Incontinence

The involuntary loss of urine or feces, incontinence can result in social isolation and embarrassment. Incontinence is NOT a normal part of aging, pregnancy, nor menopause. If you are experiencing incontinence, you DO have a choice!

Following are the common pelvic floor exercises or “Kegels” that have been prescribed by physicians and physical therapists for years. However, the problem many experience is not knowing whether you are performing the exercises correctly because this is a group of muscles that you can’t “see.” Be sure to refer to the hints on identifying the correct muscles.

Another method of strengthening the pelvic floor is through the use of vaginal weights. These can be very effective, but many women have become very frustrated as the weights may continually fall out if you are extremely weak. A condition that often negates the use of vaginal weights is a cystocele or rectocele. These conditions are due to either the bladder or the rectum actually pushing into the vaginal canal, thereby pushing the weight right out. Talk to your physician if you feel pressure or a feeling of “falling out” as the day progresses. Check out www.endocare.com for more information.

Pelvic Floor Exercises

Begin these exercises now and continue them throughout your life for the continued health and strength of your pelvic floor.

To make sure you are “squeezing” the correct muscle group, try the following…

  • Stop urine test: Stop your flow of urine while using the toilet. ***DO NOT perform this during the first urination in the morning, and do it ONLY ONCE A MONTH.
  • Squeeze test: Insert 2 of your fingers into your vagina and squeeze OR squeeze your partner during intercourse (these are the same muscles that, once strengthened, can enhance sexual pleasure).
  1. Endurance strengthening (to help you “hold” your urine until you reach the toilet)
    Gently squeeze and hold for a count of 3, relax
    • Repeat 10 times
    • Weekly, increase time of hold by 1 count, with a goal of reaching 10 counts
    • Do this 2 times a day
  2. “Quick flick” strengthening (to hold your urine in when you cough, sneeze, laugh)
    • Squeeze quickly and tightly for a quick count of 2
    Relax completely
    • Repeat 3 times
    • Weekly, increase number of repetitions by 1, goal is 10 repetitions
    • Do this 2 times a day
  3. Elevator exercise (facilitates control and relaxation)
    • Totally relaxed = the “basement.” Gently contract, raising the “elevator” to the “first floor.” Hold for a count of 2. Do not relax.
    • Gently contract further, raising the “elevator” to the “second floor.”
    • Hold again for a count of 2. Do not relax.
    • Contract to the fullest, raising the “elevator” to the penthouse, again holding for a count of 2. Do not relax.
    • Gently lower the elevator back down, floor by floor, hold for a count of 2 at each floor, until you reach the basement again, then totally relax.
    • Weekly, increase repetitions by 1, with a goal of 3 repetitions.
    • Do this 2 times a day.

***REMEMBER…During all of these exercises, squeeze only the pelvic floor muscles, NOT the abdominals, buttocks, or inner thighs. Also, remember to BREATHE.

Controlling Urinary Urge

The sudden URGE to urinate, coupled with a weak pelvic floor muscle, often results in incontinence. You can use the pelvic floor muscles and gain control as the “bladder boss” by using the following technique:

STEP #1: Stop and stand still.
Sit down if you are able or stand quietly.
Do not move and try to maintain control and establish who’s “boss.”
STEP #2: Perform your “quick flick” exercise 5 times to keep from leaking.
Use moderate to maximum effort for the exercise.
Try to distract yourself by thinking of something else.
STEP #3: Relax, do 5 diaphragmatic breaths slowly and deeply.
Continue with distraction and positive thoughts.
REPEAT: If the urge returns, repeat the above steps to maintain control.

Once you have gained control and the urge has subsided, you can walk SLOWLY AND NORMALLY to the bathroom. Use this technique to increase the time between voids to 2 to 3 hours. Don’t let your bladder be in control.

Defecation and Urgency

Remember that the longer you keep a bowel movement inside, the drier and harder it becomes. This only enhances constipation and can lead to a variety of problems. Because of this the urge to defecate should not be delayed, only controlled to the point that you are not “rushing” to get to the bathroom.

Controlling Stress Incontinence

Stress incontinence is caused by internal pressures on the bladder that cannot be counteracted by a weak pelvic floor muscle. In order to train your pelvic floor muscle to work against these pressures, try the following exercises to develop the habit of contracting your pelvic floor during these times:

Sit to Stand Exercise:

  • From a seated position, contract the pelvic floor (PF) muscle.
  • Keep the PF muscle contracted as you stand up, EXHALING as you do so.
  • Relax the PF and breathe.
  • Return to sitting, again contracting the PF and EXHALING as you sit down.
  • Do this 10 times.

Lunges:

  • From a standing position, contract the PF
  • Keep the PF contracted as you step forward then back again with one foot
  • Remember to EXHALE throughout the movement, then relax and breathe.
  • Repeat with the other foot
  • Do a total of 10 times, alternating feet
    ***If you have poor balance, do this next to a counter, sturdy chair, or wall for support

Jumps:

  • In standing, contract the PF
  • Jump upward, EXHALING as you do so
  • Relax and breathe in-between jumps
  • Do a total of 10 jumps.
    ***If you have poor balance, keep your feet on the ground as you “pretend” to jump up

Cough Exercise:

  • In standing, slightly bend at the knees and slightly lean forward
  • Contract the PF and cough
  • Relax
  • Do a total of 10 times.
This information brought to you by…
New Horizons Physical Therapy

(406) 363-2570 Fax (406) 363-7214

120 S. Fifth Street, Suite 102
Hamilton, MT 59840