Pelvic Muscle Exercises
Pelvic muscle exercises, also called Kegel or pelvic floor exercises, have been shown to improve mild to moderate urgency and stress incontinence. When performed correctly, these exercises help to strengthen the muscles at your bladder outlet. The only way to get results from these exercises is to do them consistently. Even if you take medications for urgency incontinence or overactive bladder, you will see better and faster results if you combine your medication with pelvic floor muscle exercises. Through regular exercise you can build strength and endurance to help improve, regain, or maintain bladder and bowel control. Pelvic muscle exercises also help improve sexual enjoyment.
How to find and recognize the muscles:
Imagine that you need to hold back gas. Squeeze and lift the rectal area, and for women also the vaginal area, without tightening the buttocks or belly (abdomen). When you first begin your exercise program, check yourself frequently by looking in a mirror or by placing your hands on your abdomen and buttocks to insure that you do not feel your belly, thighs, or buttocks move. If there is movement, continue to experiment until you have isolated the correct muscles of the pelvic floor.
Another technique used only to help you identifying the correct pelvic muscles is to attempt to stop or slow the flow of urine. While urinating, partially empty your bladder then try to stop or slow the flow of urine. Remember to relax and completely empty your bladder when you have finished this test. Do not be discouraged if you are unable to stop or change the flow. Slowing the flow is a good start. Twice a month, you may try to stop the stream as a test to see if your muscle strength is improving. Do not do this start-and-stop test on a regular basis. It is not a helpful way to exercise the pelvic floor muscles.
There are two types of exercises you need to do. Doing both types of exercises is the best way to help improve your bladder control.
The first exercise, type 1, works on the holding ability of the muscles (building a strong dam to hold back urine). It is done by slowly tightening, lifting, and drawing in the pelvic floor muscles and holding them to a count of five. At first, you will probably notice that the muscles do not want to stay contracted or tightened very long. If you feel the contraction letting go, just retighten the muscles. In a week or two, you will probably notice an improvement in the control and holding power of the contractions. In fact, in the beginning, you may only be able to hold the contraction for 1-2 seconds. Concentrate on lifting the muscles and holding the contraction while progressing slowly over a period of weeks to a goal of 10-seconds. Rest for 10 seconds between each contraction. Rest is just as important as the exercise, so never skip this step. Once you have rested, contract your muscles again. Repeat this exercise a few times. In the beginning, you may find that you can only repeat the contraction five times, or maybe not even that. As you continue these exercises, you will be able to add more repetitions. Try adding an extra repetition once or twice every week. Eventually, you should be able to complete twenty repetitions, two times a day.
The second exercise, type 2, is a quick contraction. The muscles are quickly tightened, lifted up, and let go. This works the muscles that quickly shut off the flow of urine (like a faucet) to help prevent accidents. Squeeze your muscles quickly and strongly for just a second or two, release the contraction for just a moment, and contract again. Your goal is to do five repetitions of this exercise two times a day. Begin with as many as you can, and build up to this goal.
When to do the Exercises:
To improve muscle function, PMEs must be done regularly. In the beginning, you should do your exercises at least two times a day. It is advisable to start with three sets of ten quick and ten slow contractions, twice a day. Ultimately, the number of repetitions and sets can progress to three sets of fifteen quick and fifteen slow contractions, three times a day. Remember, this is your goal, and it is fine if you cannot do this many repetitions at first. Keep working at it, be consistent, and you will see your endurance increase and your pelvic floor get stronger.
Once you have achieved your desired pelvic floor muscle strength, you may do fewer exercises all at one time if you prefer, since maintaining muscle strength takes less work that building that strength when it is lost. Your bladder and bowel control will usually begin to improve in six weeks or less. However, some people take three to six months to see improvement.
Make PMEs a Habit
Once you reach your goal of pelvic floor muscle strength, this is the time to make an effort to incorporate these exercises into your normal routine, until they become as natural as brushing your teeth. You can do a few contractions while you are doing normal activities such as:
- Brushing and flossing your teeth
- Waiting in line or at a stoplight
- Watching commercials on television
- Driving to work
- Loading and unloading the dishwasher
Remind yourself how far you have come, and make the commitment to maintain your pelvic floor muscle health.
Signs of Improvement:
Don’t be discouraged if you are not able to control your bladder as soon as you would like, but rather look for these signs as proof that your pelvic floor muscle exercises are working and that you are on your way to better bladder health:
- Longer time between bathroom visits
- Fewer “accidents”
- Ability to hold the contractions longer, or to do more repetitions
- Drier underwear, without the feeling of always being wet
In addition to increased control of your incontinence, strong pelvic floor muscles can help you prepare to avoid a leak. Once you get comfortable with practicing PMEs, keep a couple of tips in mind in order to avoid accidents. When you feel a cough or a sneeze coming on or when you clear your throat or blow your nose, for example, practice contracting your pelvic floor muscles. As you get stronger, this should considerably reduce or eliminate these types of leakage. You may also use PMEs to help suppress a strong urge to urinate until you can locate an appropriate place to empty your bladder.
If you have any questions or difficulties with these exercises, talk to a healthcare provider. Other behavioral treatments, such as biofeedback training to help isolate and use the correct muscles and electrical stimulation of the muscles, may help with your exercise efforts. As a training aid for PMEs, you can use vaginal weights, wands, or other devices that provide resistance against muscle contractions. Some of these aids are prescribed by a health professional and used under professional supervision, and others are available without prescription.
Sometimes a combination of all or some of these techniques is most helpful in managing and improving your incontinence. To ensure proper identification of pelvic floor muscles, to stimulate damaged nerves, and to establish an exercise routine, you may also need to see a nurse specialist or physical therapist to undergo biofeedback therapy or pelvic floor stimulation.
NAFC publishes a pelvic muscle exercise kit for men and women to assist with pelvic muscle exercises. It is most helpful for women with mild to moderate stress and urgency incontinence and men experiencing urine leakage after prostate surgery. The audio recording teaches how, coaches through, and encourages continuously. The accompanying manual helps you to follow the verbal instructions with written descriptions and detailed drawings. Refer to our Online Store for ordering information.