Urinary incontinence, the involuntary leakage of urine, is a common condition influenced by factors like pregnancy, childbirth, aging, and being overweight. While it can be disruptive, it is often manageable. For many, specific exercises are a first-line approach to improving bladder control by strengthening the body’s structures to reduce or prevent leakage.
Understanding Your Pelvic Floor
Your pelvic floor is a group of muscles that forms a supportive sling, or hammock, stretching from your pubic bone at the front to your tailbone at the back. This muscular layer holds pelvic organs, including the bladder, uterus, and bowels, in their proper positions. The strength and coordination of these muscles are needed to maintain continence.
The pelvic floor muscles surround the urethra, the tube that carries urine out of the body. When these muscles contract, they tighten around the urethra, helping to keep it closed and prevent urine from leaking out, especially during moments of increased abdominal pressure, such as when you cough or laugh. If these muscles weaken, they may not provide adequate support, leading to issues like stress or urge incontinence.
Performing Pelvic Floor Muscle Exercises
The first step in performing these exercises, often called Kegels, is correctly identifying the pelvic floor muscles. A common method is to imagine you are trying to simultaneously stop the flow of urine and prevent passing gas. You should feel a sensation of the muscles tightening and lifting internally. It is important not to use this method by actually interrupting urination as a regular exercise, as it can interfere with normal bladder function; it should only be used to find the right muscles.
Once you have located the correct muscles, find a comfortable position, such as lying down with your knees bent, to make it easier to isolate them. Contract the pelvic floor muscles, imagining you are lifting a marble upward into your pelvis. Hold this contraction for a count of three to five seconds, then completely relax the muscles for an equal amount of time. Proper form requires breathing freely and keeping your abdomen, buttocks, and thigh muscles relaxed.
A frequent mistake is to engage the wrong muscles by squeezing the buttocks or thighs, or by holding your breath, which makes the exercise ineffective. Another error is not relaxing the pelvic floor muscles completely after each contraction, as the relaxation phase is just as important for building muscle endurance. Overdoing the exercises can lead to muscle fatigue, which might temporarily worsen leakage.
There are two main types of pelvic floor contractions to practice for comprehensive bladder control. Long, sustained holds are designed to build endurance, which helps support the pelvic organs and prevent leakage throughout the day. Short, strong, and quick contractions train the muscles to react rapidly to sudden pressures like a cough or sneeze. Incorporating both types into your routine provides more complete training.
Creating a Consistent Exercise Schedule
To see improvements, a regular exercise routine is necessary. A common starting recommendation is to perform three sets of 8 to 12 contractions daily. Each contraction should be held for about 8 to 10 seconds, followed by an equivalent rest period. For those new to the exercises, it may be more manageable to start with shorter holds of 3 to 5 seconds and fewer repetitions, gradually building up as the muscles get stronger.
Consistency is more important than intensity, especially at the beginning. Spreading the exercise sessions throughout the day—for instance, in the morning, afternoon, and evening—can prevent muscle fatigue and help establish a habit. Many people find it helpful to link the exercises to an existing daily activity, such as after brushing their teeth or during a commercial break.
It is important to have realistic expectations regarding the timeline for results. Noticeable improvements in bladder control can take several weeks or even a few months of dedicated practice. Starting the exercises while lying down is often easiest, but you should progress to performing them while sitting and standing as you gain proficiency.
Supportive and Counterproductive Activities
Beyond isolated pelvic floor exercises, other physical activities can either support or hinder your progress. Low-impact exercises are beneficial because they promote overall fitness without placing undue stress on the pelvic floor. Activities like walking, swimming, and cycling are excellent choices. Pilates is also particularly helpful, as it focuses on strengthening the deep core muscles that work in concert with the pelvic floor.
Conversely, certain activities can be counterproductive by placing excessive pressure on the pelvic floor. High-impact exercises, such as running, jumping, and high-intensity interval training (HIIT), involve repetitive jarring motions that can strain these muscles and potentially worsen urine leakage. Heavy lifting also increases intra-abdominal pressure, which can overwhelm a weakened pelvic floor.
If you participate in high-impact sports or have a job that requires heavy lifting, it does not mean you must stop. Instead, focus on proper form, such as exhaling during the exertion phase of a lift to reduce abdominal pressure. Engaging your core and consciously contracting your pelvic floor muscles before and during moments of impact or strain can also provide extra support. Maintaining good posture helps by aligning the pelvis and reducing chronic strain.
Seeking Professional Medical Advice
It is advisable to seek professional medical guidance if you are unsure whether you are performing the exercises correctly. A consultation with a doctor or a pelvic floor physical therapist can provide clarity. These specialists can use techniques like biofeedback to confirm you are activating the right muscles and help refine your technique for better results.
Professional help is also warranted if you do not see any improvement in your symptoms after several months of consistent exercise. A lack of progress could indicate that there are other contributing factors to your incontinence or that the condition requires a different approach. A healthcare provider can perform a thorough assessment to develop a more personalized treatment plan.
If incontinence is severe, accompanied by pain, or significantly impacting your quality of life, consulting a healthcare professional is an important step. Treatment options may include medication, further specialized physical therapy, or other medical interventions tailored to your specific needs.