Pelvic Floor Exercises

Urinary and bowel control (continence) involve muscles of the pelvic floor. The pelvic floor muscles include muscles that begin at the pubic bone and attach to the tailbone. Openings in the muscle allow the urethra and rectum to pass through as well as the vagina in women. Keeping these muscles in good health and strength minimize urine or stool control problems. The external sphincter is controlled voluntarily and allows interruption of the stream or squeezing to ‘hold back’ the urge to void. The internal sphincter is under subconscious control and is responsible for keeping us dry when we are not paying attention to our bladder.

Kegel exercises refer to a method of exercising these muscles to improve urinary control. By exercising the voluntary (external sphincter) muscles, the involuntary (internal sphincter) is indirectly exercised. When tightening the pelvic floor muscles, breathing should be regular. Abdominal and buttock muscles should not be tightened, instead, just the muscles around the urethra, anus (and vagina).

FOR MEN: First squeeze the rectum closed. Visualize pulling up the scrotum. Imagine you are in a crowded room and you have to pass gas. Tighten those muscles without interrupting regular breathing. The penis should shorten like a turtle pulling its head inside its shell. If leakage persists during the exercise, you are probably pushing down rather than pulling up on the pelvic floor. If you leak more after these exercises, you have probably overdone them or performed the exercises incorrectly.

FOR WOMEN: Place your index finger into the opening of the vagina. Squeeze the pelvic floor as though you are trying to tighten around your finger and pull it up into the vagina. By sensing the tightness around your finger, you can measure how strong the muscles are and how well you can hold the squeeze. Do not hold your breath or tighten the abdomen or buttocks. You do not always have to have your finger in the vagina, but it is useful to check on your technique and progress.

EXERCISE ROUTINE: Get in the habit of performing pelvic floor exercises three times daily, for life. If you are sore or fatigued after the exercises, reduce the duration and frequency. Initially start with 3 sets of 10-15 exercises of short squeezes and increase the strength and duration of each squeeze as you get stronger.

URGE SUPPRESSION: Once you are experienced in these exercises, you can perform 3 short, hard squeeze and relax maneuvers to suppress a sudden urge to void that sometimes happens when you are near running water, assuming that you do not really need to void. The above exercise program should reduce the frequency of urgency.