Introduction

Many women suffer from weakness of their pelvic floor muscles.

Common symptoms include:

• leaking urine with activity, for example during running, jumping, coughing and sneezing
• a sudden and urgent need to pass urine
• leakage of stool from the back passage
• decreased satisfaction during sexual intercourse.

What do the pelvic floor muscles do?

The pelvic floor muscles are a supportive sling of muscles, stretching from the tailbone at the back to the pubic bone at the front. They are responsible for:

• supporting the pelvic organs – the bladder, bowel and womb, especially when standing; they also help protect these from external damage
• a role in sexual function during intercourse.

Your pelvic floor muscles contract when you cough, sneeze, or laugh, preventing leakage of urine.

They are kept under slight tension so that when you pass urine or open your bowels the muscles should relax and then tighten afterwards. This prevents leakage and controls the passing of urine, bowel, and gas motions.

Factors leading to incontinence or weakness

• Childbirth
• Long term cough
• Constipation
• Being overweight
• Menopausal changes
• Pelvic surgery / trauma
• Repeated heavy lifting

Pelvic floor muscles can be strengthened just like any other weak or damaged muscles. They need to be regularly exercised to work well.

How to exercise your pelvic floor muscles

• Sit, stand or lie comfortably with your knees slightly apart.
• Imagine you are trying to stop yourself from passing wind at the same time as if you are trying to stop passing urine and slowly squeeze and lift the muscles.
• A feeling of gentle tightening in your lower abdomen is normal. Try to avoid pulling in your stomach, squeezing your legs together, tightening your buttocks or holding your breath to ensure that only your pelvic floor muscles are working.

Exercise programme

First you need to find your starting point.

To do this, tighten your pelvic floor muscles and hold the contraction for as many seconds as you can up to ten seconds.

How long can you hold the contraction? ………. seconds.

Release the contraction and rest for the same time. Repeat the tightening, hold, release as many times as you can, up to a maximum of ten.

How many times can you repeat the contraction? ……….

For example, hold two seconds, rest two seconds, repeat four times.

This exercise will build the endurance of the muscles (the muscle can work harder for longer). As you improve your starting point will change.

On laughing, coughing, and sneezing your muscles need to be able to react quickly. It is important to practise quick contractions also. To do this, tighten the muscles quickly and strongly and relax.

Count how many you can do ……….

Aim for ten repetitions.

Aim to increase the number of repetitions over the next six months so that you can do up to ten at a time. You will need to practise three times per day.

Personalised programme / advice from your physiotherapist

1. Timed contractions

Pull up and hold as tightly as you can for ……… seconds, rest for ……… seconds, repeat ……… times and do this ………. times daily.

2. Fast contractions

Repeat ……… and do ………  times daily.

The most difficult part of the programme is remembering to do the exercises. The below tips may help to trigger your memory:

• Put coloured sticky notes or dots in places that will catch your eye (on the fridge, the kettle or your watch).
• Set an alarm on your watch / phone.
• Exercise after every time you have emptied your bladder.
• Exercise when waiting for the kettle to boil or washing your hands.

Further useful tips and advice

1. Avoid being overweight

Maintaining the correct weight can make a big difference to your symptoms by reducing the strain on the muscles helping to control bladder and bowel movements.

2. Avoid constipation

Straining to open your bowels stretches the pelvic floor muscles making them weaker. It is important to drink plenty of fluids and you may need to adjust your diet.

3. Drink adequate fluids

Reduce your caffeine intake as these drinks may irritate your bladder. Try to drink more water and aim to drink between 3 – 4 pints (1.5 – 2 litres) of fluid a day. Do not restrict your fluid intake. This can make your symptoms worse as your urine will be more concentrated. Regular drinking at the same times each day is best.

4. Lifting

As women do not have much muscle in the middle of their pelvic floor due to the three holes in it, it is important to avoid heavy lifting. This increases the pressure in your abdomen and puts extra strain on the pelvic floor. Remember to tighten your pelvic floor muscles before lifting and hold tight until you release the load

5. Exercise to avoid if you think your pelvic floor is weak

• Double leg lifts
• Straight leg sit-ups
• High impact exercise such as jumping and running

These activities put increased stress and pressure on the pelvic floor muscles.

6. Movement changes

Try to tighten your pelvic floor muscles before coughing, sneezing, and laughing. This will help to prevent leakage.

Bladder emptying

It is important to empty the bladder completely each time you go to the toilet. Take your time. If you think your bladder may not be completely empty try rocking your pelvis forwards and backwards, it may help to empty a little more.

Frequency of bladder emptying

The bladder normally empties between five and eight times per day. Leaving too little or too long a time between emptying may upset this normal function. This usually means emptying your bladder every two to five hours.

Less than two hours or more than five hours may lead to problems. You may need to train your bladder to hold more by trying delaying techniques when you feel the urge to go, e.g.:

• keep calm and tighten the pelvic floor muscles
• sit on a hard surface
• curl your toes hard
• distract your mind by counting backwards, singing a song etc.

If problems continue you may need to seek further medical advice.

Patient appointments

Date

Time

The information contained in this leaflet is intended for educational use only and not for the diagnosis or treatment of a specific condition, which should only be undertaken by a qualified healthcare professional.

Please contact the number below if you are unable to attend this appointment, giving as much notice as possible.

Further information

If you require any further information after reading this leaflet, please contact your physiotherapist.