| Introduction | The healthy bladder | What can go wrong | Stress | Urge | Mixed |
| Overflow | Night time | Prostate | Pelvic floor | Bowel |
Pelvic Floor Exercises For Women
How to do your Pelvic Floor Muscle Exercises
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1 The Spine 2 The Uterus (Womb) 3 The Rectum 4 The Bladder 5 The Pelvic Floor Muscles |
The pelvic floor is a large sling (or hammock) of muscles and other tissues stretching across the floor of the pelvis. It is attached to your pelvic side walls, your pubic bone in front, and to the coccyx (the tail end of the spine) behind. It forms your "undercarriage". The openings from your bladder (urethra), your bowels (rectum) and your womb (vagina) and all pass through your pelvic floor.
What does it do?
- It supports your pelvic organs and abdominal contents, especially when you are standing or exerting yourself.
- It supports the bladder to help it stay closed. It actively squeezes when you cough or sneeze to help avoid leaking. When the muscles are not working effectively you may suffer from leaking ("urinary incontinence"), and/or urgent or frequent need to pass urine.
- It is used to control wind and when "holding on" with your bowels.
- It has an important sexual function, helping to increase sexual satisfaction both for yourself and your partner during sexual intercourse.
How to do pelvic floor muscle exercises
Exercise 1
Tighten the muscles around your back passage, vagina and front passage and lift up and squeeze inside as if trying to stop passing wind and urine at the same time. You need to concentrate on using the correct muscles, so don't squeeze your legs together or tighten your buttocks. However, many people find they tighten their lower stomach muscles at the same time, so if you hollow your lower stomach at the same time, that is OK -- the muscles are helping one another.
It is most important not to hold your breath: just breathe normally.
Have a go! How many seconds can you 'lift and squeeze" the pelvic floor muscles for? Try holding them as long and as strong as you can. Rest for 4 seconds and then repeat the contraction as many times as you can up to a maximum of 10 contractions. Gradually increase the time that you can hold each contraction, aiming for 10 second holds.
Try doing these exercises in a slow and controlled way with a rest of 4 seconds between each muscle contraction. Practise your maximum number of held contractions (up to 10) about three or four times each day.
Exercise 2
It is important to be able to work these muscles quickly to help them react to sudden stresses from coughing, laughing or exercise that put pressure on the bladder. So you need to practise some quick contractions, drawing in the pelvic floor and holding for just one second before releasing the muscles. Do these in a steady manner: aim for a strong muscle tightening with each contraction up to a maximum of 10 times.
Aim to do one set of slow contractions (exercise 1) followed by one set of quick contractions (exercise 2) three or four times each day.
Get into the habit!
Get into the habit of doing the exercises. Link doing them to some everyday activities - for example, do them after emptying your bladder or whenever you turn on a tap. Or keep a simple exercise diary (you could have an unlabelled simple tick chart on a kitchen pin board) to help you remember. Practise the exercises when you are lying, sitting and especially standing. In is also important to get into the habit of tightening your pelvic floor muscles before and during activities that are likely to make you leak - such as getting up from a chair, coughing, sneezing or lifting.
How long should I do them for?
Pelvic floor muscle exercises should give optimum results with regular exercise within 3 to 6 months, but you should continue them at least once a day for life to safeguard against problems recurring.
You are strongly recommended to seek help from a health professional if you see little or no change in your symptoms after trying these exercises on your own for three months.
If you find it difficult to exercise your pelvic floor muscles by your self. . .
. . . you could consider the following techniques.
Vaginal Cones
These are small weights which can be used by women to help with their pelvic floor exercises. The idea is to place an appropriate weight cone in the vagina and use the pelvic floor muscles to hold it there. By using it for 15-20 minutes at a time while walking around at home you will give your pelvic floor muscles some good exercise.
Some makes come as a set of cones of different weights, others as a single cone that unscrews to allow you to put in different weights. In either case you start by using the weight of cone that you can keep in for a short period once or twice a day, gradually increasing the weight, frequency and length of time you use them. (Full instructions are supplied with them.) You can buy cones directly from the manufacturers or from some branches of Boots the Chemist: see our Products Directory for information. They cost from £20 upwards.
Vaginal weighted cones can be ineffective if they are not in the right position. They will not work if you have anything more than a minor degree of prolapse. Some women find that the cone either slips out of the vagina almost immediately no matter how good the pelvic floor muscles are or else stays lodged in the vagina with no muscle work required to keep it in place. In fact, the evidence seems to suggest that using cones does not add any benefit if you are doing your pelvic floor muscle exercises properly - but they may help you to do the exercises correctly and many women say they have been useful.
Overall it is recommended that you talk to your nurse or physiotherapist before you try to use weighted cones.
The nurse/physiotherapist can instruct you in their proper use - and make sure you are doing your exercises right. Phone the Continence Foundation Helpline for a start.
Biofeedback
Biofeedback techniques includes anything that increases knowledge of your own body by sight, touch, sound etc. It can help as a motivator, give incentive and make pelvic floor muscle exrcises more interesting. This is usually used along with pelvic floor exercises for symptoms of stress incontinence and/or overactive bladder.·
- A mirror can be used to see if there is any inwards movement of the perineum (the area between the vagina and back passage) when you contract your pelvic floor muscles. If you see any bulging, stop and seek further help from a specialist nurse/physiotherapist as you may be doing something that could cause problems. ·
- A sexual partner can give feedback·
- Vaginal cones may be used as described above·
- The use of more sophisticated machinery using pressure and other types of equipment. This is usually used as an adjunct to pelvic floor exercises for symptoms of stress and/or urge incontinence to show how your pelvic floor muscles are working - and hopefully improving. The most sophisticated type of biofeedback needs to be used under the supervision of a specialised practitioner, usually a specialist physiotherapist or specialist nurse. It is not directly beneficial in itself - but it does help you (if you need help) to do your pelvic floor exercises properly.
Electrical Stimulation
Electrical stimulation is used in the treatment of both stress and urge incontinence, but not usually as a first line of treatment. It may be administered at a clinic (by either a specialist physiotherapist or a specialist nurse) or by the use of a small portable stimulator at home. (However, it is recommended that home treatment is supervised by a specialised health professional). It involves using a small battery-powered unit which applies an electric current to the muscles around the bladder. This current is usually passed via a small vaginal or anal probe in close contact with the pelvic floor muscles or via surface electrodes placed on the perineum (the area between the front and back passages).
It is hard to describe what electrical stimulation feels like, especially as different frequencies produce different sensations. Most individuals will describe it as a tingling rather like pins and needles, sometimes with a involuntary tightening of the pelvic floor muscles. It will not be painful.
People are usually advised to use the unit for between 20 minutes and an hour a day. Treatment may be needed for somwhere between a few weeks and several months. Some people find this treatment very effective, and there is some evidence that it can be as useful as pelvic floor exercises.
The unit is available on loan from some local continence services and from some physiotherapy services. (Details of your local continence service can be obtained from the Continence Foundation Helpline )
Pelvic Floor Exercises For Men
How to do your Pelvic Floor Muscle Exercises
Men
experience a variety of problems with their urinary system, leading to
unwanted leakage of urine. Some also have difficulty controlling wind
or leakage from the bowels. Often this is due to a weakness of the muscles
of the pelvic floor, which have an important function in preventing these
troublesome conditions. In particular, pelvic floor exercises have been
shown to be effective following surgery on the prostate and when men experience
a dribble after passing water.
The floor of the pelvis is made up of layers of muscle and other tissues stretching from like a hammock across the floor of the pelvis and attached to your tail bone (coccyx) at the back and to the pubic bone in front. The urethra (bladder outlet) and the rectum (back passage) pass through the pelvic floor muscles. The hammock of muscles and other tissues supports the bladder and the bowel and plays an important role in bladder and bowel control.
Why the Pelvic Floor Muscles get Weak
The pelvic floor muscles can be weakened by:
- some operations for an enlarged prostate gland
- continual straining to empty your bowels, usually due to constipation
- a chronic cough, such as smoker’s cough or chronic bronchitis or asthma
- being overweight.
Although there is no research evidence, it is thought by many that lack of general fitness and persistent heavy lifting tend to result in weakening of the pelvic floor.
Neurological damage (e.g., after a stroke or spinal injury, or resulting from multiple sclerosis or other conditions) can also produce poor pelvic muscle function. People in this group need to seek advice from a healthcare professional.
Pelvic Floor Muscle Exercises
You can improve control of your bladder and bowel by doing exercises to strengthen your pelvic floor muscles. These exercises may also be useful in conjunction with a bladder retraining programme aimed at improving bladder control in people who experience the urgent need to pass urine frequently and may not always "make it in time".
How to Identify your Pelvic Floor Muscles
The first thing to do is to identify correctly the muscles that need to be exercised.
- Sit or lie comfortably with muscles of your thighs, buttocks and abdomen relaxed.
- Tighten the ring of muscle around the back passage as if you are trying to control diarrhoea or wind. Relax it. Practise this movement several times until you are sure you are exercising the correct muscle. Do not hold your breath: keep breathing normally. You need to concentrate on using the correct muscles. Do not tighten your buttocks or thighs. Some people find they pull in the lower stomach muscles as well and this is OK because the muscles are helping one another.
- In order to contract your pelvic floor muscles it may help to imagine you are passing urine and trying to stop the flow mid-stream, then restarting it. If your technique is correct, each time that you tighten your pelvic floor muscles you may feel the base of your penis move up slightly towards your abdomen.
- If you are unable to feel a definite squeeze and lift action of your pelvic floor muscles, you should seek professional help to get your pelvic floor muscles working correctly. Even men with very weak pelvic floor muscles can be taught these exercises by a physiotherapist or continence advisor with expertise in this area. See "Seeking Help" below.
Doing Your Pelvic Floor Muscle Exercises
Now that you can feel the muscles working, you can start to exercise them:
- Tighten and draw in strongly the muscles around the anus and the urethra all at once. Lift them up inside. Try and hold this contraction strongly as you count to five, then release slowly and relax for a few seconds. You should have a definite feeling of "letting go".
- Repeat ("squeeze and lift") and relax. It is important to rest in between each contraction. If you find it easy to hold the contraction for a count of five, try to hold for longer - up to ten seconds.
- Repeat this as many times as you are able up to a maximum of 8-10 squeezes. Make each tightening a strong, slow and controlled contraction.
- Now do five to ten short, fast, but strong contractions, pulling up and immediately letting go.
- Do this whole exercise routine at least 3-4 times every day. You can do it in a variety of positions - lying, sitting, standing, walking.
- While doing the exercises:
- DO NOT hold your breath.
- DO NOT push down instead of squeezing and lifting up.
Do your exercises carefully. The quality is important. Fewer good exercises will be more beneficial than many half-hearted ones.
Make the Exercises a Daily Routine
Once you have learnt how to do these exercises, they should be done regularly, giving each set your full attention. It might be helpful to have regular times during the day for doing the exercises - for example, after going to the toilet, when having a drink, when lying in bed. You will wish to tighten your pelvic floor muscles also while you are getting up from a chair, coughing or lifting. Some men find that by tightening before they undertake such activities they assist themselves in regaining control.
Good results take time. In order to build up your pelvic floor muscles to their maximum strength you will need to work hard at these exercises. You will probably not notice an improvement for several weeks and you will not reach your maximum performance for a few months.
When you have recovered control of your bladder or bowel you should continue doing the at least once a day for life.
Other Tips to Help Your Pelvic Floor
- Avoid constipation and prevent any straining during a bowel movement.
- Seek medical advice for hay-fever, asthma or bronchitis to reduce sneezing and coughing.
- Keep your weight within the right range for your height and age.
- Share the lifting of heavy loads.
Seeking Help
To achieve your best results or if your problems persist despite doing the exercises, you may need to seek help professional help from your GP, a physiotherapist or a specialist continence nurse - you can obtain details of your local NHS specialist continence service from the Continence Foundation Helpline. You may be advised to use some additional technique, such as biofeedback or electrical stimulation.
Biofeedback
This is usually used along with pelvic floor muscle exercises for symptoms of stress and/or urge incontinence, although there has been no clear research to prove its effectiveness in men. It requires the use of mechanical or electronic equipment to provide you with visual feedback about how your muscles are working - and hopefully improving. Biofeedback needs to be used in conjunction with a specialised practitioner, usually a specialist physiotherapist or specialist nurse.
Electrical Stimulation
Electrical stimulation is used in the treatment of both stress and urge incontinence, but not usually as a first line of treatment (and again there is not yet any clear research evidence of its effectiveness in men). It may be administered in a clinic (either by a specialist physiotherapist or by a specialist nurse) or with the use of a small portable stimulator at home. (However, it is recommended that home treatment is supervised by a specialised health professional). It involves using a small battery-powered unit which applies an electric current to the muscles around the bladder. This current is usually passed via a small anal probe in close contact with the pelvic floor muscles or via surface electrodes placed on the perineum (the area between the front and back passages).
It is hard to describe what electrical stimulation feels like. Most individuals will describe it as a tingling sensation - a bit like pins and needles - sometimes with a involuntary tightening of the pelvic floor muscles. It will not be painful.
People are usually advised to use the unit for between 20 minutes and an hour a day. You may need to continue this for somewhere between a few weeks and several months. Some people find this treatment very effective.
The unit is available on loan from some local continence services and from some physiotherapy services. Details of your local continence service can be obtained from the Continence Foundation Helpline.