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Monday January 12, 2015

IUGM'S COLUMN Incontinence - Part 2

In our last issue, we discussed what causes incontinence. In this issue, we will discuss the various tips and exercises that you can do to fight incontinence. 

Pelvic floor muscle exercises

Maybe it’s the first time that you hear about your pelvic floor muscles... But remember that it’s never too late to start working on strengthening those muscles! Pelvic floor muscles strengthening exercises help reduce involuntary urine leaks. The pelvic floor is made of three layers of muscles, which line the bottom of your pelvis. These muscles are spread over the pubic bone and the coccyx, similar to a hammock; they play a vital role in the control of urine, gas and bowels. In women, they also support some internal organs such as the uterus and the bladder.    


How do I contract my pelvic muscles correctly?

The following 3 exercises should be carried out every day for 12 weeks (approximately 3 months).  They may seem difficult at first, but they will become easier with time and practice. Set aside a period of 10-15 minutes each day to do your exercises. Focus on your exercises; avoid doing any other activity during this time (such as watching TV, reading, etc.). Focus on the quality of your exercises rather than the quantity!  

Lay down on your back, with your knees bent, your feet slightly apart and your arms resting on each side of your body. For the exercises below, focus on relaxing all your muscles, especially those in your buttocks and the inside of your thighs.   

Quick tip:

Always contract your pelvic floor muscles before coughing, sneezing, lifting a heavy object, bending down, getting up from a sitting position, or any other movement that causes you to have an involuntary leak.   


Exercise 1 – Strength

• Breathe out slowly though your mouth.

• Contract your pelvic floor muscles as much as possible; pull them “in”, as if you were holding some urine or gas. Pull your pelvic floor inwards. 

• Maintain this contraction for 6 seconds. Count slowly to 6, out loud. Breathe while you count, without releasing the contraction.

• Relax your pelvic floor during 12 seconds.

• Do three sets of 10 contractions-relaxations, for a total of 30 contractions. Take a one-minute break between each set.


Exercise 2 – Coordination

• Breathe out slowly though your mouth, then contract your pelvic floor muscles as strongly as possible.  

• Maintain this contraction for one second; then cough vigorously, while keeping your pelvic floor well contracted.  

• Take a two-second break; then, repeat the exercise twice (contracting, coughing, and relaxing)

• Take a break for 30 seconds.

• Carry out two other sets of exercises.


Exercise 3 – Quick contractions

• Breathe out slowly though your mouth, then contract your pelvic floor muscles as strongly and as quickly as possible, as if you were holding urine or gas.

• Maintain this contraction for one second.  

• Relax your pelvic floor for one second.

• Do 3 sets of 6 quick contractions-relaxations, for a total of 18 quick contractions. Take a 20-second break between each set.



Increase the difficulty after 6 weeks, by doing the above 3 exercises in a sitting position rather than on your back.  


Techniques to help control strong urges to urinate

If your urine leaks appear with a strong urge, or if you need to go to the bathroom frequently (more than every two hours during the day, or more than twice every night), the following exercise may be beneficial to control the urge to urinate, in addition to the other pelvic floor exercises:

• Just stop! Don’t run to the bathroom! If possible, sit down on a hard seat. This will help you hold the urine.

• Take a deep breath and relax.

• Contract your pelvic floor muscles quickly and strongly, at least 8 times (as described in exercise #3); you can also try to maintain a strong contraction for 6-8 seconds (as described in exercise #1).

• Think of something else (for example, try to find a boy’s name or girl’s name for every letter of the alphabet). Mental control has a strong influence in controlling urges to urinate.

• If the urge hasn’t receded, repeat all previous steps.  

• Wait until the urge to urinate has passed.

• When the urge has passed, go calmly to the bathroom, only if you still feel like you need to go. Otherwise, continue your normal activities.  


Up to 85 % of people who apply the pelvic floor strengthening exercises and the above techniques to control their urges to urinate are able to solve or improve their incontinence issues. If the above tips don’t help you, other solutions are available, such as consulting with a physiotherapist to learn some exercises that are better suited to your specific situation, taking medications or undergoing surgery. Talk to your doctor... and most importantly, don’t settle for just living with incontinence!

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