Introduction

Physiotherapists, doctors and nurses know that exercising the pelvic floor muscles can help you to improve your bladder control. When done correctly these exercises can build up and strengthen these muscles and so help you to hold urine.

What is the Pelvic Floor?

The pelvic floor consists of layers of muscles and ligaments that stretch like a hammock from the pubic bone in the front to the end of the backbone and from side to side. Firm, supportive pelvic floor muscles help to hold the bladder, womb and bowel in place, and to close the bladder outlet and back passage.

How does the Pelvic Floor work?

The muscles of the pelvic floor are kept firm and slightly tense to stop leakage of urine from the bladder and of wind or faeces from the bowel. When you pass water or have a bowel motion the pelvic floor muscles relax. Afterwards, they tighten again to restore control. The muscles should actively squeeze when you laugh, cough, lift or sneeze so as to help you avoid leaking. They also have an important sexual function, helping to increase sexual awareness for both you and your partner during sexual intercourse.

Pelvic floor muscles can become weak and sag because of childbirth, prolonged straining to empty your bowel, lack of exercise, the change of life or just getting older. Weak muscles give you less control, and you may leak urine, especially with exercise or when you laugh, cough or sneeze.

How can exercising the Pelvic Floor muscles help?

Exercising the pelvic floor muscles can strengthen them so that they once again give support. This will improve your bladder control and improve or stop the leakage of urine. Like any other muscles in the body, the more you use and exercise with them, the stronger the pelvic floor muscles will be.

Finding your Pelvic Floor muscles

It is not always easy to find your pelvic floor muscles. Exercising them should not show at all "on the outside". You should not pull your tummy in excessively, squeeze your legs together, tighten your buttocks - or hold your breath!! Here is what to do:

1. Sit comfortably with your knees slightly apart. Now imagine that you are trying to stop yourself from passing wind from the bowel. To do this you must squeeze the muscle around the back passage. Try squeezing and lifting that muscle as if you really do have wind. You should be able to feel the muscle move. Your buttocks and legs should not move at all. You should be aware of the skin around the back passage tightening and being pulled up and away from your chair. Really try to feel this squeezing and lifting.

2. Now imagine that you are sitting on the toilet passing urine. Picture yourself trying to stop the stream of urine. Try doing it now while you are reading this. You should be using the same group of muscles that you used before, but don't be surprised if you find this harder. (Do not try to stop the stream when you are actually passing water as this may - if repeated - cause problems with proper emptying)

3. Now try to tighten the muscles around your back passage, vagina and front passage and lift up inside as if trying to stop passing wind and urine at the same time. It is very easy to bring other, irrelevant muscles into play, so try to isolate your pelvic floor as much as possible by not pulling your tummy in, not squeezing your legs together, not tightening your buttocks and not holding your breath. In this way most of the effort should be coming from the pelvic floor.

Practising your Pelvic Floor exercises

Now that you can find your pelvic floor muscles, here are the exercises to do.

1. Your pelvic floor muscles need to have stamina. So: Sit, stand or lie with your knees slightly apart. Slowly tighten and pull up the pelvic muscles as hard as you can. Try lifting and squeezing them as long as you can. Rest for 4 seconds and then repeat the contraction. Build up your strength until you can do 10 slow contractions at a time, holding them for 10 seconds each with rests of 4 seconds inbetween.

2. Your pelvic floor muscles also need to react quickly to sudden stresses from coughing, laughing or from exercise that puts pressure on the bladder. So practice some quick contractions, drawing in the pelvic floor and holding it for just one second before relaxing. Try to achieve a strong muscle contraction with up to ten quick contractions in succession.

Aim to do a full set of slow contractions (exercise 1)

Followed by a full set of quick contractions (exercise 2)

At least six times a day.

It takes time for exercise to make muscles stronger. You are unlikely to notice any improvement for several weeks - So stick at it!! You will need to exercise regularly for several months before the muscles can get back to their full strength.

Tips to help you

1. Get into the habit of doing your exercises with things you do regularly - every time you touch water if you are at home, every time you answer the phone if you are at work - whatever you do often.

2. If you are unsure that you are exercising the correct muscles, put your thumb or one or two fingers in the vagina and try the exercises, to check. You should feel a gentle squeeze as the pelvic floor muscles contract.

3. Use the pelvic floor when you are afraid you might leak - activate the muscles before you cough, laugh, sneeze of lift anything heavy. Your control will gradually improve as you do this.

4. Drink normally - at least 3 litres every day, avoiding excessive caffeine if you can. Don't get into the habit of going to the toilet 'just in case'. Go only when you feel that your bladder is full.

5. Watch your weight - extra weight puts extra strain on your pelvic floor muscles.

6. Once you have regained control of your bladder, don't forget your pelvic floor muscles. Continue to do your pelvic floor exercises a few times each day to ensure that the problem does not come back.

Remember: You can exercise your pelvic floor muscles wherever you are - nobody will know what you are doing!!

We're happy to address all your questions or concerns.

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