How do you do them? Pretend you’re trying to stop the flow of pee. Pull in and squeeze those muscles. Hold the squeeze for about 10 seconds, then rest for 10 seconds. Try for three or four sets of 10 contractions every day.

How do Kegels help? They strengthen the muscles that help control the urethra. When these muscles are weak, you can’t control the flow as well.

When will I see results? It takes time to build your biceps, so it takes time to strengthen pelvic floor muscles, too. Give it 3 to 6 weeks. Do them daily.

When and where should I do them? The beauty of Kegels is that you can really do them just about anywhere, anytime. No one will know unless you tell them. Try a few sets in your car, at your desk, or while you watch TV. To be sure you have it right, ask your doctor or the nurse to describe the proper form. They can also check that you are doing them correctly.

Do I need any equipment? Not for Kegels alone. Doctors may suggest that women use a weighted cone. You’ll insert it into your vagina and do your Kegels with it there. You’ll slowly increase the weight. Some doctors pair Kegels with biofeedback, a monitoring system that helps you with bodily functions like urine control. Or the doctor might add electrical stimulation for muscles in the area.

Are there other benefits to Kegels? Yes. They can also help you out in the bedroom. When your pelvic floor muscles are in shape, they’ll contract more strongly during an orgasm.

Urinary incontinence is a prevalent issue, with anywhere from 25-50 percent of women reporting an episode in the past year.

Managing urinary conditions can be frustrating and time consuming, but there are helpful tips and lifestyle changes that can reduce the burden this condition causes.

  1. Fluid schedule. Attempt to keep your fluid intake on a schedule to help retrain your bladder when to fill and when to empty. Also, limit fluid intake after 6 p.m. to reduce night-time voiding and incontinence.
  2. Toileting schedule. Plan toileting attempts at least every two to three hours during the day. This helps prevent your bladder from becoming too full and causing overflow incontinence.
  3. Pelvic floor exercises. Strengthening the muscles of the pelvic floor can reduce urinary incontinence by as much as 90 percent. Kegel exercises can help.
  4. Manage constipation. Obstruction of stool is a common cause of incontinence and retention. Maintaining a healthy elimination pattern prevents stool from obstructing the stream of urine.
  5. Keep a bladder diary. Try to keep a bladder diary for a few days to a few weeks to identify triggers of incontinence and retention. Important components to the diary include: the time of day, amount of fluid intake, how many times you went to the bathroom, how many times you leaked urine throughout the day, if you felt an urge to urinate before leaking and what type of activity you were engaged in at the time. Remember to bring this with you to appointments with your health care provider.
  6. Create a calming environment. Managing urinary incontinence can be stressful and emotional at times. Creating a calm environment takes the stress off the situation so that you can focus on emptying your bladder.

It’s important to have a conversation with your provider regarding prevention of urinary retention and incontinence. There are medications that can cause urinary retention as well as many medications that can alleviate the symptoms and causes of urinary retention.

Jenna Hoppenworth is a Family Medicine nurse practitioner in Owatonna, Minnesota.

MetroVan Urology

DOWNLOAD HANDOUT ON PELVIC FLOOR MUSCLE/KEGEL EXERCISES

Introduction

Pelvic floor training is often used to strengthen but also relax the pelvic floor. “Uptraining” or strengthening is used for patients with bladder overactivity, prolapse and incontinence. “Downtraining” or pelvic floor relaxation is used for pelvic floor pain, spasms or problems with urinary retention or emptying.

The information listed below involves details for STRENGTHENING or uptraining for the pelvic floor.

The pelvis is essentially a bowl comprised of 2 components:

  1. Pelvic bones – essentially a ring.
  2. Muscle – this forms the bottom of the bowl and is suspended from the bony ring. Note that these muscles are distinct from the muscles of the abdominal wall or the buttocks.

The pelvic floor has 2 functions:

  1. The pelvic floor is important in supporting the structures in the abdomen and pelvis. All of the structures below the chest/diaphragm are supported by the pelvic floor. This amounts to a significant amount of strain on the pelvic floor. Things such as straining, coughing, sneezing, pregnancy and excessive weight all place more stress on the pelvic floor.
  2. Openings withing the pelvic floor are necessary to allow for defecation, urination, sexual and reproductive function. The floor must allow for exit and entry when needed.

These 2 functions are often times at odds with one another and a proper balance between being ‘closed’ and ‘open’ is required for optimal function. There are many things which can weaken the pelvic floor and compromise both of those functions – especially in terms of failing to support the pelvic structures and inability to remain ‘closed’ – both of which present as prolapse or leakage (of urine or stool). In women, childbirth and age are the primary causes of weakness. In males, surgery, especially on the prostate, are major causes.

Pelvic floor exercises can help strengthen the muscle component of the pelvic floor and improve symptoms related to weaknes.

Benefits of Pelvic Floor Exercises

  • Help improve or maintain control of bladder and bowel function.
  • Improve or maintain strength and tone of pelvic floor muscles which support pelvic organs against gravity.
  • Help recover urinary control in men after prostate cancer surgery.

Key Points

  • Tighten only pelvic floor muscles. Do not use abdominal, buttock or inner thigh muscles.
  • Breathe during exercises.
  • Choose a comfortable place and quiet time of day to perform these eg. lying in bed in the morning and evening.

Performing the Excercises

  • Find the right muscles: To contract the pelvic floor muscles, squeeze the same muscles you would use to cut off your urinary stream or prevent passing gas. You should not, however, perform the exercises by trying to stop your stream – use this technique only to identify the muscles. If you are doing it correctly you will feel your genitals “drawing up and in”. Women can place a finger in the vagina and try to squeeze the surrounding muscles.
  • Perfect your technique: Like any exercise, it takes time and repetition for things to get better. It may take 3 or more months of regular exercise. Over-exercising can lead to fatigue. Try to do “10-10-3-3”
    • 10 sets of contractions
    • 10 seconds holding alternating with 10 seconds relaxing
    • 3 sets, 3 times a day
    • 3 months minimum trial
  • Problems? If you are still having trouble, we have a nurse continence advisor available for instruction – at no charge.
  • See the behavioral therapy for bladder page on how to modify these exercises to prevent urinary urgency and frequency – the “quick flick” technique.

Common Pitfalls

  • Do not hold your breath and bear down. This strains the pelvic floor and pushes out and down instead of drawing up and in. This does not contract or strengthen the pelvic floor muscles.
  • Remeber that it will take time to strengthen these muscles, just as it does for other muscles in the body. Be patient and diligent.
  • Ensure that you are doing the right exercises for you – uptraining or strengthening is appropriate for some patients but other require relaxation techniques with downtraining. Please consult with your urologist, nurse continence advisor or pelvic floor physio to identify the techniques that are appropriate for your problem.

Resources

Soul Physiotherapy & Pelvic Floor Health – an excellent resource for specialized physiotherapy in Richmond

Dayan Physiotherapy and Pelvic Floor Clinic – an excellent resource for specialized physiotherapy in Vancouver

Nicole Coffey. 108-4841 Delta Street, Ladner, BC V4K 2T9. Phone (778) 630-8800; Fax (778) 630-8801

Pelvic floor muscle exercises

Though a general fitness regime is good for you, one form of exercise is particularly beneficial in helping improve bladder and bowel control – pelvic floor muscle exercises. Strengthening your pelvic floor muscles will help you actively support your bladder and bowel. This improves bladder and bowel control and can reduce or stop leakage of urine and bowel motions. Like other muscles, the pelvic floor muscles become stronger with a regular exercise program. Pelvic floor muscle exercises are important for both men and women.

The benefits of pelvic floor muscle exercises

Pelvic floor muscle exercises can help with:

  • improving yourcontrol over bladder and bowel function
  • reducing the risk of prolapse (‘sagging’ of internal organs)
  • better recovery from childbirth and surgery (in women)
  • better recovery after prostate surgery
  • increased sexual sensation and orgasmic potential, and
  • increased social confidence and quality of life.

How to improve your muscle control

It is very important to correctly identify your pelvic floor muscles before moving into a regular pelvic floor muscle exercise program. There are many ways that you can learn more about your pelvic floor muscles. These include visiting:

  • a continence and women’s health or pelvic floor physiotherapist
  • a continence nurse advisor, or
  • contacting the National Continence Helpline on Freecall 1800 33 00 66 for free advice and access to a wide range of information.

You should see a health professional if you have difficulty identifying the correct muscles, are unsure if you are performing the exercises correctly or continue to experience symptoms.

Remember that improved control for some may involve learning to relax your muscles. Just exercising the pelvic floor is not a self-help treatment for incontinence. If there is a problem with bladder or bowel control, it is important to be properly assessed as weak pelvic floor muscles are just one of the many causes of incontinence.

To learn more about how to correctly exercise your pelvic floor muscles follow the links below:

  • Pelvic floor muscle exercises for women
  • Pelvic floor muscle exercises for men

As with all muscles, fitness involves regular training. This applies to the pelvic floor as well. Develop it as a daily habit, like brushing your teeth.

Maintaining general fitness and keeping your weight within the recommended range will assist you in all facets of your health and wellbeing.

The Continence Foundation of Australia has developed a free, safe Pelvic Floor First exercise app to both help prevent incontinence and enable people experiencing problems to continue to exercise without further straining their pelvic floor.

There are exercises for your butt, your legs, your arms, your spare tire, even your ever-texting achy thumbs. So considering the bladder itself is a muscle—and it’s surrounded by other muscles—it makes sense that you can whip that puppy into shape, too.

Of course, unless you already have the occasional leakage due to aging, genetics, or childbirth, you might not focus much exercise attention on your bladder. But strengthening those down-there muscles can stop (or prevent) so-called stress incontinence in its tracks, says Candace Howe, MD, a board-certified ob-gyn in private practice in Newport Beach, California. “Who wants to undergo surgery?” Howe says. “I’m a surgeon, and I tell my patients I wouldn’t want to! If we can fix incontinence with exercise, that’s preferable.”

When Suzanne Andrews, host of Functional Fitness, was experiencing urinary incontinence after the birth of her son, her doctor told her to consider surgery. As an occupational therapy clinician, Suzanne was seeing patients with the same symptoms and realized her exercise background could help. She created the 30 Day Bladder Fix, a pelvic floor strengthening DVD that combines seated and lying-down exercises to help control incontinence. “I remember the day I realized I didn’t have it anymore,” Andrews says. “I sneezed and nothing came out!”

So how do you fix incontinence with exercise (which, by the way, affects around 25% of women, Howe says)? With these simple but crucial moves. While there’s no magic number of reps or sets that will solve your pee problems, Howe says practicing these daily for around 6 weeks or so should bring some relief. (Looking to take back control of your health? Prevention has smart answers—get 2 FREE gifts when you subscribe today.)

Kegels

Stephen Leech/

We know, we know—we’re always telling you to do Kegels. But according to Howe, most women are are performing them wrong. So let’s go over the basics: Contract the pelvic floor muscles—which run like a hammock between the front and back of your pelvis—like you’re stopping the stream of urine. “That’s a great start, but it’s not incorporating the whole sling of muscles,” Howe says. Contract in the back too, like you don’t want to pass gas in public, she says. “All together, that is the best Kegel.”

It’s important to work beyond the Kegel, too, Andrews says. “It’s like doing a workout for your arms and just working your biceps,” she says. “It’s not just the pelvic floor muscles that help to stop urine from coming out.” Inner thigh, glute, and ab muscles all come into play too, she says.

Pelvic Floor Ball Squeeze

Healthwise Exercise, LLC

Sit up straight in a sturdy chair with your head lifted and your chin parallel to the ground, shoulders in line with your hips. Place an exercise ball (or a firm pillow if you don’t have one) between your thighs. Squeeze the ball and hold for 10 seconds. Repeat 10 times. For a challenge, sit up without leaning back against the chair, Andrews says. This will help strengthen the inner thighs and the abdominal muscles, which intertwine with those pelvic floor muscles and can contribute to better bladder control, Howe says.

MORE: 4 Moves To Slim Your Hips And Thighs

Elevator Lunge

Erik Isakson/Getty Images

Start with one leg in front of the other and inhale as you dip down into a lunge position. Visualize holding a marble inside your vagina, Howe says, and contract your pelvic floor muscles as you exhale. Inhale, holding those muscles tight, and as you exhale again, contract even tighter. Repeat until you’ve tightened 5 times, then exhale as you return to standing. Repeat on the opposite leg.

Pelvic Floor Activators

Healthwise Exercise, LLC

Sitting again on your sturdy chair, place a resistance band around your thighs with your feet together. Press your knees apart and then bring them back together. Contract your inner thigh and glute muscles when you close your knees. Do 3 sets of 20 with a 10-second break between sets, 5 times a week. If you don’t have a resistance band, use pantyhose instead, Andrews says.

Squats With Pulse

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With your feet shoulder-width apart and your toes turned slightly outward, lower down into a squat position. Tilt your pelvis forward to engage the pelvic floor muscles at the back of your body. Pulse up and down an inch or two 10 times, inhaling as you squat and exhaling as you contract the pelvic floor muscles and come up, Howe says.

C Curve Abdominal Contraction

Healthwise Exercise, LLC

Sitting at the edge of your chair, draw in your abdominal muscles toward your back as you curve into a C-shape with your arms extended. Then straighten your back and focus on good posture. Do 3 sets of 10, Andrews says.

MORE: 6 Simple Moves To Ease Sciatica

Running

Johner Images/Getty Images

You might think running is off limits if your bladder doesn’t always behave, but Howe says all it takes is a little fix to your form to focus more of your running energy on your pelvic floor muscles. “Imagine running in more of a ski jump position,” she says. Leaning slightly forward in this way will take some of the pressure off of your heels and backside. Transferring the pressure can help retrain the front side of your pelvis, resulting in less incontinence over time, she says.

(Need a little extra help with these exercises? It’s worth noting that there are physical therapists—for your vagina. These experts specialize in pelvic floor, bladder, or vaginal training and can help determine where you’re weak. Then they can develop a personalized routine to make you stronger, Howe says.)

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