Adult and Pediatric Urology
Pelvic muscle exercises are exercises to strengthen the pelvic floor muscles. These are the muscles that support the bladder and urethra, and also surround the vagina and anus. They naturally contract when a patient coughs, laughs, sneezes, or lifts something heavy. In some patients the muscles can weaken over time, and this can contribute to urinary incontinence (leaking of urine). Contraction of these muscles properly can help to decrease incontinence, and also can sometimes decrease or eliminate a sudden urge to urinate. In some patients spasm of these muscles may be a cause of pelvic pain, and learning to use these muscles properly can be a part of a program to control the pelvic pain.
The pelvic floor exercises are strengthened through exercise just like any other muscle. It is important to contract and relax these muscles many times during the day in order to strengthen them. Many women have been taught an improper way of performing pelvic floor exercises. You should not contract the pelvic floor muscles during urination, except as a test to see if you are contracting the correct muscles! It is not good for the bladder to have a sudden blockage to flow from pelvic muscle contraction, and you can only squeeze the muscles a few times a day if you only do the exercises during urination. Instead, you should do many “sets” of pelvic floor muscle exercises throughout the day. Patients can use reminders to do the exercises, such as every time a commercial comes on the TV, or everytime the car is stopped at a traffic light. It is very important that patients develop a routine for doing these exercises.
Pelvic muscle exercises involve contraction of all of the muscles of the pelvic floor at once, holding the muscles tight for as long as possible, then relaxation. This should not involve contraction of the abdominal muscles, or the muscles of the leg or buttocks. The pelvic muscles are “inside” the pelvis. The same muscles that help control bladder problems also contract around the vagina and the anus. If patients concentrate on squeezing the muscles that they would use to stop a bowel movement from coming out, they will be squeezing the pelvic floor muscles. We have heard an old army colonel tell patients to pretend they are “trying to break an egg in your arse.” This is a vivid description of contraction of the pelvic muscles! Women can also place two fingers in the vagina during pelvic muscle contraction, and they should feel a squeeze if they are contracting the muscles properly.
Patients should squeeze the pelvic muscles for as long as they can, which at first is only a split second. It will get longer over time. When the patient feels the muscle relax then they should rest for a few seconds, and then squeeze the muscles again. Patients should do a “set” of 10 of these pelvic muscle contractions, and then rest. It is helpful to do as many “sets” of these contractions during the day as possible. Patients who learn to contract the pelvic muscles will also be learning how to relax the pelvic muscles, which can help to relieve pelvic muscle pain or tension.