How to use exercise to relieve urinary incontinence

Exercise, particularly targeted pelvic floor muscle training (Kegel exercises), is a highly effective first-line treatment for various types of urinary incontinence, especially stress incontinence (leakage during coughs, sneezes, laughs, or physical activity) and urge incontinence (leakage with a strong, sudden urge to urinate, often associated with overactive bladder).1

Here's a guide on how to use exercise to relieve urinary incontinence, based on actual practices:

1. The Core: Pelvic Floor Muscle Training (Kegel Exercises)

The pelvic floor muscles form a sling-like hammock at the base of your pelvis, supporting your bladder, bowel, and in men, affecting sexual function.2 Strengthening these muscles directly improves bladder control.3

A. How to Find Your Pelvic Floor Muscles:

This is the most crucial step – ensure you're engaging the correct muscles.

• Stopping Urine Flow (Test, not a regular exercise): While urinating, try to stop or slow the flow of urine mid-stream.4 The muscles you use to do this are your pelvic floor muscles.5 Do this only to identify the muscles, not as a regular exercise, as it can be harmful.6
  
  

• Preventing Gas (More Recommended): Imagine you are trying to stop yourself from passing gas.7 Squeeze the muscles around your anus as if you are trying to "lift" them up and in.8 You should feel a tightening and lifting sensation.9 Your buttocks and thighs should remain relaxed.10
  
  

• Male-Specific Clue: For men, when you contract your pelvic floor muscles, you might notice your penis drawing in slightly and your scrotum lifting up.11
  
  

B. How to Perform Kegel Exercises (Technique):

Once you've identified the muscles, you can do Kegels in any position (lying, sitting, or standing), but starting lying down can be easier.12

1. Slow Squeezes (Endurance):

• Squeeze your pelvic floor muscles and lift them up and in.13
  
  

• Hold the contraction for 3 to 5 seconds (or as long as you can comfortably, without holding your breath).14
  
  

• Slowly relax the muscles completely for the same amount of time (3 to 5 seconds).15 Ensure full relaxation before the next squeeze.
  
  

• Repeat 10 to 15 times.16
  
  

2. Fast Squeezes (Quick Response):

• Quickly squeeze your pelvic floor muscles, lifting them up and in.17
  
  

• Release them immediately.

• Repeat 10 to 15 times.18 These train your muscles for sudden pressure like coughing or sneezing.19
  
  

C. Consistency and Progression:

• Frequency: Aim for 3 sets of 10-15 repetitions (both slow and fast squeezes) three times a day, every day.20
  
  

• Don't Overdo It: If your muscles get tired, stop and resume later.21 Over-exercising can lead to muscle fatigue and counterproductive results.
  
  

• Focus: It's vital to isolate the pelvic floor muscles.22 Avoid tensing your abdominal, buttock, or thigh muscles, and breathe normally.
  
  

• Results: You may notice improvements within a few weeks to a few months.23 Consistency is key.24 It can take 3-6 months to see significant results.25 Continue the exercises as a lifelong habit to maintain benefits.
  
  

• When to use: Try to squeeze your pelvic floor muscles just before and during activities that cause leakage, such as coughing, sneezing, laughing, lifting, or standing up.26 This is often called "the knack" or "bracing."27
  
  

D. Seeking Professional Help:

If you're unsure if you're doing Kegels correctly, or if you don't see improvement after 6-8 weeks, consult a pelvic floor physiotherapist or a continence nurse advisor. They can provide personalized guidance, use biofeedback (sensors to show muscle activity), or even electrical stimulation to help you locate and strengthen the correct muscles.28

2. General Exercises for Core Strength and Overall Well-being

While Kegels are primary, a strong core can indirectly support bladder control by improving posture and reducing pressure on the pelvic floor.

• Pilates: Focuses on core strength, flexibility, and body awareness, which can be beneficial for pelvic floor function.29
  
  

• Yoga: Certain poses can gently engage the pelvic floor and improve overall flexibility and stress reduction. Examples include Child's Pose, Cobbler's Pose, and Bridge Pose.

• Pelvic Tilts: Lie on your back with knees bent.30 Gently flatten your lower back against the floor by tilting your pelvis upwards, engaging your abdominal and pelvic muscles.31
  
  

• Bridge Exercises: Lie on your back with knees bent, feet hip-width apart.32 Lift your hips towards the ceiling, squeezing your glutes and pelvic muscles.33
  
  

What to Avoid (or Modify):

• High-Impact Exercises: Activities like jogging, jumping, or heavy lifting can put excessive downward pressure on the pelvic floor, potentially worsening leaks, especially with stress incontinence.34 If you do them, remember to engage your pelvic floor before and during the activity.
  
  

• High-Impact Abdominal Exercises: Traditional sit-ups or crunches can increase intra-abdominal pressure.35 Opt for core exercises that protect the pelvic floor, often guided by a pelvic floor physiotherapist.
  
  

3. Lifestyle Modifications to Support Exercise Efforts

Exercise alone might not be enough for everyone. Complementing it with lifestyle changes can significantly improve outcomes.

• Maintain a Healthy Weight: Excess body weight puts pressure on your bladder and pelvic floor, weakening these muscles. Losing weight can significantly reduce incontinence symptoms.

• Manage Constipation: Straining during bowel movements significantly weakens the pelvic floor. Ensure a high-fiber diet, adequate fluid intake, and regular exercise to promote healthy bowel movements.36
  
  

• Fluid Management:

• Drink Enough Water: Don't restrict fluids excessively. Concentrated urine can irritate the bladder.37 Aim for 6-8 glasses (1.5-2 liters) of water daily, unless advised otherwise by a doctor.38
  
  

• Timing of Fluids: If nighttime urination (nocturia) is an issue, reduce fluid intake a few hours before bedtime.39
  
  

• Limit Bladder Irritants: Reduce or avoid caffeine (coffee, tea, cola, energy drinks), alcohol, carbonated beverages, spicy foods, and acidic foods (like citrus fruits), as these can irritate the bladder and worsen symptoms.40
  
  

• Quit Smoking: Chronic coughing from smoking puts significant strain on the pelvic floor.41
  
  

• Bladder Training: This involves gradually increasing the time between trips to the toilet to help your bladder hold more urine.42 This is often done with guidance from a healthcare professional and involves keeping a bladder diary.43
  
  

• Good Toilet Habits:

• Go to the toilet when you feel a normal urge, not "just in case."

• Don't strain to empty your bladder or bowels.44
  
  

• Ensure proper posture on the toilet (e.g., using a footstool to elevate knees).

Always consult with a healthcare professional (doctor, urologist, or pelvic floor physiotherapist) before starting any new exercise program for incontinence, especially if your symptoms are severe or persistent. They can diagnose the type and cause of your incontinence and recommend the most appropriate and safe exercise regimen for your specific situation.