Stress urinary incontinence (SUI) is the unintended leaking of urine with coughing, sneezing or physical activities. It has a significant impact on women’s quality of life. SUI is the result of weakening of the pelvic floor muscles due to stretch or injury to the pelvic floor support structures – this can happen in about a third of women after vaginal birth. 

Urgency urinary incontinence is the leakage of urine associated with or preceded by a strong feeling of urgency, where one may not be able to reach the bathroom without leaking. This can also happen after childbirth, although more so as a consequence of aging. 

Urinary Incontinence

There can be a significant improvement in these symptoms with pelvic floor muscles exercises or “Kegel exercises”. The most important factors for success with pelvic floor muscle training include proper technique and regular and continuous training of the muscles 

Technique 

  • Working with a pelvic floor physiotherapist is beneficial to developing the correct technique, and regular follow up will help you stay motivated 
  • Proper technique can also be developed by using a biofeedback device; like a vaginal cone or vaginal balloon that allows you to feel when you’re contracting the correct muscles
  • Some women can benefit from the functional electrical stimulation, where a small electrical current is used to trigger a contraction in your pelvic muscles. This is particularly useful for women who may have trouble identifying the correct muscles to contract during Kegel exercises 

Regular Training 

  • Like training any other muscle group, regular training is important. Setting aside some time dedicated to training the pelvic floor muscles may help you continue the habit long term. See below for an exercise regimen. 
  • Having regular follow up with your care provider can be helpful to keep you motivated to continue doing the exercises. 

The benefits of pelvic floor muscle exercises include 

  • Increase the strength and tone of the pelvic floor muscles so they provide more support to the structures in your pelvis, this decreases the risk of prolapse; the sagging of the bladder, bowels or uterus through the vagina 
  • Decreased risk of developing stress urinary incontinence and controlling its severity
  • Control of urgency incontinence 
  • Can prevent or delay the need for surgery to manage the above mentioned conditions 

How to correctly perform pelvic floor muscle exercises 

  • Start in a comfortable seated position with your knees wide apart or lying on your back with your legs slightly apart 
  • Then contract your muscle – imagine you are both stopping urine from leaking and preventing gas from passing 
  • It is important to isolate your pelvic floor muscles so keep your abdomen, thighs and buttock muscles relaxed. Keep breathing, as holding your breath reflects a tensed abdominal muscle.
  • Tips: 
    • It can be helpful to see what your muscles are doing – use a mirror while you are contracting. You should see your anus and vagina lifting and drawing in 
      • If you notice that the vagina is widening rather than lifting you are pushing down when you contact, rather than contracting up 
      • If you leak urine during the contraction you are also likely pushing down rather than contacting up  
    • It can also be helpful to feel what your muscles are doing; insert a finger into the vagina and then perform the contraction, if you can feel the muscles tighten around your finger you are contracting the correct muscles 
    • You can try to learn how to contract the correct muscles by interrupting the stream of urine as you void, but once you have correctly identified the muscles you need to squeeze, do not perform pelvic floor muscle exercises while voiding as you are teaching your bladder to empty despite a voluntary obstruction 

How often the exercises should be done 

  • The initial exercise regimen aims to strengthen your pelvic floor muscles with both endurance and quick exercises, this period of exercise may last at least 3 months
    • Endurance 
      • Find your baseline ability: contract your muscle and see how long you can stay contracted with a maximum length of 10 seconds 
      • Then find how many repetitions you can do: contract for your maximum amount of time, rest for the same amount of time you were contracted and repeat until you cannot do any more contractions, to a maximum of 8-12 repetitions 
      • Continue this regimen of 3 sets of 8-12 repetitions, three or more times per day, increasing the length of hold as the muscles get stronger  
    • Quick holds 
      • Contract your pelvic floor quickly and then release, rest for 1-2 seconds and repeat, completing many as you can with proper form 
      • Continue these until you can do 8-12 repetitions 3 times a day 
  • After this initial exercise regimen the maintenance of the pelvic floor muscles is very important 
    • Continue to complete both your endurance and quick exercises at your maximal ability 2 days a week completing 3 sets of 8-12 repetitions, 3 times during the day

Once you have strengthened your muscles, start using them! 

  • For Stress Urinary Incontinence: This means that just before you pick up something heavy, sneeze or cough, as you are covering your mouth (which you have time to do just before coughing or sneezing!), think about squeezing your pelvic floor to enhance the reflexive contraction! 
  • For Urgency Urinary Incontinence: when you have a strong urgency to void (and fear you won’t make it on time), sit down, perform 5-10 quick contraction/relaxation of your pelvic floor, and once the urgency has released, move slowly to the bathroom.

What to expect 

  • Properly performing these exercises take time! If you notice that you are initially doing these exercises incorrectly, keep trying and most women are able to properly perform these exercises with practice 
  • If you continue to have difficulty isolating the correct muscles, the aid of a pelvic floor physiotherapist will be very beneficial 
  • With regular practice and the correct technique you can expect to see some improvement within 3-6 weeks, but it can take as long as 6 months, so it is important to keep up with the exercises! 

References:
1.    SOGC Conservative Management of Urinary Incontinence
2.    IUGA Pelvic Floor Exercises: https://www.yourpelvicfloor.org/media/pelvic-floor-exercises-english.pdf