Condition guide
Leaking urine when you cough, sneeze, laugh or strain is very common, especially in women who have given birth and in women past middle age, and it often goes unspoken because people feel embarrassed. The good news: regular pelvic floor exercises are the first-line treatment for this kind of leaking, and they work very well.
The pelvic floor is a group of muscles that stretches like a hammock across the base of the pelvis and supports the bladder, womb (uterus) and bowel. These muscles help you control your bladder and bowels. Pregnancy and childbirth, the menopause, a long-lasting cough, constipation, excess weight and heavy lifting can all weaken them.
A 2018 Cochrane review of 31 studies involving 1,817 women found that women with stress incontinence who did pelvic floor exercises were 8 times more likely to recover than those who did not exercise (56% vs 6%). Across all types of incontinence, they were 5 times more likely to recover (35% vs 6%). Quality of life also improved clearly, and side effects were rare and mild.
The UK's NICE guideline recommends at least 3 months of pelvic floor exercises, supervised by a specialist, as the first-line treatment for stress or mixed incontinence. The programme should include at least 8 contractions, done 3 times a day, and should be continued if it helps.
The guideline also recommends losing weight if your body mass index (BMI) is over 30, cutting down on caffeine if you have urge symptoms, and adjusting how much you drink if you drink too much or too little.
Squeeze and lift the muscles inwards and upwards, as if you were trying to stop yourself passing urine and holding in wind. When you do it correctly, almost no movement can be seen from the outside.
Exercises at home
Start lying down; once you can find the muscles easily, do the exercises sitting and standing. Work on both long (held) squeezes and quick squeezes.
Lie on your back with your knees bent. Squeeze your pelvic floor muscles inwards and upwards, as if you were trying to stop yourself passing urine and holding in wind. Do not squeeze your buttock, tummy or thigh muscles, and do not hold your breath. Hold the squeeze for as long as you can, then relax fully for the same length of time.
8–10 times, holding for up to 10 seconds, 3 times a daySit up straight on a chair with your feet on the floor. Do the same squeeze sitting down; then add a few quick squeezes, tightening the muscles quickly and letting go straight away. Quick squeezes help the muscles switch on fast when you cough or sneeze.
8–10 long and 10 quick squeezes, 3 times a dayOnce you can do the squeeze comfortably lying down and sitting, try it standing up. Doing it standing teaches the muscles to take the load in everyday life. You can do it while washing up or waiting in a queue.
8–10 squeezes, 3 times a dayJust before you cough, sneeze, laugh or lift something, squeeze your pelvic floor muscles and hold the squeeze until the movement is over. This habit helps to reduce leaking at moments of strain.
Before every moment of strainLie on your back with your knees bent and your feet flat on the floor. First squeeze your pelvic floor muscles, then slowly lift your hips; hold for 3 seconds, lower back down and relax the muscles.
10 repsWear comfortable shoes and walk at a pace where you can talk but not sing. On bad days, walk for less time, but do not stop altogether.
Start with 5–10 minutes; add a few minutes each weekIt is common, but it is not inevitable, and it can often be treated. Do not feel embarrassed to talk to your doctor or physiotherapist; for most women, the first-line treatment is pelvic floor exercises.
Muscles take time to get stronger; the guideline recommends at least 3 months of regular exercise. If the exercises help, you need to keep doing them.
Many people squeeze their tummy, buttock or thigh muscles, or hold their breath, when they first start. The guideline recommends that the exercises are taught by a specialist; a physiotherapist can help you find the right muscles and adjust your programme. Do not practise by stopping your flow of urine midway on the toilet.
Pelvic floor exercises are also used in men, especially after prostate surgery. The programme needs to be planned together with a urological assessment.
See a doctor without delay if you have any of the following:
Sources
İhsan Eren