Pelvic Floor Exercises

 Pelvic floor exercises are sometimes called Kegel exercises, after the obstetrician who developed them. Another name for the exercises is pelvic floor muscle training (PFMT).

What kind of incontinence can they help?

Pelvic floor exercises are one of the first-line treatments for stress urinary incontinence (SUI).
There is no evidence they are effective for urge urinary incontinence.

How effective are they?

In 1998 Norwegian scientists carried out a six-month trial on different treatments for SUI:

• pelvic floor exercises
• electrical stimulation
• vaginal cones
• no treatment.

The women who did pelvic floor exercises showed the most improvement.

How do they help SUI?

The exercises are designed to:

• make your pelvic floor stronger
• make you more able to tighten your pelvic floor muscles before pressure increases in your abdomen, eg when you sneeze, cough or laugh.

How do you do the exercises?

Pelvic floor checklist

1. Identify the muscles.
2. Contract the muscles correctly.
3. Use fast and slow contractions

Pelvic floor exercises are best taught by a specialist, eg a continence adviser or physiotherapist.
Visit your GP or phone the Bladder and Bowel Foundation helpline for details of advisers in your area.

1. Identify the muscles

First you need to find your pelvic floor muscles.
Try to tighten your muscles around your vagina and back passage and lift up, as if you’re stopping yourself passing water and wind at the same time.
A quick way of finding the right muscles is by trying to stop the flow of urine when you’re in the toilet. Don’t do this regularly because you may start retaining urine.
Once you've found the muscles, make sure you relax and empty your bladder completely.
If you're not sure you are exercising the right muscles, put a couple of fingers into your vagina. You should feel a gentle squeeze when doing the exercise.

2. Contract the muscles correctly

The movement is an upward and inward contraction, not a bearing-down effort.
When you first start the exercises, check that you are doing them correctly. Put your hands on your abdomen and buttocks to make sure you can’t feel your belly, thighs, or buttocks moving.

• Don't hold your breath. You should be able to hold a conversation at the same time, or try counting aloud while you're doing the exercises.
• Don't tighten the tummy, thigh or buttock muscles - you'll be exercising the wrong muscle groups.
• Don't squeeze your legs together.

3. Fast and slow contractions

You need to train your pelvic floor muscles through repetition, in the same way as you would train a muscle group at the gym.

Slow contractions

Slow contractions help to increase the strength of your pelvic floor. They help your muscles to hold back the urine.

• Lift your pelvic floor muscles to a count of ten.
• Hold the muscles tight for 10 seconds.
• You may find at first that you can only hold the contraction for one or two seconds, so concentrate on lifting your muscles and holding the contraction for as long as you can.
• Gradually increase the time until you reach 10 seconds.
• Relax your muscles and rest for 10 seconds.
• Repeat the contractions up to 10 times.

Fast contractions

Fast contractions help your pelvic floor to cope with pressure, for example when you sneeze, cough or laugh. This works the muscles that quickly shut off the flow of urine.

• Lift your pelvic floor muscles quickly.
• Hold the contraction for one second.
• Relax the muscles and rest for one second.
• Repeat the contractions 10 times.

How often should I do the exercises?

Try to do one set of slow exercises and one set of fast contractions six times a day.

Pelvic floor checklist

1. Identify the muscles.
2. Contract the muscles correctly.
3. Use fast and slow contractions

The Chartered Society of Physiotherapists also recommends that you do a quick contraction just before you cough, sneeze or laugh.
You may also find it useful to do a fast contraction just before you get out of a chair. This is because the movement of getting up puts pressure on your bladder and pelvic floor.

How do I know they are working?

You can test your muscle strength with the stop-start test. When you urinate, partially empty your bladder and then try to stop the flow of urine.
If you can’t stop it completely, slowing it is a good start. Try the test every two weeks or so to see if your muscles are getting stronger. Don't do the test more often than this.

The pros of pelvic floor exercises

• They’re simple.
• They’re cheap.
• They’re effective.
• You can do them when sitting, standing or lying down.
• You don’t need any special equipment, but until you get into the habit of doing them, you may find that a tick chart helps to remind you to do your exercises.
• You can do them with or without vaginal cones.

The downside of pelvic floor exercises

• You have to keep doing them for the rest of your life.
• It can take up to 15 weeks before you see any difference.
• If you haven’t noticed a difference after three months, see your continence adviser again to check whether you’re doing them correctly or if there's another problem.

 

References

Bo et al: Bo K, et al. Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women. BMJ 1999;318(7182):487-93.
Based on a text by Dr Dan Rutherford, GP

Article -Pelvic Floor Muscles
Reviewed by Dr Hilary McPherson, consultant obstetrician and gynaecologist and Dr Kate Patrick, specialist registrar