Kegels: The 30-second exercise that can improve incontinence and sex

If there was an exercise that took 30 seconds, didn’t require equipment, didn’t require a doctor’s appointment before starting, and had physical and possibly even sexual benefits — you’d do it, right?

Then it’s time to learn about kegel exercises.

As a urogynecologist and co-director of the Center for Pelvic Health, I specialize in female pelvic medicine and reconstructive surgery. I fully encourage patients to learn more about kegels, who should do them, and why they’re part of a leading-edge treatment for many conditions.

What are kegels?

A kegel (pronounced kee-gull) is a pelvic floor muscle exercise that can strengthen pelvic muscles, support pelvic organs, and help control incontinence of urine, bowels and gas. While there’s little scientific evidence to prove it, some doctors believe it also has potential to make sex more pleasurable.

What are the benefits of doing kegels?

They help with the leakage from urine, gas or fecal incontinence. They also can improve the symptoms of pelvic organ prolapse (a herniation that causes the vaginal walls to collapse and protrude, causing the pelvic organs to descend from their normal anatomical position).

Can kegels improve sex?

Kegels improve blood circulation to the pelvic floor and vagina, and this may be helpful for arousal and lubrication. A lot of women, after childbirth, feel like their vagina is not as tight as it was before and they want to have surgery for that. But strengthening the pelvic floor muscles with kegel exercises can make it a little bit more taut. It might be tighter because women are better able to contract their muscles, and that might improve sensation. Even if it’s psychological, it can help women feel better about their pelvic floor, so there’s a positive benefit.

Are kegels only for women? Or, are kegels for men, too?

They’re beneficial to men, too. They help men with overactive bladder symptoms, stress, gas, or fecal incontinence symptoms. For example, men who undergo prostate surgery may benefit from kegel exercises.

Are kegels only for people with pelvic problems? Or can anyone do them?

They’re not harmful to anyone. It’s like any muscle in our body. We go to a gym to address muscles in our arms and legs, but we neglect the pelvic floor muscles. Keeping up with pelvic floor health is good. During pregnancy, women can benefit from them if they do them correctly. A lot of women do them wrong and that can exacerbate certain problems.

What can happen if you do a kegel incorrectly?

Women often incorrectly contract their buttocks or gluteal muscles, or inner thighs, and basically squeeze their thighs together. Many strain and increase their abdominal pressure. That’s not good for two reasons. One, it’s ineffective. And two, straining results in the opposite effect. Chronic straining is a risk factor for developing and worsening problems like pelvic organ prolapse or stress incontinence.

Do you recommend them to all your patients?

They are pretty much beneficial for all patients. There are very rare situations when they’re not recommended, such as in patients with urinary retention problems. They have incomplete bladder emptying, so you don’t want them to further strengthen their pelvic floor muscles and possibly worsen their bladder emptying.

Can physical therapists help with kegels?

Absolutely. Pelvic floor physical therapists can teach you how to do kegels in a correct and more effective way. They use different techniques for monitoring and provide feedback. It’s like having a personal trainer at the gym. You can find instructions for kegels online and do them on your own, but if you have someone who teaches you how to do them, and gives you professional feedback, it helps you do the exercises correctly and more effectively. It’s been proven in research studies that it’s more effective than doing them on your own. At the University of Chicago Medicine, we have a very good physical therapy team that specializes in pelvic floor issues.

What types of things does UChicago Medicine’s Center for Pelvic Health do that make it stand out from other hospitals?

We’re lucky that our team of specialists at the Center for Pelvic Health is truly a multispecialty group. So, we are able to manage a very wide spectrum of conditions. We can provide care for any condition related to the pelvic floor. We have a very strong colorectal team, which is focused on pelvic floor dysfunction. All the members of the center are very dedicated and cherish very collaborative relationships. That’s really our strength. We include urogynecologists, urologists, colorectal surgeons, pelvic floor physical therapists, pain specialists, minimally invasive gynecological surgeons, radiologists and more.

The Best At Home Incontinence Exercises

Don’t let stress or urge incontinence rule your bladder when there are tons of incontinence exercises that you can do to retrain your bladder, strengthen your pelvic floor and enhance your ability to stop leaks. Best of all, you don’t have to join a gym. Incontinence exercises for both men and women can be performed in the comfort of your own home.

Stress Incontinence: Stress incontinence occurs when a physical movement or activity such as laughing, lifting something heavy, coughing, or sneezing that causes pressure on the bladder leading to bladder leakage. Stress incontinence symptoms are more common in women, especially after childbirth.

Urge Incontinence:  Urge incontinence is characterized by the sudden urge to urinate followed by sudden bladder contractions leading to leaks. This may cause the bladder to fully void. Once the urge suddenly strikes many patients are unable to make it to the toilet in time.

However, by doing exercises that target the pelvic floor you can strengthen your ability to hold urine until you make it to the restroom. The pelvic floor muscles support the urinary tract organs such as the bladder, uterus, small intestine, and bowel and assist with urinary control, continence, and sexual function.

1. Kegel Exercises

Kegel exercises can strengthen your pelvic muscles enough to stop urine midstream. Also, even though this exercise is usually associated with women, it can be beneficial for men as well. They help with a speedy recovery after childbirth or prostate surgery and can help prevent vaginal and bowel prolapse.

To perform your Kegels: 

• Focus to find the muscles used while you urinate.
• Tighten those muscles as tight as possible.
• Hold that position for 3 to 5 seconds. The muscles should feel as if they are lifting upwards as a result.
• Take a rest for several seconds.
• Over time as your muscles get stronger, you can hold them for longer periods of time.

2. Squats

Squats are a bit of a more intensive exercise but can provide pelvic and buttocks strengthening results for both men and women. If you’re physically able, it’s worth a try. However, never participate in any physical activity until you’re fully healed. It may be worth talking to your doctor before moderately exercising.

To squat things out: 

• Stand comfortably with your feet flat on the floor, hip-width apart.
• Slowly bend your knees while positioning your buttocks towards the floor. Be sure to keep your back straight and slightly lean forward. Keep your knees in line with your toes.
• Then slowly return to a standing position while keeping your buttocks and pelvic floor tight.
• Take a few seconds to rest in-between each rep and repeat this exercise 10 times.
• Rest between each set of reps.

3. The Bridge

The bridge primarily targets your glutes but helps with the pelvic floor as well. So, why not have buns of steel and better bowel control?

To do the bridge:

• Lay down on the floor on a yoga mat or a soft comfortable spot with your knees bent, feet flat on the floor, and arms down by your sides.
• Pull your buttocks and pelvic muscles tight and lift your buttocks several inches off the ground.
• Hold this position in the air for 5 to 10 seconds.
• Relax your muscles and slowly lower your buttocks back to the ground.
• Repeat this process up to 10 times and rest in between each rep.
• Teak a rest in between each set and try to perform three sets of reps daily.

4. The Squeeze and Release

The squeeze and release is your secret weapon towards getting your pelvic muscles to respond quickly. This can be very helpful for stopping leaks in pinch!

To squeeze and release: 

• Sit or stand in a comfortable position and think of the muscles used to control your urine flow.
• Squeeze your pelvic muscles as quickly as possible and rapidly release them with no attempt to hold the position.
• Take a rest for 5 to 10 seconds.
• Repeat contracting your pelvic muscles for 10 to 20 reps.
• Perform this exercise 3 times throughout the day.

There are also a variety of relaxing yoga poses to help you relieve stress and anxiety while gaining physical strength and toning your pelvic floor. These poses can also improve digestion, lower blood pressure, and relieve pain in the pelvic area.

1. Hook Lying With Block

This relaxing technique helps strengthen your hips, pelvis, buttocks, and lower back!

• Relax by laying on the floor with your knees bent, keeping your feet slightly apart.
• Place a yoga block between your knees.
• Slowly exhale as you squeeze the block with your knees and lift your pelvis off the floor.
• Inhale and relax your muscles as you return your buttocks to the floor without dropping the block.
• Do this for 8 reps.

2. Reclining Bound Angle Pose (Supta Buddha Konasana)

• Remain on the floor, but remove your yoga block, while keeping your knees bent.
• Inhale and slowly spread your knees, dropping them to the floor on the sides.
• Exhale while slowly bringing your knees together and lifting your pelvis off the floor.
• Contract your pelvic muscles.
• Release them and return to the floor.

3. Two-Footed Pose (Dvipada Pittham)

Bonus Incontinence Tips

You don’t have to rely on incontinence exercises that you can easily do anywhere to reduce symptoms. There are simple everyday lifestyle changes that will ease pressure on your urinary tract for more confidence when it comes to controlling leaks.

• Maintain a healthy diet. Avoid eating sugary, fried, greasy, or spicy foods that may upset your stomach. Instead get plenty of fiber, fruits, and vegetables to add bulk to your stool.
• Get active by moderately exercising a few times a week to lose weight. Yoga, power walking, swimming, or using an elliptical are all great ways to shed extra pounds and strengthen your core.
• Be prepared with the right supplies to confidently catch-all liquids and odors if they occur. The right incontinence supplies for you may be covered through insurance, so don’t battle your symptoms without them.
• Practice training your bladder by trying to extend the amount of time between visiting the bathroom once an urge strikes. Start by trying to hold it for a minute then slowly add extra minutes as your muscles become stronger.

Pelvic Floor Exercises | Stress Incontinence

If you develop stress incontinence, there is a good chance that it can be cured with pelvic floor exercises. Pelvic floor exercises are also useful to prevent incontinence, particularly for women who have had children.

What are the pelvic floor muscles?

The pelvic floor muscles are a group of muscles that wrap around the underneath of the bladder and rectum. Your doctor may advise that you strengthen your pelvic floor muscles:

• If you develop stress incontinence. In stress incontinence, urine leaks when there is a sudden extra pressure (‘stress’) on the bladder. Urine tends to leak most when you cough, laugh, or exercise (like jump or run). Strengthening the pelvic floor muscles can often cure stress incontinence.
• After childbirth. The common reason for the pelvic floor muscles to become weakened is childbirth. If you do pelvic floor muscle exercises after childbirth, it may prevent stress incontinence developing later in life.

In addition, some people feel that having strong pelvic floor muscles heightens the pleasure when having sex.

Female urinary system

Pelvic floor exercises to treat stress incontinence

It is important that you exercise the correct muscles. Your doctor may refer you to a continence advisor or physiotherapist for advice on the exercises. They may ask you to do a pelvic floor exercise while they examine you internally, to make sure you are doing them correctly.

The sort of exercises are as follows:

Learning to exercise the correct muscles

• Sit in a chair with your knees slightly apart. Imagine you are trying to stop wind escaping from your back passage (anus). You will have to squeeze the muscle just above the entrance to the anus. You should feel some movement in the muscle. Don’t move your buttocks or legs.
• Now imagine you are passing urine and are trying to stop the stream. You will find yourself using slightly different parts of the pelvic floor muscles to the first exercise (ones nearer the front). These are the ones to strengthen.
• If you are not sure that you are exercising the right muscles, put a couple of fingers into your vagina. You should feel a gentle squeeze when doing the exercise. Another way to check that you are doing the exercises correctly is to use a mirror. The area between your vagina and your anus will move away from the mirror when you squeeze.\
• The first few times you try these exercises, you may find it easier to do them lying down.

Doing the exercises

• You need to do the exercises every day.
• Sit, stand or lie with your knees slightly apart. Slowly tighten your pelvic floor muscles under the bladder as hard as you can. Hold to the count of five, then relax. These are called slow pull-ups or long squeezes.
• Then do the same exercise quickly and immediately let go again. These are called fast pull-ups or short squeezes.
• The aim is to do a long squeeze followed by ten short squeezes, and repeat this cycle at least eight times. It should only take about five minutes.
• Aim to do the above exercises at least three times a day.
• Ideally, do each set of exercises in different positions. That is, sometimes when sitting, sometimes when standing and sometimes when lying down.
• As the muscles become stronger, increase the length of time you hold each slow pull-up or long squeeze. You are doing well if you can hold it each time for a count of 10 (about 10 seconds).
• Do not squeeze other muscles at the same time as you squeeze your pelvic floor muscles. For example, do not use any muscles in your back, thighs, or buttocks.
• Some people find it difficult to remember to do their exercises; a chart or a reminder on your phone may help.
• Try to get into the habit of doing your exercises at other times too, whilst going about everyday life. For example, when brushing your teeth, waiting for the kettle to boil, when washing up, etc.
• You may find it helpful to do a ‘squeeze’ just before you do something that would otherwise cause you to leak, like coughing or lifting.
• After several weeks the muscles will start to feel stronger. You may find you can squeeze the pelvic floor muscles for much longer without the muscles feeling tired.

It takes time, effort and practice to become good at these exercises. It is best do these exercises for at least three months to start with. You should start to see benefits after a few weeks. However, it often takes two to five months for most improvement to occur. After this time you may be cured of stress incontinence. If you are not sure that you are doing the correct exercises, ask a doctor, physiotherapist or continence advisor for advice.

If possible, continue exercising as a part of everyday life for the rest of your life. Once incontinence has gone, you may only need to do one or two bouts of exercise each day to keep the pelvic floor muscles strong and toned up and to prevent incontinence from coming back.

Other ways of exercising pelvic floor muscles

Sometimes a continence advisor or physiotherapist will advise extra methods if you are having problems or need some extra help performing the pelvic floor exercises. These are in addition to the above exercises. For example:

• Electrical stimulation. Sometimes a special electrical device is used to stimulate the pelvic floor muscles with the aim of making them contract and become stronger.
• Biofeedback. This is a technique to help you make sure that you exercise the correct muscles. For this, a physiotherapist or continence advisor inserts a small device into your vagina when you are doing the exercises. When you squeeze the right muscles, the device makes a noise (or some other signal such as a display on a computer screen) to let you know that you are squeezing the correct muscles.
• Vaginal cones. These are small plastic cones that you put inside your vagina for about 15 minutes, twice a day. The cones come in a set of different weights. At first, the lightest cone is used. You will naturally use your pelvic floor muscles to hold the cone in place. This is how they help you to exercise your pelvic floor muscles. Once you can hold on to the lightest one comfortably, you move up to the next weight and so on.
• Other devices. There are various other devices that are sold to help with pelvic floor exercises. Basically, they all rely on placing the device inside the vagina with the aim of helping the pelvic muscles to exercise and squeeze. There is little research evidence to show how well these devices work. It is best to get the advice from a continence advisor or physiotherapist before using any. One general point is that if you use one, it should be in addition to, not instead of, the standard pelvic floor exercises described above.

Pelvic floor exercises if you do not have incontinence

The type of exercises are exactly the same as above. If you are not used to doing pelvic floor exercises then perhaps do the exercises as often as described above for the first three months or so. This will strengthen up the pelvic floor muscles. Thereafter, a five-minute spell of exercises once or twice a day should keep the muscles strong and toned up which may help to prevent incontinence from developing in later life.

Kegel Exercises for Urinary Incontinence

You won’t really look like you’re working out. You’ll be watching television, driving in your car, working at your desk, or brushing your teeth. But you’ll also be squeezing and strengthening the pelvic floor muscles through Kegel exercises, a series of muscle contractions that can help control or prevent urinary incontinence.

Dr. Arnold Kegel created these pelvic floor exercises in 1948 as a way to help women who developed stress urinary incontinence following childbirth.

Childbirth or menopause can weaken the pelvic floor muscles that hold the bladder and urethra in place. With those muscles weak, any additional pressure on the bladder caused by a laugh, sneeze, cough, or exercise can cause urine to leak.

Kegel exercises, if done correctly and over an extended period of time, strengthen those muscles to better support your bladder. A review of studies from New Zealand found that women who regularly practiced Kegels were up to 17 times more likely to be cured of incontinence symptoms than women who did not.

Men can benefit, too. Though women make up 75 to 80 percent of the 25 million Americans living with incontinence, men may face similar bladder issues after they’ve had their prostate removed. Kegels are often prescribed for women, but recent research published in the Journal of the American Medical Association suggests more men should be doing them as well. The study found that men who did Kegels over an eight-week period had fewer than half as many weekly incontinence episodes as they had prior to learning the exercises.

Performing Kegel Exercises

Before you start your Kegel regimen, you’ll need to figure out which muscles are the correct ones to focus on. The best way to do that is to sit on the toilet with your legs slightly apart and start to urinate. After a few seconds, try to stop the stream of urine by squeezing without moving your legs. If you stop the urine flow, you’ve likely used the pelvic floor muscles: These are the muscles you will need to strengthen to help control urinary incontinence. It may take more than one try to be sure you have found the right muscle group.

The individual contractions of a Kegel workout require you to squeeze the pelvic floor muscles just as you would if you were trying to stop urine flow. Ideally, Kegel exercises should be done as follows:

• Empty your bladder before beginning.
• Contract the pelvic floor muscles and hold for a count of 10.
• Relax the muscles completely for a count of 10.
• Stand and perform 10 of these contractions. Repeat 10 times each while sitting, and 10 times while reclining, for a total of 30 contractions in a single exercise routine.
• Perform your Kegel exercises three times a day, for a total of 90 contractions a day.

Your Kegel Program

Ninety contractions a day may sound daunting, but keep in mind that you can do them anywhere-while waiting on a supermarket line or pumping gas, for example. After all, no one can see you doing them.

You can help make these exercises second nature by performing them during set triggers — for example, whenever you are stopped at a red light or during commercial breaks. After a while, you might find yourself performing Kegel exercises automatically.

Remember that these are like any other exercises in that results are not automatic. Most notice some improvement in their urinary incontinence after four to six weeks, but it could take as long as three months before you experience noticeable results.

And as with other forms of exercise, remember that overdoing it is a bad thing. Some people try to speed up their progress by performing more repetitions or doing their exercises more often. By doing so, they’re running the risk of overtiring or injuring the pelvic floor muscles, which can make urinary incontinence worse.

Behavioral Methods for Urinary Incontinence

Treatment Overview

Several types of behavioral methods are used for treating urinary incontinence: bladder training, habit training, biofeedback, and pelvic muscle exercises. People who have incontinence due to physical or mental limitations (functional incontinence) can try timed voiding and prompted voiding.

Bladder training

Bladder training (also called bladder retraining) is used to treat urge incontinence. Bladder training attempts to increase how long you can wait before having to urinate. You are taught about the structure of the lower urinary tract and the causes of incontinence.

A schedule for urinating is established, and you are trained to resist the first urge to urinate and to refrain from urinating until the scheduled time. The interval between scheduled bathroom visits is increased until you can refrain from urinating for several hours.

Biofeedback

Biofeedback
is a technique for learning to control a body function that is not normally under conscious control, such as skin temperature, muscle tension, heart rate, or blood pressure.

People with incontinence are taught bladder-sphincter biofeedback methods along with pelvic floor exercises. During biofeedback, bladder, rectal sphincter, and abdominal pressures as well as electrical activity are recorded and displayed for you. By watching the information, you learn to relax your bladder and abdominal (belly) muscles and contract your pelvic floor muscles based on the information displayed.

Women may also use a weighted cone inserted in the vagina as a biofeedback technique during pelvic floor muscle training.

Learning biofeedback requires practice in a lab or other setting with the guidance of a trained therapist. Home biofeedback units also are available.

Pelvic floor muscle training

Pelvic floor (Kegel) exercises can help strengthen some of the muscles that control the flow of urine. These exercises are used to treat urge or stress incontinence. To do Kegel exercises:

• Squeeze the same muscles you would use to stop your urine. Your belly and thighs should not move.
• Hold the squeeze for 3 seconds, then relax for 3 seconds.
• Start with 3 seconds, then add 1 second each week until you are able to squeeze for 10 seconds.
• Repeat the exercise 10 to 15 times a session. Do three or more sessions a day.

Kegel exercises can be done when you are at home or away from home. They can be done at any time of day. No one will be aware that you are doing the exercises. So you can do them often, no matter where you are.

Kegel exercises are often combined with biofeedback techniques to teach the proper exercise methods and to make sure the exercise is working. To be effective, pelvic floor (Kegel) exercises with or without biofeedback techniques require a high level of motivation and frequent repetition.

What To Expect After Treatment

These methods are often successful in reducing or stopping urinary incontinence.

Why It Is Done

Behavioral methods may be used to treat:

• Urge incontinence (using bladder training).
• Stress and urge incontinence (using pelvic muscle exercises).

How Well It Works

Bladder training

• Bladder training does not work well for everyone. But some people benefit significantly.
• Many people who use bladder training have fewer symptoms of incontinence. For some people, the incontinence completely stops.

Biofeedback

There is not a lot of evidence for biofeedback combined with other behavioral therapies for urinary incontinence. More research is needed.

Pelvic floor muscle training in men

Two reviews were done of men using pelvic floor muscle training to improve continence after prostate surgery. Results were not the same, but there does seem to be a benefit in men who do pelvic floor muscle exercises. One review showed that pelvic floor muscle training did help men control leakage of urine after a radical prostatectomy for prostate cancer.^{footnote 1} But the other review showed no benefit overall in men trying pelvic floor muscle training after any prostate surgery.^{footnote 2}

Another study showed that men who did pelvic floor muscle exercises after prostate surgery had much improved urine leakage compared to men who did not do the exercises. ^{footnote 3}

Pelvic floor muscle training in women

Women who do Kegel exercises are more likely to improve, and even cure, their incontinence. These women had fewer leakage problems a day and said their quality of life was better.^{footnote 4} Women who do these exercises during and after pregnancy can reduce their chance of urine leakage after delivery.^{footnote 4}

Women who did these exercises for urinary incontinence (urge, stress, or mixed incontinence) got better. The exercises seem to work better in women who have stress urinary incontinence and who keep doing the exercises.^{footnote 5}

Risks

No risks are associated with these treatments.

What To Think About

Behavioral methods such as bladder training require a high level of motivation.

To be effective, pelvic floor (Kegel) exercises with or without biofeedback techniques require a high level of motivation and frequent repetition.

References

Citations

1. MacDonald R, et al. (2007). Pelvic floor muscle training to improve urinary incontinence after radical prostatectomy: A systematic review of effectiveness. BJU International, 100(1): 76–81.
2. Campbell SE, et al. (2012). Conservative management for postprostatectomy urinary incontinence. Cochrane Database of Systematic Reviews (1).
3. Goode PS, et al. (2011). Behavioral therapy with or without biofeedback and pelvic floor electrical stimulation for persistent postprostatectomy incontinence. JAMA, 305(2): 151–159.
4. Hay-Smith J, et al. (2008). Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews (4).
5. Dumoulin C, Hay-Smith J (2010). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews (1).

Credits

Current as of:
June 29, 2020

Author: Healthwise Staff
Medical Review:
E. Gregory Thompson MD – Internal Medicine
Adam Husney MD – Family Medicine
Avery L. Seifert MD – Urology

Current as of: June 29, 2020

MacDonald R, et al. (2007). Pelvic floor muscle training to improve urinary incontinence after radical prostatectomy: A systematic review of effectiveness. BJU International, 100(1): 76-81.

Campbell SE, et al. (2012). Conservative management for postprostatectomy urinary incontinence. Cochrane Database of Systematic Reviews (1).

Goode PS, et al. (2011). Behavioral therapy with or without biofeedback and pelvic floor electrical stimulation for persistent postprostatectomy incontinence. JAMA, 305(2): 151-159.

Hay-Smith J, et al. (2008). Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews (4).

Dumoulin C, Hay-Smith J (2010). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews (1).

What are pelvic floor exercises?

Pelvic floor exercises strengthen the muscles around your bladder, bottom, and vagina or penis.

Strengthening your pelvic floor muscles can help urinary incontinence, treat pelvic organ prolapse, and make sex better too.

Everyone can benefit from doing pelvic floor exercises.

Find your pelvic floor muscles

You can feel your pelvic floor muscles if you try to stop the flow of urine when you go to the toilet.

It’s not recommended that you regularly stop the flow of urine midstream as it can be harmful to your bladder.

Pelvic floor exercises

To strengthen your pelvic floor muscles, sit comfortably and squeeze the muscles 10 to 15 times.

Do not hold your breath or tighten your stomach, bottom or thigh muscles at the same time.

When you get used to doing pelvic floor exercises, you can try holding each squeeze for a few seconds.

Every week, you can add more squeezes, but be careful not to overdo it, and always have a rest between sets of squeezes.

After a few months, you should start to notice results. You should keep doing the exercises, even when you notice they’re starting to work.

To find out more about pelvic floor exercises, watch a video about pelvic floor strengthening on the Health and Care Video Library.

Pregnancy and pelvic floor exercises

If you’re pregnant or planning to get pregnant, you can start doing pelvic floor exercises immediately.

The exercises will lower your chance of experiencing incontinence after having your baby.

Find out more about exercise in pregnancy, including pelvic floor exercises.

How pelvic floor exercises can help with sex

Strong pelvic floor muscles can also mean increased sensitivity during sex and stronger orgasms.

Strengthening and training the pelvic floor muscles can help also reduce the symptoms of erectile dysfunction.

Further information

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Page last reviewed: 14 April 2020
Next review due: 14 April 2023

Kegel exercises for urinary incontinence

What are Kegels?

They are pelvic floor muscle exercises. They are done to make the muscles that support the urethra, bladder, uterus, and rectum stronger. To do them you tighten the muscles inside your pelvis.

Why should I do Kegels? 

Often the pelvic floor muscles are weak. This can lead to urine or stool leaking and pelvic organ prolapse.

Studies show doing Kegels:

• Makes your muscles stronger when the exercises are done regularly and with the right technique
• Makes many bothersome symptoms women have better
• Is also risk-free, low cost, and painless

How to do Kegels: 

Many women are not sure what muscles to squeeze at first. Work with your provider to learn the right technique.

You can also check yourself by placing a finger in your vagina and squeezing.

You are using the right muscle when you feel:

• Pressure around your finger
• Your finger draws in and up (not pushed out or down)

Tips to help you do it right are:

• Do not bear down or push.
• Keep your other muscles (stomach, legs, buttocks) relaxed.
  • Do not squeeze your thighs, back, bottom, or abdominal muscles.
• Tighten the right muscles by thinking about lifting up and in.
  • Think about contracting the muscles you use to stop urine or passage of gas.
  • Breathe slowly and deeply.
• It may be easier to start doing these exercises when lying down. As you get stronger you can do them while sitting or standing.

How often should I do Kegels?

• Be sure you are doing them the right way before you start a routine.
• Always empty your bladder before starting.
• Have a routine or link them with something you do every day. 
  • Many women do them for 5 minutes before they get up in the morning and 5 minutes before they go to sleep.
  • Do them while watching TV or stopped at a traffic light.
• Do 10 squeezes 3 times each day.
• Hold each squeeze and count to 3. Then relax and count to 3.
  • You may not be able to do it 10 times or hold it while you count to 3 at first.
  • Slowly hold the squeeze longer, until you can hold it up to a count of 10.
  • As you practice and your muscles get stronger it will be easier.

When will my symptoms get better?

It takes some time for your muscles to get stronger. You will need to do Kegels regularly for at least 6 weeks before you can expect your symptoms to get better.

After your symptoms are better, keep doing Kegels to maintain your strength and symptom control.

Should I change anything when the Kegels get easy?

You can make your muscles stronger by:

• Doing more than 10 squeezes.
• Doing them in more challenging positions (standing, sitting, having your knees apart).
• Squeezing quickly followed by relaxation or squeezing for longer amounts of time.

Additional helpful hints

• Listen to music. This can make it more fun.
• Keep a calendar. Give yourself a check mark or star each time you do Kegels. This will help you keep track of when you started and keep you motivated.
• It takes regular practice to see results. If you stop, start again.
• Reach out to your provider if you are having trouble. Working with a pelvic floor physical therapist may help you strengthen and coordinate your pelvic floor muscles.

90,000 Urinary incontinence: Exercises to improve bladder control

The main muscles responsible for urinary retention are the pelvic floor muscles. Ideally, they allow a person to control urination. However, in some individuals, the pelvic floor muscles are weakened, which may result in urine leakage or difficulty controlling urine flow.

There are many causes of urinary incontinence, including: pregnancy and childbirth, which can weaken the pelvic floor muscles; prolonged constipation, which puts additional pressure on the bladder; untreated urinary tract infections or inflammation; weight gain, which puts additional pressure on the bladder; vaginal surgery in women or for prostate cancer in men.

To cope with urinary incontinence, it is important to do certain physical exercises to strengthen your pelvic floor muscles. The latter are located around the opening of the urethra, vagina and rectum in women. Like all muscles, they need training. Doctors often recommend Kegel exercises as a way to strengthen these muscles and control the bladder. To begin their implementation, it is important for a person to determine which muscles should be trained. To do this, you can use the following methods: when preparing to urinate, focus on stopping the flow of urine, focus on the sensation of the pelvic floor muscles, stopping the flow of urine or at least slowing it down.Men will be able to see small movements of the penis and scrotum as these muscles contract.

Once a person has identified the pelvic floor muscles that require training, you should focus on doing Kegel exercises 2 times a day. For this you need:

• to contract the muscles of the pelvic floor, as if to stop the flow of urine;
• to hold the muscles in a contracted state for 3 s;
• relax muscles;
• repeat this procedure 25 times.

As your muscles get stronger, you can increase your repetition rate from 25 to 50 by doing it 2-3 times a day. Kegel exercises while urinating can affect a person’s ability to empty the bladder completely, which can lead to a bladder infection, so they should not be done while urinating. In addition to Kegel exercises, there are other methods of training the pelvic floor muscles using short and long muscle contractions.

Short cuts . The goal of this exercise is to contract your pelvic floor muscles as quickly as possible and then relax them. It must be performed 2 times a day for 10 repetitions.

Prolonged reductions . The purpose of this exercise is to contract the pelvic floor muscles and hold them in this state for 10 seconds, and then relax. Do 10 repetitions 3 times a day.

The National Association For Continence recommends performing both short and long contractions of the pelvic floor muscles in a single workout.These exercises should be done for about 3 to 6 months before the person feels the benefits of bladder control.

Both men and women with an overactive bladder and urinary incontinence can experience the beneficial effects of pelvic floor muscle strengthening exercises. Women can also use certain tools to train these muscles, such as the vaginal cone.

Other ways to control the bladder include dietary changes – reducing the amount of food that irritates the bladder and reducing the amount of fluids you drink before bed, medication to reduce bladder spasm, and surgery.

Based on materials from www.medicalnewstoday.com

90,000 Exercises to strengthen the pelvic floor muscles

The main method of non-drug treatment of lung and urinary incontinence is exercises to strengthen the muscles of the pelvic floor.

Improvements are observed in almost 70% of people experiencing stress incontinence. This occurs as a result of strengthening the muscles that support the bladder. But remember: to achieve results, you need to exercise regularly, without taking breaks.

Where to start?

First of all, it is necessary to correctly identify these muscles. The best way is to try to interrupt the flow of urine while urinating. If you can do this, it is thanks to certain muscles that you should work with. Please note that this is only a muscle definition test and should not be repeated regularly.

Correct contraction of the pelvic floor muscles is felt as a slight contraction and lifting of the muscles in the lower pelvis into the body.In this case, there should be no additional stress on other parts of the body, for example, the buttocks.

How to do exercises to strengthen the pelvic floor muscles?

• Exercises for contraction / relaxation of the pelvic floor muscles are performed in four counts, for each contraction for 5 minutes, at least 2 times a day. It may take 8 to 12 weeks of focused training before results are achieved.
• When exercising, care must be taken to achieve relaxation between muscle contractions.
• Observe consistency in the exercise. After a few weeks, even the elderly will be able to notice positive results.
• In addition to exercising several times a day, contract your pelvic floor muscles as needed, such as when laughing, coughing, bending over, and when doing any other activity that causes the involuntary flow of urine.
• When you feel that you can control mild and drip urinary incontinence, you can reduce your exercise frequency.To ensure that your muscles work effectively, we recommend training them every day.

Kegel exercises for mild and drip urinary incontinence

Today, in medical practice, an effective and recognized method of treating lung and drip urinary incontinence is exercises to strengthen the muscles of the pelvic floor .

Kegel exercises are considered the simplest and easiest way to train the muscles responsible for urine excretion.This complex includes training to prevent mild and drip urinary incontinence or reduce its manifestations in both men and women. It is believed that the involuntary discharge of urine drops in women associated with pregnancy and childbirth can be prevented if you regularly perform a special set of training.

The complex of Kegel exercises includes training of various types of complexity, all of them help to strengthen the muscles of the pelvic floor. They must be performed continuously and regularly, gradually increasing in complexity and duration.Exercise for lung and drip urinary incontinence is equally effective for both sexes. These include:

• Slow compression. This Kegel exercise involves tightening the muscles that are used to stop the flow of urine. It is necessary to strain them, count to three, and then relax. During relaxation, they also count to three and tighten the muscles again. Over time, you can increase the voltage time up to 5-20 seconds. A more difficult level of this exercise for lung and drip incontinence in women and men is the so-called lift.In this case, a person gradually squeezes the muscles with little force (1st “floor”), then without relaxing them, squeezes even more and holds for 3-5 seconds. This is followed by an even higher “floor”, on which the duration of the voltage also increases, and so on. Upon reaching the 4-7 “floor”, a slow “descent” begins in the reverse order: from more tension with a longer duration to less intense muscle contraction.
• Abbreviations. This type of exercise involves the fastest possible alternating relaxation and muscle contractions.
• Ejection. Kegel exercises of this type are accompanied by the tension of those muscles that are activated when a person pushes. In women, this complex from mild and drip urinary incontinence will be similar to attempts at stool or childbirth. Men need to push as if urinating or stooling.

Exercises to help those diagnosed with mild and drip incontinence should be started gradually. Try slow contractions for 10 reps, 5 times a day to get started.

After you have mastered the simplest level of Kegel exercises with involuntary release of drops of urine, you can proceed to more complex training. So, after a week of regular workouts, you can add 5 repetitions to each approach until their number reaches 30. Then you need to perform 150 exercises daily to maintain muscle tone. At the same time, you can try pushing and contracting.

How to do the exercises

If you have any difficulties, consult your doctor.

Regular performance of Kegel exercises will not require any additional skills or efforts from a person. It will not be noticeable to anyone around you that you are performing this complex; you can do contractions and contractions at any time in a place convenient for you. Practice according to the Arnold Kegel method, and the result will not be long in coming!

How effective is behavioral therapy for stress urinary incontinence

Home »Articles» How effective is behavioral therapy for stress urinary incontinence?

Behavioral therapy is one of the methods of conservative treatment of stress urinary incontinence in women.A set of activities aimed at changing lifestyle often really helps to solve the problem. However, for certain objective reasons, this is not enough to cope with annoying symptoms.

What is behavioral therapy

Behavioral therapy is indicated for various transient urinary disorders at any age, provided that they are not caused by infection or anatomical features. It is prescribed during pregnancy or at the planning stage, as well as if a woman has stress urinary incontinence after childbirth.

Therapy includes:

• adherence to a diet aimed at reducing the volume of secreted fluid;
• Changing behavioral factors to minimize the likelihood of symptoms;
• use of individually selected hygiene products;
• Kegel exercise to strengthen the pelvic floor muscles.

With this diagnosis, it is recommended to reduce the amount of fluid consumed to 1.5 liters

Features of behavioral therapy for urinary incontinence

Patients with such a problem are advised to almost completely abandon coffee and tea, not to consume carbonated drinks, chocolate, and also to remove spicy and salty foods from the diet, which retain fluid in the body. Such measures can minimize the load on the kidneys and urinary system in order to help them adapt and readjust to the correct work.

During behavioral therapy, women use specially selected hygiene products that have special requirements:

• Pads must quickly and reliably absorb and then retain liquid for several hours;
• The surface must remain dry to avoid skin irritation;
• Hygiene products must have an anatomical shape, prevent the spread of odor, and be comfortable and invisible under clothing.

Molimed – specialized pads for people with urinary incontinence

How to do pelvic floor exercises correctly

Exercises that are widely used today for stress urinary incontinence in women, after childbirth or surgery, were developed back in 1948 by Californian gynecologist Arnold Kegel. They consist in sequential contraction and relaxation of the pelvic floor muscles. Over time, this technique was included in various complexes of physiotherapy exercises, and a little later, the author’s varieties of training appeared – gymnastics according to Atabekov, Yunusov, Yagunov, Elkin, Mikeladze, etc.

Kegel exercises are aimed at:

• restore the tone of the pelvic floor muscles;
• to correct the closure function of the urethral sphincter;
• restore normal anatomical relationships between the urethra, symphysis and bladder neck.

It turns out that a seemingly simple Kegel exercise can be performed incorrectly, thereby harming your body. What mistakes are made most often and how to avoid them?

Why behavioral therapy is done in a group format

The problem of stress urinary incontinence is relevant for many women after childbirth or surgery, but most of them feel embarrassed to see a doctor.Medical practitioners have concluded that it is much more effective to work in a group – by analogy with anonymous treatment for alcohol or drug addiction.

Classes are conducted by specially trained personnel. The participants realize that they are not the only ones who have faced such a disease, therefore they take advice more calmly. The motivation to implement the recommendations increases, and therefore the results are more obvious.

Group therapy for this problem is more effective than individual therapy

When behavioral therapy does not work

Sometimes stress urinary incontinence cannot be corrected with behavioral therapy, for example, if the woman does not have enough willpower to follow all the recommendations, or the case is clinically difficult.Most often, patients lack motivation, but sometimes the reason for the lack of success is in significant anatomical disorders of the positions of the pelvic organs. In such cases, it is impossible to influence the situation either medically or with the help of behavioral therapy.

It is unwise to eliminate anatomical abnormalities with behavioral therapy

The functionality of the urethral sphincter can be improved by injecting the drug in the form of a DAM + gel. The drug is injected through a cystoscope with a thin needle into the submucosa of the urethra and the bladder neck.The procedure is performed under local anesthesia. The drug is evenly distributed in the tissues and forms a dense substance, by analogy with a pillow, that is, it restores the turgor and physiological volume of the tissue.

After the introduction of the implant, the sphincter acquires the ability to better resist the increase in intravesical pressure. This means that the problem of urinary incontinence in a woman is solved after the first procedure. With the help of a similar endoscopic correction, it is possible to effectively eliminate the signs and symptoms of vesicoureteral reflux 2, 3, 4 degrees in children and adults.

If the urinary disorder is episodic, caused by psychogenic factors and the patient agrees to numerous restrictions, it makes sense to practice behavioral therapy. In other cases, when urologists insist on a surgical operation, you can turn to a modern, much safer method – injection implantation of Dam Plus gel.

90,000 Kegel exercises for men with urinary incontinence: rules, benefits and contraindications

In 1948 g.Arnold Kegel has developed a therapeutic gymnastic complex to strengthen the pelvic floor muscles, increase their flexibility and improve blood circulation. Most often, these exercises are recommended for women, but Kegel gymnastics for men with urinary incontinence is no less effective.

According to the observations of doctors, thanks to exercises for urinary incontinence in men, it is possible to reduce the manifestation of pathology by 50% after a month. Those who practice three times a day for 5 minutes, six months later, can completely eliminate the problem or reduce the frequency of manifestations to a minimum.

The effectiveness of training increases with the correction of a lifestyle in favor of a healthy one (nutrition, daily regimen, rejection of bad habits). But before you start training, you need to understand the causes of the problem in tandem with a specialist, and, if necessary, undergo diagnostics in order to determine the treatment regimen. Causes of incontinence:

• excessive fluid intake;
• Weakening of the ligaments and muscles that ensure the functioning of the bladder;
• operations on the pelvic organs;
• inflammatory diseases.

Kegel exercises for men with urinary incontinence are effective if the cause of the problem is in the weakness of the muscles and ligaments. In other cases, additional research is required and complex treatment is necessary.

Who is not allowed to study

Despite the seeming safety and ease of implementation, Kegel gymnastics for men with urinary incontinence has contraindications:

• undergone abdominal abdominal surgery;
• benign and malignant tumors of the prostate and pelvic organs;
• infectious, acute inflammatory process in the body.

There are other, temporary and permanent, contraindications that you can ask your doctor (urologist or therapist) about.

Basic rules for performing gymnastics

The benefits of gymnastics for urinary incontinence in men will be if you follow the correct technique and exercise regularly. Fundamental rules:

• Start with small loads, gradually increasing the time of muscle tension. If the studied exercise is given without much effort, it is time to increase the load;
• number of repetitions – up to 30 times;
• performance is provided not by one exercise, but by the whole complex;
• when positive dynamics appear, you cannot stop training.It is allowed to reduce the load, but continue to do gymnastics throughout life;
• Control the muscles involved in order to eliminate tension in the muscles of the thighs and buttocks.

If you follow these rules, you can soon feel the first positive changes. Gymnastics is useful not only for the health of the genitourinary system, but also for the whole organism.

Useful complex

Before you start performing a set of Kegel exercises for men with urinary incontinence, you need to locate the desired muscles. The main one responsible for the control of urination is the pubococcygeal one. To find it, you need to put 2 fingers behind the testicles while urinating and try to stop the stream. At this moment, the work of the desired muscles is felt.

The first exercises may not work because the pelvic muscles are too weak, but the effect will definitely be there. You need to do gymnastics at least twice a day. Where to study, everyone decides for himself – at home, at work, in transport or on the street. This versatility is another advantage of this gymnastics.

The most beneficial exercises for male incontinence are:

1. Increased stamina. Slowly strain the pubic-coccygeal mouse (LMB), hold it in a tense state for a couple of seconds and relax. Repeat 10 times. After a week, start gradually increasing the stress time.
2. Improved control. Slowly tense your muscles and then quickly relax them. Repeat 10 times. In the future, repeat the number up to 30 times.
3. Expansion of the coverage area of ​​the paintwork.Mentally count to 10, in parallel straining the pubococcygeal muscle. Relax at the same pace. It takes 10 approaches.
4. Increase in reaction speed. Contract and relax LMB at a fast pace so that the penis begins to twitch. Repeat for a minute.
5. Gradual voltage build-up. Tighten the working muscle, hold for a couple of seconds, then tighten it even more and continue until the maximum contraction. And then relax in the same way.

It is important to maintain calm breathing with each exercise for urinary incontinence in men.If discomfort, pain, burning sensation occurs, stop exercising immediately and consult a doctor.

How to diversify loads

If over time the standard gymnastics for urinary incontinence in men gets bored, you can diversify the complex by changing the starting positions. The load on the pelvic floor muscles varies according to the position of the body. By varying the starting position from time to time, you can work out all the muscles and improve their tone. It is advisable to perform the daily complex 3 times, each in a different position.

A set of exercises:

1. Starting position – standing, spread straight legs shoulder-width apart. The palms are on the buttocks. Make circular movements with the hips and pelvis, straining the muscles of the lower body as much as possible.
2. Starting position – on all fours. Emphasis on knees and elbows. Relax your back, cross your arms in front of you and rest your head on them. Move the pelvis in and back, contracting and straining the pelvic muscles.
3. Lie on your stomach, stretch your arms along the body.Bend one leg at the knee. Perform sequential contraction and expulsion 10 times. Change leg, repeat.
4. Lie on your back, with the feet of your bent legs resting on the floor. Put one palm on the lower abdomen, the other under the lower back. It is necessary to breathe deeply, while inhaling, drawing in the stomach and holding the position, then relaxing as you exhale. Reduce paintwork during press tension.
5. Starting position – “Lotus” pose. Tighten the muscles of the perineum, while moving the pelvis up and inward.

It is better to perform such gymnastics at home, when no one interferes. During each exercise, it is important to control the work of the desired muscles. Before starting training, be sure to consult a doctor.

How to train the pelvic floor muscles in women to reduce incontinence

Did you know that you can significantly reduce the manifestations of incontinence, and in some cases even completely get rid of it, by doing exercises to strengthen the muscles of the pelvic floor for only 5 minutes a day? It’s never too late to start.And once you get used to the exercise, you can do it anywhere, anytime.

Exercises for the pelvic floor muscles step by step:

• Start doing the exercises lying down, it is more comfortable to contract the muscles.

• To find the muscles you want, start contracting the muscles around the anus. Next, continue to squeeze the muscles around the vagina and urethra. Continue to squeeze them as if you are trying to hold something in the crotch.Relax your hips and buttocks. Continue contracting the muscles for 2 seconds, relaxing them for 2 seconds. Repeat as many times as you can.

• Strong squeezes: Squeeze your pelvic floor muscles as hard as possible and hold for 5 seconds. Then relax your muscles for 5 seconds. Repeat the exercise 5-10 times.

• Prolonged Squeezes: Squeeze the muscles with medium force for as long as possible. Try to keep the muscles clenched for 60 seconds.Do this exercise after squeezing hard.

• Rapid Squeezes: Squeeze the muscles as hard as possible for 2 seconds. Then relax them for 2 seconds. Do the exercise 5-10 times a day, and every time you sneeze, cough, or laugh.

Urologic Incontinence Pads for Women

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90,000 Treatment of urinary incontinence: technology methods

Interview with obstetrician-gynecologist, surgeon, candidate of medical sciences Slobodyanyuk Boris Aleksandrovich. He talks about such a delicate female problem as urinary incontinence. It is this topic that is the main one in medical practice for Boris Alexandrovich.Here he answers each question in as much detail as possible, fully revealing this problem and the possibilities of solving it.

How to get rid of it, who usually gets it, what types are there and what recommendations can you give?

This is my main theme. Urinary incontinence in women is a serious problem that reduces the quality of life. There are many different types of this pathology. The main criterion is the loss of urine through the excretory canal in different situations.

Main types of urinary incontinence:

1. Stressful. However, stress here does not mean the state of the psyche, but the translation from English “stress” – load. That is, this is a loss of urine without the urge – when sneezing, coughing, jumping or lifting weights. For example, many women are unable to go to the gym or jump rope, as this results in a loss of urine every time. Stressful urinary incontinence is the most common type of urinary incontinence.
2. Urgent. With this type, there are very strong, unexpected urges to urinate, which the woman cannot control.Usually, in this case, there are also frequent daytime urination. When it is necessary to go somewhere, women suffering from this disease drink little liquid and, as a rule, always know where toilets are along the way. It turns out that they move from one toilet to another. There are even mobile apps with marked toilets (eg Where is Public Toilet) especially for people with this problem.

   Often, the worst thing is that they still have nocturia – nocturnal frequent urination (more than 2 times). In severe cases, a woman can empty her bladder completely in bed at night. Patients with this pathology suffer greatly, as they experience severe psychological stress. Sometimes, after such episodes, you have to go to the toilet up to 10-15 times in one night, in this condition it is already impossible to talk about any normal sleep.

   Both frequent daytime and nighttime urination and urinary incontinence due to strong urge are included in the concept of overactive bladder syndrome.This is a complex problem, in urology it is treated mainly with medication.

   However, in our research, we saw that 80-85% of cases are associated with prolapse of the uterus. That is, a purely neurogenic factor is a very small percentage. According to our observations, prolapse, even to a small extent, may be the main cause of this pathology. In each case, all this is assessed, examined and appropriate recommendations are given.

3. Mixed view. It contains both a strong urge to urinate and urinary incontinence when coughing and sneezing. When stress urinary incontinence dominates, this is one situation, when urge incontinence is another. These patients are also difficult and require complex treatment. But we have different approaches for different states.
4. Overflow Failure. This type of incontinence is more common in neurological patients, such as multiple sclerosis. In this situation, when the bladder overflows, an involuntary loss of urine occurs.

I have listed the main types of urinary incontinence.Unfortunately, many women face this. We believe that the main cause of incontinence is still pregnancy and childbirth. With pressure and the passage of the head through the birth canal, damage to various structures occurs. In particular, if we are talking about stress urinary incontinence, then, among other things, the pubo-urethral ligament is stretched during childbirth. Also, urinary incontinence is often combined with prolapse of the genitals (uterus and walls of the vagina).

What methods of treatment are there?

Of the conservative methods of treatment, I would like to note the methods of training the muscles of the pelvic floor.There are techniques for electrical myostimulation of the pelvic floor muscles and biofeedback, when a woman learns to correctly use the muscles that lift the anus. This helps in a number of situations.

There is also tibial neuromodulation. This is, so to speak, a method of teaching the bladder to retain urine, some regulation of the system. This method helps 30% of women.

In some cases, it is required to perform either surgical treatment or drug treatment with drugs that relax the bladder.Unfortunately, drug treatment is often only symptomatic, that is, we carry it out – there is an effect, we finish – the effect disappears. Often there are patients in menopause who have atrophy of the vaginal walls, in connection with which we must carry out hormone replacement therapy. In most cases, the female sex hormone estrogen is used – in the form of suppositories or cream in the vagina. All this in combination helps to achieve good results.

As for the surgical treatment of stress urinary incontinence, we have sling operations – inserting a loop under the middle part of the urethra.In almost all patients, we use an adjustable sling, which allows us to tighten or loosen the loop within a week. Thus, we improve our results, reducing the likelihood of complications such as difficulty urinating and recurrence of urinary incontinence in the postoperative period. This method is preferred as it has very good results. A special loop is installed to restore the same pubo-urethral ligament. The loop bends the urethra when coughing, sneezing, or other exertion, but does not interfere with normal urination.

We are applying these techniques, as the efficiency reaches 90%. Studies have been conducted in which the effect persisted up to 17 years. Apparently, this is due to the fact that the loop consists of inert non-absorbable materials.

With mixed urinary incontinence or a combination of incontinence with prolapse (prolapse of the uterus and vaginal walls), more sophisticated techniques are required. The operations are carried out in two stages – first, prolapse is eliminated, and after 3 months urinary incontinence is corrected.Sometimes these stages are carried out at the same time. Nevertheless, we have had positive experiences in the treatment of various forms of urinary incontinence.

At what age do patients usually face this problem?

We are currently conducting research on the symptoms of this pathology during pregnancy, immediately after childbirth, and also within a year after them. About 30% of women have various pelvic floor dysfunctions during this period. Fortunately, in most cases, these processes regress. This is explained by the fact that the connective tissue is stretched for childbirth, since it must be more elastic so that not only the head passes through the birth canal, but there are no ruptures.For some, everything is recovering well, but for some women, full recovery does not occur. This process is not fully understood. However, it is known for sure that pregnancy and childbirth are the trigger factor.

The second moment is the onset of menopause. After 45 years, the collagen content in the connective tissue begins to decrease. Collagen is a protein that provides a framework for the entire body. Perhaps everyone noticed that at a certain age, the skin becomes more elastic. In the vagina and paravaginal tissues, about the same happens.In this regard, after menopause, various symptoms of pelvic floor dysfunctions may appear or worsen. Further, with age, the frequency of these disorders only increases, because many women are engaged in hard physical labor, do not devote time to themselves, do not engage in exercises to strengthen the muscles of the pelvic floor, carry weights, do little sports, smoke, become overweight, diabetes. All these moments do not add health.

How often do conservative treatments help?

We carry out conservative methods of treatment in any case, even if an operation is needed.Before and after surgery, we always ask patients to train muscles, apply local estrogens, if there is a lack of female sex hormones, leading to genitourinary atrophy.

Do conservative methods help well?

Depending on the severity of the problem. With a mild degree of prolapse, the patient can prevent surgery using conservative methods. It’s the same with urinary incontinence. According to various sources, a successful outcome is 20-30%. If there is a pronounced degree of urinary incontinence, then conservative methods become insufficient and, as a rule, surgical treatment has to be performed.

I can say about the methods in which hyaluronic acid is injected periurethrally or laser therapy is used. In my opinion, these methods are insufficiently studied and safe, and also, which can be definitely noted, are short-lived. Doing this procedure once, after a year, almost everyone needs to undergo repeated treatment. I think this is unacceptable, it is necessary to offer the patient a treatment strategy with the longest effect, so that the woman can live peacefully, not thinking about how the same symptoms will return within a year.Therefore, we do not use such methods in our practice.

Can you recommend any exercises for a person to do them himself?

Yes, the so-called exercises of A. Kegel. He is a physical therapist who pioneered the field of pelvic floor rehabilitation in the 1950s.

1. Pulling the anus up and holding this position for some time. We recommend that women do this procedure 100-200 times a day. Let’s say you are drinking tea, riding in a minibus or reading a book – at this time you can do the exercise.The only thing the doctor needs to check is the correctness of the exercise, because many women strain antagonist muscles, for example, the abdominal muscles, which should not be involved at the time of exercise. Therefore, we recommend keeping your hands on your stomach in order not to strain these muscles.

I advise you to check with a doctor who is engaged in gynecology, urogynecology or physiotherapy and will be able to control both the strength of the development of these muscles and the correctness of the exercise.

2. The use of vaginal cones – special weights that a woman holds in the vagina for a certain time.
3. There is a very good method – a portable vaginal electrostimulator, when the necessary muscles are stimulated with the help of an electric current. Subsequently, the woman understands how to properly contract these muscles herself.
4. It is also important to do squats, but shallow, so that the angle at the knees is no more than 90 degrees. That is, deep squats do not need to be done.

In general, yoga, and any physical exercise, physical activity has a very beneficial effect on the pelvic floor. If patients are overweight or obese, we definitely recommend correcting this.

How is the diagnosis carried out in order to give any recommendations, prescribe treatment?

In most cases, just an analysis of complaints, examination is enough, a vaginal examination is also carried out, sometimes with a full bladder, an ultrasound scan. We ask the patient to cough and objectively see what is happening.The most important thing is complaints.

There is also a so-called urodynamic study. Some urologists believe that it is necessary for the diagnosis, but we only use it in controversial, difficult cases. For example, when there was already treatment, but a relapse occurred. We also believe that if there is a combination of genital prolapse and urinary incontinence, then urodynamic examination is completely uninformative. Basically, analysis of complaints is enough. For example, if a patient loses urine at night, then no objective research can verify this.

A so-called PAD test is also used, in which a pad is given to the patient and the amount of urine she is losing is measured. This reflects to some extent the severity of the disease. However, all the same, the effect on the quality of life of the symptoms is determined only by the patient herself, because no one dies from this disease and to someone, for example, one drop on shorts or a small loss of urine during sexual activity is already a tragedy, but for someone, let’s say , 3-4 urological pads a day – normal, the patient says that everything is fine, and it is so, and the neighbor is the same.It turns out that there are no objective criteria for the severity of the disease. This is very subjective and only a woman determines how much it affects her life. In this regard, we use questionnaires that assess the severity of symptoms, their severity for patients directly and how they affect everyday affairs (these are the PFDI-20, PFIQ-7, FSFI questionnaires translated into Russian)

So, and once again you can clarify, if in simple language: there are two options, either prolapse or incontinence? Descent – is it when the uterus descends?

Prolapse is a separate disease, it can be cystocele, rectocele, enterocele, prolapse of the uterus and vaginal walls.And urinary incontinence is a completely different story. However, very often these things are combined. It happens that complicated genital prolapse, that is, prolapse, is sometimes combined with incontinence of intestinal contents, constipation, urinary incontinence, including stressful or urgent – these are strong urges, nocturia, that is, night urination, sometimes pelvic pain, very often difficulty urinating … This is a separate big conversation, a separate topic, and everything is very different for everyone.

Have you had an interesting incident in your practice, perhaps surprising, unusual or funny?

I don’t know, for us one thing is funny, for patients it’s quite another.Maybe it’s better for them not to know. Since we talked about urinary incontinence and prolapse, I can note that after the treatment of a severe form of combined urinary incontinence and complete restoration of urination to the state it was before childbirth, for example, in a week, the patients can sometimes hug, cry and say : “Thank you Doctor! You did it in a way I never dreamed of! ” It is always very pleasant to see the result of our work. And this is not so rare. Many women suffer for many years and consider this the norm.All these problems can be solved, and we have a very high percentage of good results.

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90,000 It is not customary to talk about him: urinary incontinence in women

Some topics related to intimate health are tacitly prohibited. They are embarrassed to talk about them even with close people. When a problem is not discussed, it seems that it is not. Often, a woman with urinary incontinence thinks she is the only one “wrong” and is very ashamed of her disorder.In fact, this is not the case. Let’s see what the statistics say.

There is no need to be afraid, shy and endure. If you are faced with this unpleasant problem, the doctors of the SOVA clinic will definitely help you. And you can be sure that nobody but our doctor will know about your disorder.

Types of urinary incontinence

Depending on the manifestations, there are several types of urinary incontinence:

• Stress urinary incontinence is most common.Leaks happen when the pressure in the abdomen rises: during laughing, sneezing, coughing, exercising, or lifting heavy objects. The most common cause of this condition is weakening of the pelvic floor muscles, prolapse of the vagina and uterus.
• Urgent incontinence. When the urge to urinate arises, the woman does not have time to reach the toilet. This is due to the overactivity of the muscles in the bladder wall.
• Continuous urine leakage . It is caused by a violation of the nervous regulation of the bladder, the work of the sphincter muscles, which normally should hold urine.
• Reflex urinary incontinence is the result of nerve impulses from the brain not reaching the bladder. For example, this condition develops after serious damage to the spinal cord.
• Leakage of urine after urination . Due to muscle dysfunction after using the toilet, there is still some urine in the bladder, which then flows out under the influence of gravity.
• Bedwetting (enuresis) is diagnosed in women and girls over 5 years of age if involuntary urination occurs during sleep.

Why is urinary incontinence more common in women, and what causes it?

The prevalence of the problem among men is only 1.5% – almost ten times less than among women. This is due to some of the features of female anatomy and physiology.

During pregnancy 4 out of 10 women suffer from urinary incontinence, especially in the third trimester. As the fetus grows, it puts more and more pressure on the bladder, urethra, and pelvic floor.The muscles that support the pelvic organs are stretched, and as a result, urinary retention is impaired.

During labor , the pelvic floor muscles experience even more stress. They stretch, the nerves are compressed. Muscles usually recover within 6 weeks and no more urine leaks. If the disorder persists, a doctor should be consulted.

Women have a shorter urethra compared to men. Because of this, with an increase in intra-abdominal pressure, urine leaves the bladder more easily.

During menopause and as a result of age-related changes in the body, the pelvic floor muscles continue to weaken and stretch, changes occur in the mucous membranes.

Stress urinary incontinence is a very common condition among women today. You can and should fight with it. Self-medication using folk methods will not help here. See a doctor.

This is serious

Stress urinary incontinence is not just an unpleasant symptom, it can greatly affect all areas of life.The psycho-emotional state of a woman suffers, she has complexes, anxiety, she tries not to be outside the house for a long time, because “this” can happen at the most unexpected moment. Relationships with the opposite sex, work suffer, you have to limit yourself in many things.

The risk of genitourinary infections increases. Due to the constant exposure to urine, irritation, rash, itching appear on the skin.

How is urinary incontinence treated?

Before starting treatment, you need to understand the causes of the disorder.This often requires a thorough examination. Gynecologists and urologists are involved in the diagnosis and treatment of urinary incontinence in women. After the examination, the doctor may prescribe a general and bacteriological analysis of urine, measurement of residual urine (which remained in the bladder after urination) using an ultrasound scan. The patient is asked to keep a notebook in which she should record the volume of fluid and urine excreted, the number and time of urges, incontinence episodes.

When the cause is clearly and unambiguously established, you can begin treatment.There are many techniques.

Temporary urinary incontinence may be caused by an infection of the genitourinary organs. Usually, the problem disappears as soon as the underlying disease is eliminated. Doctors of the SOVA clinic successfully treat cystitis and other infectious and inflammatory pathologies. Do not wait for complications, make an appointment with a specialist.

There are special methods of “training” the bladder and pelvic floor muscles:

• Kegel exercises, named after the American gynecologist who developed them, strengthen the pelvic floor.You need to tense, as if you are trying to hold back the flow of urine, and try to keep the muscles in this state for 10 seconds. It is recommended to do the exercise 3 times a day for 10 approaches.
• Retention of urination: when the urge to urinate arises, you need to be patient for a few more minutes.
• Double urination: a few minutes after using the toilet, you need to urinate again.
• “Urination on a schedule”: you need to visit the toilet in advance at a certain time (every 2-4 hours), and not when you really want to.

When lowering the vagina and uterus, pessaries are used – rings made of a special material that are inserted into the vagina. To strengthen the muscles, electrical stimulation is used with electrodes inserted into the vagina or rectum. Sometimes a device resembling a pacemaker is implanted under the skin – it sends impulses to the muscles. The doctor may prescribe various medications, correction with fillers, which reduce the lumen of the urethra. With an overactive bladder, botulinum toxin injections help.

Modern manufacturers offer a huge selection of pelvic muscle trainers. These devices can be of different shapes and are inserted into the vagina. Some devices just need to be held inside, straining the muscles, while others have the function of vibration, electrical stimulation. They can be connected to a smartphone and set training programs. These machines can be helpful, but you should consult your doctor before using them.

In case conservative treatment does not help, there are different types of surgical interventions.