Kegel exercises Perineal and pelvic rehabilitation


Tips and exercises to strengthen your pelvic floor

A number of studies, such as the International Consultation on Incontinence (ICI), have shown that pelvic floor strengthening exercises can improve and even correct urinary incontinence, depending on the severity of your condition.

These exercises and tips can also help you control an urgent need to urinate and aid with issues related to organ descent, i.e., a prolapse. It has been shown that doing exercises supervised by a physiotherapist who specializes in perineal and pelvic floor rehabilitation is more effective than only getting information from a fact sheet.

You should do the intensive exercise for about 4 to 6 months and then continue 3 times a week to maintain your muscle strength. It will take about 4 to 6 weeks for you to see a significant difference. A basic physiotherapy treatment lasts about 4 treatments.

 

What is the pelvic floor?

Pelvic floor in women
Pelvic floor in women
Pelvic floor in men
Pelvic floor in men

Several different muscles form the pelvic floor, which extends like a hammock from the pubic bone to the coccyx. In women, the openings of the anus and vagina pass through these muscles. 

  • Functions of the pelvic floor:
  • Supports the pelvic organs (bladder, anus, as well as the uterus in women).
  • Controls continence of urine, feces and gas.
  • Plays a role in sexual function (orgasm in women and men).
  • With the help of your abdominal and lumbar spine muscles, helps stabilize your pelvis.

Before doing the strengthening exercises, make sure that you are contracting the right muscles. Here are a few tips:

  • With a flat hand, feel your perineum region. As you contract this region, your perineum should contract inward and not push against your hand. Make sure you can feel the difference between the two movements.
  • Another tip for women: insert a finger in your vagina. If your finger moves inside the vagina when you contract, then you are performing the movement correctly. If your finger is pushed outside your vagina when you contract, you are pushing outward as though you are having a bowel movement.

Be careful: pushing out could further weaken your pelvic floor muscles. It is important to know how to correctly perform the movement before exercising these muscles.

For women

When you do the contraction, imagine that you are trying to hold in urine and gas.

For men

Tighten your anus and imagine that you are trying to shorten your penis (mental visualization). 

Exercise 1: Maximum-intensity contraction

While lying down on your back with your knees bent, breathe out and contract your pelvic floor muscles as hard as you can, as though you are trying to hold in urine and gas.

  1. Hold the contraction for 5 seconds while breathing normally, then release and rest for 10 seconds between each contraction.
  2. Do 3 sets of 10 maximum-intensity contractions and rest for 60 seconds between each set. Do this 5 days a week.

Repeat the exercises in a seated position with your back straight and then when standing.

Increase the contraction time up to for 10 seconds with a 20-second rest.

Tips:

  • Count out loud so that you don’t hold your breath and to avoid increasing your abdominal pressure, which makes it harder to correctly maintain the contraction.
  • To achieve the best possible pelvic floor contraction, relax all other muscles as much as you can, especially your buttock and inner thigh muscles.

Exercise 2: fast contraction

Same position as for the previous exerci

  1. When you breathe out, quickly squeeze your pelvic floor muscles as hard as you can as though you are trying to hold in urine or gas and then fully release them.
  2. Do 3 sets of 10 contractions and rest for 60 seconds between sets.

Repeat 5 days a week.

Follow the same advice as for the previous exercise.

 

Exercise 3: perineal lock (functional exercise)

Before coughing or sneezing, tighten your pelvic floor muscles to avoid urine leakage and reduce pressure on the pelvic floor muscles.

Do the same before any effort, such as getting up, walking or lifting a load.

Bladder irritants

As you re-educate your muscles, some liquids and foods will be irritating to the bladder.

During this re-education phase, reduce your intake of the following as much as possible:

Bladder irritants
Coffee, Tea, Cola, Alcohol, Chocolate, Acidic fruits (tomatoes), Spicy foods

Also note that dark urine (due to a high concentration of urea) is another irritant for overactive bladders.

To soften stool and make it easier to pass, you need to increase your intake of not only fluids but also fibre (fruit, vegetables and grains, such as bran, oats and wheat). If you are on a prescribed medical diet, talk to your doctor or nutritionist.

Constipation and a poor defecation technique can weaken your muscles and increase the risk of hemorrhoids.

 

 

Water bottle
Increase your fluid intake to 2 litres per day.
Toilet
Stopping your urine flow as you urinate will increase your risk of a urinary tract infection.

Proper bearing-down technique to evacuate stool

Seated position on the toilet

  1. Seated position: your hips should be at an angle that is greater than 90° (put your feet on a small bench). This position mimics a crouched position, which makes it easier to pass stool.
  2. Keep your feet apart and put your knees together (this relaxes the pelvic floor muscles).
  3. Lean slightly forward, with your back straight and your forearms on your knees (this helps relax the anal sphincter)
    • If you have a prolapse (i.e., descended organ), lean slightly back, as this will help expel the stool.

  4. Relax and make sure your perineum is also relaxed; if the stool does not come out on its own, contract your abdomen and breathe out gently into a closed fist. It is important not to push by holding your breath, as this puts too much pressure on your perineum.
  5. If you can’t pass the stool quickly, don’t force it. Instead, wait until you feel the need to go again. Only go to the bathroom when you feel the urge. If you push, you will weaken the pelvic floor muscles and increase your risk of hemorrhoids.

Tip: To stimulate a bowel movement, drink a glass of cold water in the morning when you wake up.

The information on this page comes from:

Nathalie Rodrigue
Physiotherapist, MIC, RRP, Perineal and Pelvic Rehabilitation Specialist,
Physiothérapie Universelle

In collaboration with:

Caroline Jean
Urology Nurse
Hôpital de la Cité-de-la-Santé
CISSS de Laval

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