Robert MacDermott - Consultant Gynaecologist
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  KIMS Hospital
  Kent, ME14 5FT
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Pelvic Floor Exercises

Pelvic floor muscles can help 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 muscle and ligaments that stretch like a hammock from the pubic bone in front to the bottom of the backbone. This muscle holds and supports your organs, i.e. the bladder, the bowel and in women the womb. It also supports and holds your water pipe (urethra) and bowel (anus and rectum) closed.

Pelvic Floor Exercise

 How does the pelvic floor work?

The muscle of the pelvic floor is kept firm and slightly tense to prevent leakage of urine from the bladder, 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 to help you avoid leaking. They also have an important sexual function, helping to increase sexual awareness for both yourself and partner in sexual intercourse.

Pelvic floor muscles can become weak and sag because of childbirth, prolonged straining to empty your bowel due to constipation, chronic cough, obesity, lack of exercise, the menopause or just getting older. Weak muscles give you less control, and you may leak urine, especially with exercise or when you laugh, cough, lift 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 leakage of urine. Like any other muscles in the body, the more you use and exercise 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 much on the outside. You should not pull in your tummy excessively, squeeze your legs together, tighten your buttocks or hold your breath. Here are some suggestions how to exercise your pelvic floor. Find the way which suits you.
  1. Sit comfortably with your legs slightly apart. Now imagine that you are trying to stop yourself 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 skin around the back passage tightening and being pulled up and away from your chair. Really try to feel this squeezing and lifting.

  2. 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 do not be surprised if you find this harder. (Do not try to stop the stream when you are actually passing water, as research has shown that there is no benefit in doing this).

  3. Imagine your vagina is a lift which you must pull up inside to the top floor. Try not to contract all the other muscles, (buttocks, tummy etc). Think of the top floor as number 10 and relax at the ground floor, number 0.

 Practising your exercises

Now you can find your pelvic floor muscles, here are the exercises for you 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 floor muscles as hard as you can. Try lifting and squeezing them as long as you can. Rest for five seconds and repeat the contraction. As a suggestion, build up your strength until you can do 10 slow contractions at a time, holding them for about 5 seconds each with rests of 5 seconds in between.

  2. Your pelvic floor muscles also need to react quickly to sudden stresses from coughing, laughing or exercise that put 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 tightening with up to ten contractions in succession.
Aim to do a set of slow contractions (exercise 1), followed by a set of quick contractions (exercise 2) 3-6 times a day. It takes time for the exercises to make the muscles stronger. You are unlikely to notice any improvement for 1-2 months so stick at it! You will need to exercise regularly for several months before muscles gain their full strength.

 Tips to help you

  1. Get into the habit of doing your exercises with things you do regularly, e.g. every time you touch water if you are at home, every time you answer the telephone if you are at the office, while waiting at traffic lights if you are in a car-whatever you do often. It may help to put red dots around the house to remind you to do your exercises.

  2. If you are unsure that you are exercising the right 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 contracts.

  3. Use the pelvic floor when you are afraid you might leak-pull up the muscles before you cough, laugh, sneeze or lift anything heavy.

  4. Drink normally, reduce your caffeine intake if you can, do not get into the habit of going to the toilet 'just in case'. Go only when you feel that your bladder is full.

  5. Try to avoid constipation, by eating a healthy balanced diet.

  6. Watch your weight. Extra weight puts extra strain on your pelvic floor muscles.

  7. Once you have regained control of your bladder, do not 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!

 Do you have any questions?

This information sheet is designed to teach you how to control your stress incontinence symptoms so that you will be dry and comfortable. If you have any problems doing the exercises or if you do not understand any part of this information sheet, ask your Doctor, Nurse, Continence Advisor or Physiotherapist for help.

Do your pelvic floor exercises every single day. Have faith. You should begin to see results in about three months. Do not stop them - make the exercises a permanent part of your daily life.

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