Exercises You Can Do to Reduce Urinary Incontinence

Another approach for men and women who want to try nonsurgical methods first is to strengthen the muscles of the pelvic floor through exercise. The strength and proper action of your pelvic floor muscles are important in maintaining continence. Like weakened or damaged muscles elsewhere in your body, their condition can usually be improved with regular exercise and, if needed, physical therapy.

It may seem odd, but tight pelvic floor muscles, too, can cause incontinence. That’s because tight muscles (resulting from pelvic, back, or hip surgery or other causes) can’t relax when they are supposed to. And when the time comes for them to contract to control the flow of urine, they can’t because they are already tightly contracted. Instead, they go into spasm. This condition is often best treated by pelvic floor physical therapy performed by a qualified pelvic floor physical therapist.

Basic pelvic muscle exercises are often called Kegel exercises, named for Arnold Kegel, the physician who first developed them. Regular Kegel exercises may be helpful particularly for women with mild to moderate stress incontinence. Learning to perform a strong and fast pelvic muscle contraction just before and during actions that commonly cause problems for those with stress incontinence (such as coughing or jumping) reduces leakage. Pelvic muscle exercises may help overactive bladder and mixed incontinence as well.

For men, Kegels can help prevent post-void dribbling (see “Dribble relief”). But studies have not shown Kegel exercises alone to be particularly effective in preventing or treating incontinence that results from prostate surgery.

Because Kegels cost nothing and are quite safe, they are recommended for most patients, either alone or in combination with other treatments. To perform a Kegel, you first need to find your pelvic floor muscles and then repeatedly contract and relax them.

Locate your pelvic muscles. Pretend you are trying to avoid passing gas; if you are a woman, you can pretend to tighten your vagina around a tampon. Both actions involve the pelvic muscles. You will feel a correct contraction more in the back than the front, like you are pulling the anal area in or stopping gas from escaping.

Choose your position. You can start by lying on your back until you get the feel of contracting the pelvic floor muscles. Later, you can practice while sitting and standing as well.

Practice contractions. Practice both short contractions and releases (sometimes called “quick flicks”) and longer ones (gradually increasing the strength of the contraction and holding it at your maximum for up to 10 seconds). Consciously relax the muscles between each repetition, and hold the relaxation phase for the same amount of time as the contraction.

Keep other muscles relaxed. When doing pelvic floor exercises, don’t push out your abdominal muscles, contract your leg or buttock muscles, or lift your pelvis. Place a hand gently on your belly to detect unwanted abdominal action.

Repetitions. Your health professional may advise you how many Kegel exercises to do. It is more effective to spread the exercises throughout the day than to do them all at once. One simple starting regimen is to do 10 before getting out of bed, 10 standing after lunch, 10 in the evening while sitting watching TV, and another 10 before going to sleep. You can do them at other times as well: in the car sitting at a stoplight, waiting for an elevator, or waiting in a grocery line.

Determine your strategy. You can practice using these exercises to control your symptoms. If you have stress incontinence, tighten your pelvic floor muscles just before lifting, coughing, laughing, or whatever usually causes urine leakage. Do the same several times when you have the urge to urinate and doubt you are going to make it to the toilet. This should relax your bladder muscle so you can walk to the toilet under control.

Be consistent. Practice consistently, using whatever schedule works for you. It may take a few months for you to notice an improvement in your symptoms.

Pelvic floor physical therapy

Your physician may recommend seeing a physical therapist with training in pelvic floor therapy. Many people find it useful to have a trained expert help them identify the proper muscles and teach them to perform exercises correctly. A physical therapist trained in this specialty can also use biofeedback to aid in the process or electrical stimulation to help strengthen weak muscles.

Body posture, also known as body mechanics, is another important part of keeping pelvic floor muscles and structures functioning as they should be. In addition, a physical therapist with specialty training can advise a patient on bladder training and lifestyle modifications and can provide regular reinforcement and advice.

Not all physical therapists have expertise in bladder training, so ask about it before you begin your physical therapy sessions.

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