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• Exercises to Help Prevent Bladder Incontinence
• Safety Considerations

Incontinence can have a number of causes, from surgery to injuries to pregnancy or age. Regardless of the cause of incontinence, it’s normal to want to reduce or relieve its symptoms. Most types of urinary incontinence are at least partially the result of weak pelvic muscles. Both men and women can suffer from weak pelvic muscles, though this is more common in women. 

Most bladder incontinence exercises are known as Kegel exercises, and focus on strengthening your pelvic floor muscles. This type of exercise has two important effects. First, it helps condition these muscles so they can help hold urine for longer. Second, it gives you better conscious control over urination, since you are more aware of the muscles and how to use them.

Kegel exercises are one type of workout you can do anywhere, anytime. When you’re doing Kegel exercises properly, they are invisible to others. The most important thing to understand is that Kegel exercises only involve the pelvic muscles, not the stomach or chest muscles. You should feel like you’re clenching up and in, not pushing down and out like a bowel movement. 

Finding Your Kegel Muscles

The first step to properly exercising your pelvic muscles is to feel them in your body.

Step 1: While sitting down or standing up, feel the sensation of urinating.

Step 2: Imagine the sensation of stopping your urine stream before your bladder is empty.

Step 3: Notice which muscles tense when you imagine this sensation. These are your pelvic muscles. The way they tensed in this exercise is the beginning of most Kegel exercises.

Note: don’t actually do this when urinating. Regularly stopping your urine before your bladder is empty can damage your bladder and even result in bladder infections. If this exercise isn’t helpful, you can also imagine the sensation of avoiding passing gas or squeezing a tampon if you have a vagina.  

Sitting Fast-Twitch Exercise

You have two important kinds of muscle tissue, known as fast-twitch and slow-twitch muscles. You have both in every part of your body, including your pelvic muscles. Fast-twitch muscles react quickly, and can help you avoid stress incontinence such as a urine leak while laughing. 

Step 1: While sitting in a chair, find your pelvic floor muscles. 

Step 2: Clench these muscles like you’re attempting to squeeze something.

Step 3: Release almost immediately.

You can repeat this up to ten times per set, and three sets per day.

Sitting Slow-Twitch Exercise

Slow-twitch muscle tissue is important as well. Strong slow-twitch pelvic muscles support your lower organs and allow you more time between bathroom trips.  

Step 1: Sitting in a chair, bring your attention to your pelvic floor muscles. 

Step 2: Clench your pelvic floor muscles like you’re trying to avoid passing gas.

Step 3: Hold for up to ten seconds, then relax. 

You can repeat this ten times per set, and complete three sets per day.

Horizontal Kegel Exercise

Practicing Kegel exercises while lying down may be more comfortable for you, and this position is equally good at improving your pelvic strength.

Step 1: Lie flat on your bed, a couch, or the floor. If it feels more comfortable, bend your knees so that your legs are at an angle. Place your hands on your stomach.

Step 2: Direct your attention to your pelvic muscles, then squeeze them. Your stomach muscles should not noticeably change under your hands.

Step 3: Hold the pelvic muscle squeeze for up to ten seconds, then release.

You can repeat this ten times per set, and try three sets per day. 

Standing Kegel Exercise

If you notice incontinence or pelvic discomfort while standing, you can also practice Kegels while standing up.

Step 1: Stand upright and pay attention to your pelvic muscles.

Step 2: Squeeze your pelvic muscles up and in. You may notice some tension in your thighs or buttocks, but there should not be additional tension in your stomach. 

Step 3: Hold the pelvic muscle squeeze for up to ten seconds, then relax.

You can repeat this ten times per set, and try three sets per day. 

While training your Kegel muscles is important to reducing incontinence, you should not need to clench them at all times. Certain types of incontinence may actually be linked with overly-tight pelvic floors, since the muscles cannot contract further during stress incidents like coughing fits.. If you believe your pelvic floor is too tense, you should contact your physician. 

Kegel exercises should never cause pain. If you complete a Kegel exercise and it is painful, stop immediately. If the pain continues, contact your physician to identify the cause. 

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Kegel Exercises for Urinary Incontinence & Other Bladder Problems

Kegel exercises are one of the best natural ways to control urinary incontinence.

These simple moves can help many women and men, regardless of your age or what’s causing your problem. They strengthen your pelvic floor muscles, which support your bladder. When these muscles are weak, you’re more likely to have leaks.

Here’s what you need to know:

Who benefits from Kegels? Anyone, at any age, who suffers urinary incontinence or leaks urine. While the exercise mainly helps those with stress urinary incontinence, it can also work if you have urge incontinence from overactive bladder. This causes a sudden urge to pee. You might not always make it to the bathroom. Men can do Kegel exercises to control urinary incontinence that can happen after prostate surgery.

How do you do them? Pretend you’re trying to stop the flow of pee. Pull in and squeeze those muscles. Hold the squeeze for about 10 seconds, then rest for 10 seconds. Try for three or four sets of 10 contractions every day.

How do Kegels help? They strengthen the muscles that help control the urethra. When these muscles are weak, you can’t control the flow as well.

When will I see results? It takes time to build your biceps, so it takes time to strengthen pelvic floor muscles, too. Give it 3 to 6 weeks. Do them daily.

When and where should I do them? The beauty of Kegels is that you can really do them just about anywhere, anytime. No one will know unless you tell them. Try a few sets in your car, at your desk, or while you watch TV. To be sure you have it right, ask your doctor or the nurse to describe the proper form. They can also check that you are doing them correctly.

Do I need any equipment? Not for Kegels alone. Doctors may suggest that women use a weighted cone or even small weights. You’ll insert it into your vagina and do your Kegels with it there. You’ll slowly increase the weight. Some doctors pair Kegels with biofeedback, a monitoring system that helps you with bodily functions like urine control.  Vaginal weights are another option. The small weights are inserted into the vagina and your pelvic muscles contract to hold them in while you are standing. They should be used about 15 minutes a day, twice a day. A non-invasive device – pants with electrical pads – work to stimulate the muscles of the pelvic floor and re-educate them to help control bladder leakage. Another FDA approved method includes a coin-sized device called a tibial neurostimulator that can be implanted in the lower leg and reduce urinary incontinence symptoms. Just like therapy for a weak/injured shoulder there are specialists dedicated to helping with pelvic floor weakness and dysfunction, so pelvic floor physical therapy is an option. 

Are there other benefits to Kegels? Yes. They can also help you out in the bedroom. When your pelvic floor muscles are in shape, they’ll contract more strongly during an orgasm.

SOURCES:

American Academy of Family Physicians: “Urinary Incontinence: Kegel Exercises for Your Pelvic Muscles. “

National Kidney and Urologic Diseases Information Clearinghouse: “Urinary Incontinence in Women.”

National Library of Medicine MedlinePlus Medical Encyclopedia: “Urge Incontinence.”

WebMD Medical News: “Kegel Exercises Help Women With Urinary Incontinence.”

WebMD Medical News: “Kegel Exercises Ease Stress Incontinence.”

WebMD Health Guide: “Benefits of Kegel Exercises for Incontinence.”

WebMD Sex Matters: “What is a Kegel and can it really help my sex life?

Women’s Pelvic Floor Strengthening Exercises

This fact sheet has been compiled to educate patients about pelvic floor strengthening exercises.

More than 50% of women who have given birth have problems with urination, and at an older age, prolapse of the uterus (prolapse), which can be caused by weakness of the pelvic floor muscles.

Strong pelvic floor muscles help improve bladder and sexual function, as well as maintaining internal organs in a normal anatomical position. Pelvic floor muscle problems can be caused by pregnancy, childbirth, chronic constipation, being overweight, smoking, menopause, and neurological problems.

Symptoms of pelvic floor weakness may include incontinence when coughing and sneezing, frequent urination and the need to urinate at night, vaginal pain, pain during sex.

To prevent and alleviate urinary incontinence and organ prolapse, it is very important to learn how to contract the pelvic floor muscles correctly.

The pelvic floor muscles are located in the pelvic floor area between the pubic bone and the coccyx. Their function is to maintain the correct position of the organs (uterus, bladder, intestines) inside the pelvis, as well as to keep the urethra and anus closed to prevent involuntary leakage of contents, and to relax them during emptying.

Like all other muscles in the body, the pelvic floor muscles also need special training.

Manual

Get into a comfortable sitting or lying position. Try to tighten your pelvic floor muscles as if you are trying to interrupt the flow of urine or intestinal gases by pulling the muscles up.

You may feel tension when the muscles contract. Do not hold your breath, take a deep breath through your nose and slowly exhale through your mouth. At the same time, the abdominal muscles can also tense up, this is normal.

Try to keep the muscles of the buttocks and legs relaxed. After each contraction of the pelvic floor muscles, try to completely relax these muscles.

Three basic ways to control the correct contraction of the pelvic floor muscles:

1. Observe the perineum through a mirror and tighten the pelvic floor muscles. Watch to see if the vagina moves inward in the opposite direction from the mirror. If you see the movement of the vagina towards the mirror, stop immediately and seek help from a physical therapist who specializes in training the muscles of the pelvic floor.
2. Place your thumb or index finger into your vagina. As your pelvic floor muscles contract, you should feel your vagina tighten around your finger.
3. Contract your pelvic floor muscles during sex, asking your partner if they feel pressure.

How to Do Pelvic Floor Exercises

1. Contract your pelvic floor muscles and try to hold that contraction for a count of seconds, and then relax those muscles for the same number of seconds. For how many seconds can you maintain muscle tension? How many reps can you do?
2. Alternately contract the pelvic floor muscles for 1 second and then relax them also for 1 second. How many of these short repetitions can you do before you feel tired in the muscles? Always relax your pelvic floor muscles before each new contraction.

Your goal is to do 10 long contractions while holding the muscle tension for 10 seconds; each contraction should be alternated with a 10 second relaxation. Then do 10 short contractions; each contraction should alternate with a short relaxation.

You can start with a shorter duration and fewer repetitions. Do exercises at least 3 times a day. At first, the exercises are easier to perform in a sitting or lying position. You should feel the results in 3-5 months. Subsequently, to maintain the result of the exercise, you can do it once a day. As your muscles strengthen, try to do the exercises in other positions as well (for example, lying on your side, while resting on your knees, standing, while moving).

Try to tense your pelvic floor muscles before coughing, sneezing, lifting weights, laughing.

Avoid carbonated or caffeinated drinks to prevent constipation. Drink at least 1.5 liters of water per day. When you have a bowel movement, place your feet on a small footrest to squat as if (this makes it easier to have a bowel movement). When you have a bowel movement during constipation, pressure on the pelvic floor muscles increases.

Eat healthy and be physically active (move at least 150 minutes per week).

Try to make pelvic floor muscle training your daily routine, so as not to forget about it, you can set a reminder on your phone. Do these exercises while waiting for public transport or in line at the grocery store.

ATTENTION! Interruption of the stream of urine during urination is allowed only as a control exercise 3 months after you start doing the exercises. This should not be done every time you urinate, as this can interfere with normal bladder emptying.

If you experience pain or problems while exercising your pelvic floor muscles, ask for help from a physiotherapist who specializes in pelvic floor exercises.

ITK963

The information material was approved by the Health Care Quality Committee of East-Tallinn Central Hospital on 10/14/2020 (minutes no. 10-20).

Improvement of urinary retention | Memorial Sloan Kettering Cancer Center

This information will help you improve your ability to hold urine.

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What is urinary retention?

Urinary retention is the ability to prevent involuntary leakage of urine from the bladder. The involuntary leakage of urine is called incontinence. Incontinence can be caused by surgery or radiotherapy to the pelvis, or an overactive bladder.

There are a number of ways to help you exercise your bladder and improve your ability to hold urine. It depends on the diagnosis and the treatment you received. If you have questions or need to know which ones are best for you, talk to your doctor or nurse.

Drink less liquid

• Limit your fluid intake if your doctor or nurse advises. There are no hard and fast rules about how much water you need. You must drink when you are thirsty.
• If you frequently urinate (small to the toilet) at night, do not drink any liquids after dinner.
• If you take medication in the evening, take it with just one sip of water.

Empty your bladder frequently

• Urinate every 1 to 2 hours if possible.
  • If you do leak urine during this time, urinate more frequently.
  • If no urine leakage is observed after 1–2 hours, increase the time between urination.
• Don’t wait until the last minute before you urinate.
• Empty your bladder as much as possible every time you go to the toilet.
• If you are having difficulty urinating, urinate once and then exit the toilet. Urinate again after 5-10 minutes. Use the muscles of the abdominal wall (abdomen) to empty your bladder.

Keep a urinary log

Your doctor or nurse will provide you with a urinary log. Use it to record data on the amount of urine and the frequency of urination. They will also give you a plastic container to collect your urine. (women are given a collection bowl, men – a urinal).

Select any 3 day period. During these three days, urinate only into a bowl or urinal. If you leave home before the end of the collection period, take a urinal or collection bowl with you, as well as a urination journal.

Measure the amount of urine after each urination. Write it down in your urination journal. Then pour the urine down the toilet and flush.

If you have incontinence, write down this information as well. Please indicate how this happened:

• when you were tense;
• pressure on the bladder, such as when coughing, sneezing, bending over, lifting or changing position;
• with uncontrolled urge;
• on the way to the toilet;
• without your knowledge.

Take your urinary log with you to your next appointment. Your healthcare provider will review it with you. If you forgot to measure the amount of urine or cannot do it, tell him about it.

Do Kegel exercises (pelvic floor exercises)

The main purpose of Kegel exercises is to strengthen the pelvic floor muscles. This will help prevent urinary incontinence.

To find your pelvic floor muscles, imagine that you are urinating. Tighten (squeeze) the muscles with which you would interrupt the stream of urine during urination. You can also contract the muscles that keep gas in when you don’t want to let it out.

For Kegel exercises:

1. Tighten your pelvic floor muscles for 2-3 seconds.
2. Relax your pelvic floor muscles completely for 10 seconds.
3. Repeat the exercise 10 times. This is one approach.

Start doing Kegel exercises with 3 sets daily. Increase the number of approaches to 7-10 per day. Follow your doctor’s recommendations for safe Kegel exercises.

When you feel the urge to urinate, do 4-5 Kegel exercises. Focus on stopping the urge to urinate. Before coughing, bending over, or lifting heavy things, you should also do Kegel exercises.

For more information, see Pelvic Floor (Kegel) Exercises for Women or Pelvic Floor (Kegel) Exercises for Men. For more information, visit the National Association for Continence (NAFC) website www.nafc.com.

Limit or eliminate foods and drinks that irritate the bladder.

Changing your diet will help you feel less need to urinate. Limit the amount of certain foods and drinks consumed at one time. For example, don’t include apple juice, cereal with milk, and a banana in your breakfast at the same time.

Talk to your healthcare provider about how to safely change your diet. If you’re a coffee drinker, ask your doctor if you can add milk and sweetener.

Some foods and drinks can irritate the bladder. Examples include foods and drinks containing caffeine or chocolate. Caffeine is a diuretic that makes you urinate more often. Other examples are shown in the table below.

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When to call your health care provider

Call your health care provider if you experience any of the following:

• You experience pain or discomfort while doing Kegel exercises.