How many times have you heard someone wish their incontinence could be cured without surgery, pills, injections or side effects? Imagine telling them that for some types of incontinence this treatment is not only possible, but is recommended as first line treatment by the International Continence Society.
The treatment is called Pelvic Floor Muscle Training (PFMT) and when done correctly under the supervision of a Pelvic Floor Physiotherapist, is a highly effective for stress urinary incontinence, urge urinary incontinence and mixed urinary incontinence. Not only is there level 1a evidence that it works, but it has been available since 1948.
PFMT takes about 3 months of supervised therapy, mostly done at home, to make a significant difference to a person’s continence status. Once optimal pelvic floor function is achieved, a regular maintenance dose of home exercises is prescribed to maintain the results.
So how does it work?
Step 1 Find your pelvic floor muscles:
They fill the gap at the base of the pelvis and are surprisingly small for the vital role they play. Like other muscles they get stronger with training and weaker without.
The muscles attach to the coccyx bone at the back, the pubic bone at the front and the two ischial tuberosities on either side. They form a sling to support the pelvic organs and have openings for the urethra, vagina and anus.
Step 2 Get it right:
When the muscles contract they close off the urethra and anus; and narrow the vaginal opening or retract the penis.
The contraction cannot be seen on the outside and should not interfere with normal breathing. Most people can feel the muscles squeeze the anus and urethra closed and lift the vagina or scrotum, however up to 1/3 of the population can’t feel the muscle working and may not be able to do the exercise correctly without extra help.
Contracting strong pelvic floor muscles stops passage of urine or faeces while relaxing them allows the urine or faeces out. So the ability to relax the pelvic floor muscles is as important as contracting them.
If you can feel your pelvic floor muscles contracting and relaxing, then you can try doing 8 to 10 strong contractions in a row – Strengthening helps stop urine leaking with a cough or sneeze. You can also try 3 or 4 longer contractions of 10 and 30 seconds each – Endurance helps give you more time to get to the toilet. It may take a few weeks for the muscles to get stronger, although some people notice a difference as soon as they get the hang of the training.
Step 3 Precautions:
People with incontinence often can’t feel the pelvic floor muscles contracting and commonly use incorrect muscles or bear down when trying to contract. Other people have very tight or stiff pelvic floor muscles which also causes problems. If they can’t feel the pelvic floor muscles squeezing, lifting and relaxing then visiting a Pelvic Floor Physiotherapist for assistance is essential. It’s also important to get expert advice if they have previously tried pelvic floor muscle exercises with no improvement.
PFMT needs a little personal effort and sometimes professional assistance, but the rewards clear. Remember it’s never too late to start.
Call us on 1300 220 871 for more information about health professionals who can assist with pelvic floor muscle training in your area.
Author: Therese (Terry) Wesselink is a registered physiotherapist with post graduate qualifications in Pelvic Floor Physiotherapy. She is one of the continence clinicians at the Victorian Continence Resource Centre’s Bladder and Bowel clinic and is a sought after speaker at community and professional events. Therese has adapted much of the information in this article from the booklet Reclaim Your Core – Finding the right muscles, which is available from our Online Shop
- Abrams, L.C., L; Khoury, S; Wein, A, ed. INCONTINENCE 5th International Consultation on Incontinence,. 5th ed., 2013, ICUD: Paris.
- Bo, K.B.; Berghmans, B.; Morkved, S.; Van Kampen, M., ed. Evidence-Based Physical Therapy for the Pelvic Floor. 2007, Elsevier.
- 3. Jones, E.G.; Kegel, A. H., Treatment of urinary stress incontinence with results in 117 patients treated by active exercise of pubococcygeii. Surg Gynecol Obstet, 1952. 94(1): p. 179-88.