About Incontinence - Treatment Options - Pelvic Floor Exercises
Medical Reviewer: Diana Hankey-Underwood, MS, WHNP-BC
Everyone has a pelvic floor. The pelvic floor is a group of muscles that form a hammock shape in your pelvis.
Pelvic floor muscles hold up the pelvic organs and keep them in the right place. In women these organs are the uterus, bowel and bladder. In men the same muscles hold the bowel and bladder. The muscles of the pelvic floor can become weak and can start to sag. This can happen because of injuries, pregnancy, childbirth, or surgery (including surgery for prostate problems and hysterectomies). The muscles can also become weaker from carrying extra weight, or from chronic coughing.
When you cough, laugh, sneeze, run, or do other physical activities, pressure is added on the pelvic floor muscles. If they aren't strong enough to keep your bladder or your bowel in place, you may leak during these times of physical stress. This is what we call stress urinary incontinence, or SUI. Leaking from the bowel is called fecal incontinence. Pelvic floor exercises make the pelvic floor muscles stronger and this can help you have more control over leaking during times of physical stress, such as laughing, coughing, or sneezing.
In the following illustration, you can see how weak pelvic muscles can allow urine to leak (left). Strong pelvic muscles keep the urethra closed (right) and stop any urine from leaing.
How?
Because many people have trouble finding their pelvic floor muscles, pelvic floor exercises work best when taught by a professional, such as a physical therapist, an enterostomal therapist, or a urology nurse. Make sure whoever you go to has a special interest and training in pelvic floor exercises. A skilled health professional can help you find the right muscles and exercise them the right way.
To try to find one of the muscles on your own, simply stop the flow of urine the next time you are going to the bathroom. Stop the flow only for a second or two, until you understand the feeling, but don't make a habit of doing it each time you go to the bathroom because it isn't healthy for your bladder and urethra (the tube that leads urine from your bladder out of your body). When you squeeze to stop the urine, you are contracting the muscle called the sphincter. When doing pelvic floor exercises, you want to remember to only contract the sphincter muscle. Do not contract your stomach, legs or the outside cheeks of your bottom. There are a number of tools and programs that can help you do pelvic floor exercises. Some men and women use biofeedback. Women can use vaginal weights or other plastic vaginal exercisers.
Who?
Pelvic floor exercises are great for people who have stress urinary incontinence (SUI). They also help many people who have stress incontinence and who have a bladder that makes them feel like they have to go to the bathroom all of the time. This is called “mixed incontinence” because it is a mix of stress incontinence and urge incontinence or overactive bladder (OAB).
These exercises are also a wonderful thing to do to keep from getting leakage problems in the future. Women can do them before, during, and after pregnancy. The exercises can also help men who are getting treatment for enlarged prostate (BPH) or prostate cancer.
The Pros
-
The exercises are easy once you learn how to do them.
-
You can try the exercises, and if they don’t work you can always try another treatment, like surgery, later.
-
Many people get wonderful results and say that it changed their lives for the better.
-
After you spend money to get trained in how to do the exercises correctly, it doesn’t cost very much to keep doing them. You can just do the exercises on your own. The only cost might be new vaginal weights or cones if you want to buy new ones, and if you choose to use them.
The Cons
-
These exercises don't work for everyone.
-
Many people will find some benefit from the exercises, maybe even a lot of help, but they still leak a little, so they still have to buy and wear some protection.
-
It can take six to eight week to start noticing results.
Tips and Tricks
Make sure that you see a medical professional for an examination and to learn the correct way to do the exercises. Your medical provider may suggest physical therapy and biofeedback. You may be asked to use vaginal cones or weights. You should try all of the suggestions and do all of the exercises because you will get the best results this way.
Diana Hankey-Underwood, MS, WHNP-BC, is Executive Director of Grace Anatomy, Inc. She was recently awarded two National awards: the Nurse Practitioners in Women’s Health Bayer Health Care 2007 Inspiration in Women’s Health Award and the National Association For Continence 2007 Continence Care Champion (CCC) award.
Her current work includes research on results of pelvic floor surgery, teaching classes on incontinence and working with international surgeons on improving the outcomes for children born with birth defects of the genitourinary and GI systems.
Page last modified 2 August 2009