Treatment with Exercise

Anti-incontinence exercises are designed to strengthen the pelvic floor muscles (the muscles that hold the bladder in place). These muscles are also called the 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 (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 you are using abdominal muscles or contracting the buttocks, these exercises are being performed improperly. If you have difficulty identifying the levator muscles, biofeedback therapy can help. For some people, electrical stimulation further enhances pelvic muscle rehabilitation therapy.

Pelvic Floor Exercises

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. Be sure to avoid contracting the abdominal, buttock, or inner thigh muscles. Use one of the following techniques to learn how to squeeze these muscles: (1) try to stop the flow of urine while in the middle of going to the bathroom; (2) squeeze the anal sphincter as if to prevent passing gas; and (3) tighten 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 (you may have to start with a count of two or three). Do this one time every hour while awake. You can even do them while driving, reading, or watching television. After practice, you may be able to hold each contraction for at least 10 seconds, 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 you do not notice an improvement after four to six months, you may need additional help, such as electrical stimulation.
• For urge incontinence, pelvic floor muscle exercises are used to retrain the bladder. When you contract 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 you feel urinary urgency, you can try to stop the feeling by strongly contracting the pelvic floor muscles. These steps may give you more time to walk slowly to the bathroom with urinary control.
• This technique may be used for stress and urge symptoms (mixed incontinence).
• Be sure that you are not contracting your abdominal muscles when performing these drills. This can worsen urinary incontinence.
• Practice contracting the levator ani muscles immediately before and during situations when leakage may occur. This is known as the guarding reflex. Involuntary urine loss is stopped by tightening the urinary sphincter at the appropriate time (for example just as you are about to sneeze). By making this muscle squeeze a habit, you can develop a protective mechanism against stress and urge incontinence.
• Success in reducing urinary incontinence has been reported to range from 56-95%. Pelvic floor exercises are effective, even after multiple anti-incontinence surgeries.

Vaginal Weights

Vaginal weight training can be used to strengthen the pelvic floor muscles and treat stress incontinence in women. Vaginal weights look like tampons and are used to enhance pelvic floor muscle exercises. Shaped like a small cone, vaginal weights are available in a set of five, with increasing weights (for example, 20 g, 32.5 g, 45 g, 60 g, and 75 g). As part of a progressive resistive exercise program, a single weight is inserted into the vagina and held in place by tightening the muscles around the vagina for as long as 15 minutes. As the levator ani muscles become stronger, the exercise duration may be increased to 30 minutes.

• This exercise is performed twice daily. With the weight in place, you can feel the appropriate muscles working so you know you are contracting the pelvic floor muscles. The contraction needed to keep the weight in place within the vagina increases the strength of the pelvic floor muscles.
• The best results are achieved when standard pelvic muscle exercises (Kegel exercises) are performed with intravaginal weights. In premenopausal women with stress incontinence, the rate of cure or improvement is approximately 70-80% after four to six weeks of treatment. Vaginal weight training also may be useful for postmenopausal women with stress incontinence; however, vaginal weights are not effective in the treatment of pelvic organ prolapse.