Anti-incontinence exercises are designed to strengthen and improve the pelvic floor muscles (the muscles that hold the bladder in place). These muscles are also called "levator ani" muscles. They are named levator muscles because they hold (elevate) the pelvic organs in their proper place. When the levator muscles weaken, the pelvic organs move out of their normal place (prolapse), and stress incontinence results. Physical therapy is usually the first step to treat stress incontinence caused by weakened pelvic muscles. If aggressive physical therapy does not work, surgery may be necessary.
There are special exercises to strengthen the pelvic muscles. Exercises can be done alone or with vaginal cones, biofeedback therapy, or electrical stimulation. In general, exercise is a safe and effective treatment that should be used first to treat urge and mixed incontinence. These exercises must be performed correctly to be effective; if the patient is using abdominal muscles or contracting the buttocks, these exercises are being performed improperly. If individuals have difficulty identifying the levator muscles, biofeedback therapy can help. For some people, electrical stimulation further enhances pelvic muscle rehabilitation therapy.
The first step in pelvic muscle rehabilitation is to establish a better awareness of the levator muscle function. Pelvic floor exercises, sometimes called Kegel exercises, are a rehabilitation technique used to tighten and tone the pelvic floor muscles that have become weak over time. These exercises strengthen the sphincter muscle to prevent urine from leaking out due to stress incontinence. These exercises can also strengthen the pelvic floor muscles to prevent pelvic prolapse (improper movement of pelvic organs). Kegel exercises can also eliminate urge incontinence. Contracting the urinary sphincter muscle makes the bladder muscle relax. Pelvic floor muscle rehabilitation may be used to reprogram the urinary bladder to decrease the frequency of incontinence episodes.
People who tend to benefit most from pelvic floor exercises alone are younger women who can identify the levator muscles accurately. Older adults who may have difficulty recognizing the right muscles need biofeedback or electrical stimulation in addition. Pelvic floor exercises work best in mild cases of stress incontinence with urethral hypermobility but not intrinsic sphincter deficiency. These rehabilitation exercises may be used for urge incontinence as well as mixed incontinence. They also benefit men who develop urinary incontinence following prostate surgery.
Pelvic floor muscle exercises are performed by drawing in or lifting up the levator ani muscles. This movement is done normally to control urination or defecation. Individuals should avoid contracting the abdominal, buttock, or inner thigh muscles. The following techniques can be used to learn how to squeeze these muscles: (1) trying to stop the flow of urine while in the middle of going to the bathroom; (2) squeezing the anal sphincter as if to prevent passing gas; and (3) tightening the muscles around the vagina (for example, as during sexual intercourse).
For treatment of stress incontinence, beginners should perform the squeezing exercise five times, holding each squeeze for a count of five (a person may have to start with a count of two or three). This should be done one time every hour while awake. These exercises can be performed while driving, reading, or watching television. After practice, a person may be able to hold each contraction for at least 10 seconds, and then relax for 10 seconds. The pelvic floor exercises must be performed every day for at least three to four months to be effective. If an individual does not notice an improvement after four to six months, he or she may need additional help, such as electrical stimulation.
For urge incontinence, pelvic floor muscle exercises are used to retrain the bladder. When one contracts the urethral sphincter, the bladder automatically relaxes, so the urge to urinate eventually goes away. Strong contractions of the pelvic floor muscles suppress bladder contractions. Whenever an individual feels urinary urgency, they can try to stop the feeling by strongly contracting the pelvic floor muscles. These steps may give the person more time to walk slowly to the bathroom with urinary control.
This technique may be used for stress and urge symptoms (mixed incontinence).