Pelvic Floor Exercises for Stress Incontinence


What is stress incontinence?

Stress incontinence means that the bladder leaks urine when put under sudden pressure e.g. coughing, sneezing, laughing, aerobics etc. Weak pelvic floor muscles are one of the main causes of this type of leaking. It can affect people of all ages but often starts during pregnancy, after childbirth or the menopause when the muscles of the pelvic floor become weak and lose tone. The good news is that once stress incontinence is diagnosed, leakage can usually be improved by exercising the pelvic floor muscles.

What is the pelvic floor?

The pelvic floor is a layer of supportive muscle that lies like a sling between your thighs. These muscles lie at the base of the pelvis. The back passage (anus), birth canal (vagina) and urinary passage (urethra) pass down through them.

Functions -
  1. Prevent leakage of urine on sudden movements.
  2. Support the contents of the pelvis e.g. the bladder, bowel and uterus.
  3. They affect the enjoyment of sexual intercourse for both partners.

How to do pelvic floor exercises?

They may be done in any position, but these may be best to start with -
  1. Lying on your back with your knees bent and comfortably apart.
  2. Sitting down (leaning forward, resting your elbows on your knees).
  3. Standing with feet slightly apart (more difficult).

To contract the pelvic floor muscles -
  1. Pull up the muscles around your back passage (as if trying to stop the passage of wind) and at the same time pull up the muscles around your vagina and urinary passage (as if trying to stop passing water). Hold as strongly as possible, then relax and rest for a few seconds.
  2. Try not to hold your breath or tighten your buttocks or squeeze your legs together.

Repeat stages 1 and 2 as many times as possible for a couple of minutes or so, several times a day. It is a good idea to empty your bladder before doing the exercises, so why not try doing them after you have passed water when still sitting on the toilet.

It is not advisable to practice "stopping and starting" mid stream when you are passing water. Do not expect too much too soon - weak muscles tire easily.

General Tips

  1. The Counter Brace. If you are about to lift, push, cough, laugh, blow, sneeze or do any action that causes a downward pressure, prepare yourself to take the increased stress by contracting your pelvic floor and holding it tightly until the exertion is over.
  2. Being Overweight. This gives the muscles extra work to do. Getting down to your correct weight can make a considerable improvement to your symptoms.
  3. Constipation. Straining to force the bowels open stretches the pelvic floor. Diet is the best way to cope with constipation, try to keep a healthy fibre diet with plenty of fresh fruit, vegetables and wholemeal bread.
  4. Liquid Intake. You should drink approximately 1500 to 2000 mls (about 6 - 7 mugs) of liquid a day. NO NOT restrict your intake - it will not make you leak less. If you don't drink enough your bladder will be irritated by the small volume of strong urine which could make things worse.
  5. Heavy Lifting. Puts a strain on the pelvic floor so repeated heavy lifting should be avoided when possible. If you need to lift something heavy remember to tighten the pelvic floor muscles before you do so, continuing until after you have put the load down.
  6. Strenuous Tummy Exercises. Such as sit ups and double leg lifts (lying down and lifting both legs together) put severe pressure on the pelvic floor and must not be done if they cause leakage.
  7. Frequency of Bladder Emptying. Try not to get into the habit of emptying your bladder too frequently as this can reduce its capacity. Do not develop bad habits by going (voiding) "just in case". Up to eight times a day is considered the normal.
  8. Bladder Emptying. It is important to completely empty your bladder each time you go to the toilet. Any small amount of urine left inside may irritate the bladder lining and cause inflammation. If you feel you may not have fully emptied your bladder try standing up, turning around and sitting back on the toilet, then try to pass water. When passing water you will not be able to completely empty your bladder if you do not sit on the toilet seat. It may also help to lean forward as you push to pass urine. Take your time to empty your bladder - do not rush.