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Incontinence of urine

These exercises are designed to help women with incontinence of urine. Incontinence means wetting yourself when you do certain things such as coughing, running, sneezing or laughing, or when your bladder gets full and you pass urine before you reach the toilet.

Pelvic muscle exercises

The muscles around the pelvis (pelvic muscles) are very important in supporting the bladder, urethra, vagina and rectum (see diagram). Following childbirth or with advancing age, these muscles may weaken. They may be strengthened by regularly practising pelvic muscle exercises. If these exercises are practised throughout life, they will reduce the chances of becoming incontinent. An outline of some of these exercises is given here. A physiotherapist may be able to assist in assessing and teaching pelvic muscle exercises.

Stage 1

To identify the correct muscles to exercise, do the following exercises during the first week:

(a) To identify the muscles around your back passage or rectum, sit or stand comfortably and imagine that you are trying to control diarrhoea by consciously tightening the ring of muscles around the back passage. Hold this 'squeeze' for 4 seconds each time.

(b) Go to the toilet and commence passing urine. Now try to stop the flow of urine in midstream. Once this is done, recommence voiding until the bladder has emptied. The muscles used to slow or stop the flow of urine are the front pelvic muscles, which help support the bladder.

(c) Some women find they can identify the correct pelvic muscles by inserting a finger into their vagina, then squeezing the finger by contracting the pelvic muscles. If the finger cannot be felt to be squeezed, probably the wrong muscles are being exercised or the muscles are still very weak. Do not give up, but proceed with the stage 2 exercises.

Please note

• Do not bear down as if trying to pass a bowel motion (or as a woman would do during childbirth). This strengthens the wrong muscles and may make the incontinence worse.
• It may take a week or more to begin to identify the muscles that need to be exercised to regain the strength and tone of the pelvic muscles.

Stage 2

Now that the correct muscles have been identified, these are the pelvic exercises to do every day. They should not be done while passing urine.

(a) While sitting or standing with thighs slightly apart, contract the muscles around the back passage (rectum) then the front muscles around the vagina. Hold this contraction while counting to 5 slowly. Now relax these muscles. Repeat his 4 times. Try to be aware of the squeezing and lifting sensation in the pelvis that frequently occurs when these exercises are done correctly.

(b) While sitting or standing, tighten the muscles around the front and back passage together. Hold this contraction for just 1 second and relax. Repeat this exercise 5 times in quick succession.

Please note

• These 'slow' and 'quick' exercises are important to strengthen the pelvic muscles properly.
• In stage 2, it is not appropriate to do the stage 1 exercise of stopping the flow of urine each time urine is passed at the toilet. This is only a preliminary exercise.
• These exercises ideally can be done every hour, but certainly not less than 4 times every day.
• With practice, the exercises should be quite easy to master, and they can be carried out at any time-while waiting for a bus, standing at the sink or watching television. There is no need to interrupt the daily routine.
• Once every week or two, it is important to return to stage 1 for a quick check that the correct muscles are being used.
• While these exercises are particularly useful for women, they may be helpful also for men, particularly those suffering from dribbling or urgency.
  

Note

Check with your doctor if you are having persistent problems.

Copyright 1995: John Murtagh, Professor of General Practice
Monash University, Melbourne, Australia