Pelvic Floor Exercises

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1 Directorate of Women, Children and Surgical Services Burton and District Urogynaecology Centre A Nationally Accredited Urogynaecology Unit Pelvic Floor Exercises

2 You have been given this leaflet because your GP, continence nurse specialist or physiotherapist believes it will be beneficial for you to carry out these exercises to help with your urinary incontinence, prolapse or both. Pelvic floor exercises help strengthen and relax the pelvic floor so they become firm and supportive. With the correct use of pelvic floor exercises, may women show great improvement and can avoid or delay the necessity for surgery to correct incontinence problems. What is the pelvic floor? The pelvic floor is composed of a thin sheet of muscle fibers and associated connective tissue which spans the area underneath the pelvis between the pubic bone at the front and the sacrum and the tail bone at the back. What do the pelvic floor muscles do? They help to support the organs in your abdomen when you standing. They help to protect the pelvic organs from external damage. They help to hold pelvic organs in the correct position. They contract when you sneeze, cough or strain to stop involuntary leakage of urine. They play a role in sexual function during intercourse. Why should I exercise my pelvic muscles? These muscles are like any other muscle and to carry out their function effectively they need to be fit and adequately toned. If your muscles are allowed to weaken this can then cause issues such as: Stress urinary incontinence. This is urine leakage due to physical exertion. Urge urinary incontinence. Urine leakage associated with a sudden urge to urinate. Mixed urgency and stress incontinence.

3 Pelvic organ prolapse. A bulge of the bowl, bladder or uterus into the vagina or vaginal entrance if more severe. A loss in sexual sensation, or feeling of vaginal looseness. What causes pelvic floor muscle weakness? Under use. As with every other muscle, the pelvic floor muscle needs exercise to work well. Regular and adequate intensive exercise should be maintained through out life, not just after child birth. Damage to the muscle during child birth and pregnancy. Change in hormones associated with menopause may play a role. Decreased muscle tone with aging. A chronic chough Damage to the muscles through long term straining when constipated or associated with a chronic cough or obesity. Repeated heavy lifting Menopausal changes How do I know I am working the right muscle? These are good ways to identify the muscle: 1. Try to tighten your muscles around your vagina and back passage and lift up, as if you re stopping yourself passing water and wind at the same time. 2. A quick way of finding the right muscles is by trying to stop the flow of urine when you re in the toilet. Once you know the muscle release and continue to pass urine. Don't do this regularly because you may start retaining urine. 3. If you're not sure you are exercising the right muscles, put a couple of fingers into your vagina. You should feel a gentle squeeze when doing the exercise. How to exercise your pelvic floor muscles It is important to do these exercises in the correct way and to check from time to time that they are being done correctly. Your therapist can help you understand with the use of diagrams. Doing exercises using the correct technique is much more effective that doing them incorrectly and more often. 1. Sit comfortably with your feet and knees wide apart or lay down on your back with your knees apart and in the air. Lean forward and place your elbows on your knees. Remember to keep breathing throughout and keep your stomach, leg and buttock muscles relaxed. 2. Imagine that you are trying to stop yourself passing gas from the bowel and at the same time trying to stop the flow of urine from the bladder. You should feel a lifting and tightening around the vagina and anus.

4 3. Observing the muscles can be an effective way of checking they are working correctly. Lie propped on the bed; place a small mirror between your legs with your knees bent and apart. As you pull up the pelvic floor you should see your anus and entrance to the vagina lifting and drawing in. If you notice the entrance to the vagina widening, you are pushing down and not pulling up, which is the opposite of tightening the pelvic floor muscle. Also, if you leak urine or pass gas when doing the exercises it is likely you are pushing down not pulling up. You may not be able to immediately contract and relax adequately at first, don t be disappointed. Most patients will learn to contract and relax if they are given some time by themselves at home to practice. How often should I practice? You will first need to determine you start point. Tighten your pelvic floor muscles as much as you can without using your buttocks, thigh muscles or abdominals. Hold tight for as many seconds as you can (up to maximum of 10 seconds) How many seconds did you hold for? Seconds. Rest for the length of the contraction. Repeat the; tighten, hold and release process as many times as you can up to a maximum of 8 12 times. How many times did you repeat the process? Times. This is now your starting point seconds, times.

5 From now on every time you carry out these exercises, aim to increase the duration and number of repeats you can do (up to a maximum of 10 seconds and 8 12 repeats). Once you attain a longer duration or an increased number of repeats that becomes your new starting block. These exercises aim to increase your endurance and work harder for longer. Another set of exercises called quick or fast exercises aim to increase the ability of your muscles to react quickly while laughing, sneezing or coughing. To do these, squeeze your pelvic floor as hard as you can but release them immediately after. Do these as many times as you can (do not exceed 8 12 repeats.) Things to remember: Doing the exercises using the correct technique is better than using the wrong technique for a longer duration or increased repeats. Make sure you are not: o Holding your breath o Tightening your buttocks o Squeezing your legs together o Pulling in your tummy muscles too much (although you may feel a slight tightening of your lower tummy muscles). You do not want to over work the muscle until it starts to ache. To do BOTH exercises 3 times a day for at least 6 months. Always contract your pelvic muscles before you cough, sneeze, jump or lift. This prevents leakage. How quickly will I see results? You may not feel your bladder control increase for 3 to 6 weeks but it may take up to 6 months to see any significant improvement. Do not give up! Pelvic floor exercises have shown to yield the best results as compared to alternatives such as vaginal cones or electric stimulation. After you have completed your exercise programme, it is important to maintain control. Try to keep doing both these exercises twice a week 3 times a day. If you cannot contract your pelvic floor There are additional treatments if you cannot contract your pelvic floor. Your may be offered: Biofeedback This aims to help women identify and contract and relax selectively the pelvic floor muscles using signals from their own bodies. Feeling the muscles with your fingers is one example of this. Other methods involve using small sticky electrodes which are placed on the abdomen and buttock area or in the

6 vagina or back passage and then to a probe connected to a computer. The strength and length of the contraction you perform can then be seen on the computer screen. Electrical Stimulation therapy Sometimes the pelvic floor muscles cannot (yet) contract due to nerve damage e.g. from the delivery of a baby or after surgery. Electrical stimulation will provide an artificial contraction of the pelvic floor muscles, so helping to strengthen them. This method is not suitable for women who can already continent. Pregnancy If you are pregnant, or planning to get pregnant, you can start doing pelvic floor exercises straight away. The exercises will decrease your chances of experiencing incontinence after having your baby. Other things to consider Avoid drinking tea, coffee and other caffeinated drinks. Avoid alcohol Don t get into the habit of going to the toilet just in case. Try to avoid gaining weight. Do not lift things that are too heavy for you. For further information For further information on pelvic floor exercises please visit: and search for what are pelvic floor exercises and search for pelvic floor exercises". Some national organisations available for information: In Contact: Promo Con Direct self referral for patients to continence services for postcodes in: Derbyshire: Belinda Hamblin. Tel: belinda.hamblin@derbycitypct.nhs.uk Leicestershire: Vera Macdonald. Tel: vera.macdonald@lcrpct.nhs.uk

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