Pelvic Floor Muscle Exercise

Here is some advice from physiotherapists on exercises for the pelvic floor muscles. It is designed to be shared with Residents, so please feel free to copy and paste the text into your own Resident materials.

WOMEN

Training the muscles of the pelvic floor can be an effective way to minimize or prevent urine leakage. They can be activated, and training costs nothing and has no side effects, so you may wish to try this before starting other treatment methods. Improvement may not be immediate, but don’t give up. After 2-4 months training you should notice a difference. The pelvic floor muscles are a group of muscles inside the pelvis that form its floor – hence the name. They surround the urethra (bladder passage), vagina and ano-rectum (back passage) and should, along with the sphincter muscles, maintain control over these openings, preventing leakage of urine or feces. The muscles should also support the urethra, bladder, womb and rectum, and withstand all increases in abdominal pressure that occur during physical exercise. If the pelvic floor muscles are weak leaking can occur, e.g. with coughs, sneezes, or physical activity.

How to find them

Finding the right muscles is important, and it can be difficult to do this for yourself. Studies have shown that some 30% of women who try to tighten their pelvic floor muscles do so incorrectly. Common mistakes include tensing the buttocks and thighs instead of the pelvic floor muscles, holding one's breath, or pushing down instead of squeezing and lifting in and up.

The following test should prove helpful. Try interrupting the flow when you urinate. Feel which muscles you are using to do this. These are the muscles you need to work on. Note that this is only a test to identify the correct musculature and should not be repeated on a regular basis. It might also help if you tighten your anus as if holding in gas.

Correct contraction of the pelvic floor muscles feels like a squeeze and a small lift under the pelvis up into the body, around the vagina and anus. There should be no accompanying movement of other parts of the body, e.g. the buttocks or inner thighs, and don’t hold your breath.

If you have a problem identifying the right muscles, you may want to check for yourself. Looking at the area in a mirror, as you squeeze you should see some tightening and movement in (not down towards the mirror). Or, you can wash your hands then insert one or two fingers into your vagina and feel for a squeeze against them as you tighten the muscles. Alternatively, your doctor may be able to check for you, or refer you to a specialist clinician (e.g. physiotherapist) for assessment.

Strengthening the muscles

When you have learned to use the muscles correctly, exercise them regularly, ideally several times a day. It will only take a few minutes and can be done in many different positions, e.g. sitting, standing, or lying down. Nobody can see what you are doing. At first, you may only be able to squeeze and hold for a second or two. As you improve, build this up to a maximum of 10 seconds. Always rest between squeezes for at least as many seconds as you have held, e.g. 5-second hold, 5-second rest. At the start, your muscles may feel tired after just a few squeezes. As you improve, increase this gradually to 10 repetitions. You can also practice some fast, hard contractions. Just squeeze the same muscles as hard as you can, then let go right away. Repeat up to 10 times.

Use the muscles when you need them

As well as exercising, use the muscles when you need them, e.g. squeeze and hold before you cough, sneeze, laugh, lift, bend – anything that puts pressure on your pelvic floor and might make you leak.

In order to get the best possible results you should continue to train as described above for around 6 months. After 2-4 months of regular exercise you should already be able to notice a difference. When the desired effect has been achieved you will be able to reduce the frequency, but remember to continue using the muscles every day when you need them, as described above. Research shows that many women who have trained intensively maintain their improvement months or even years later.

It is never too late to start pelvic floor exercises. Women in their 70s and older can improve or eliminate their symptoms. When you incorporate the exercises into your daily routine they will become as natural as brushing your teeth. If your symptoms do not improve consult your doctor. He/she will be able to advise you on what else can be done, e.g. referral to a specialist physiotherapist or nurse, or to a gynecologist or urologist.

MEN

The best way to find the pelvic floor muscles for men is to squeeze the muscles around your back passage as if holding back gas. The pelvic floor muscles will automatically contract with this action. You should feel a definite squeeze and lift action of the penis – it may raise a bit when the muscle is contracted. Once the PFM are located, exercise them on a regular basis to strengthen and tone.

First squeeze and hold the muscles for a count of 5. Release, rest for a few seconds and repeat this about ten times or until tired. Increase the count and increase the number of repetitions as the muscles strengthen. The second exercise is to contract the muscles quickly in rapid succession. Squeeze, release then repeat ten times. Breathe well throughout the exercises and don't hold your breath. Make sure these muscles are fully relaxed.

There should be significant improvement after daily exercise of 30-40 repetitions in about a three- to four-month period.