Doing Pelvic Floor Exercises Properly

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I have a question for anyone with daytime urinary incontinence who has also benefited from pelvic floor physio therapy.

I recently started seeing a pelvic floor physiotherapist and have been prescribed some exercises to help work on my lack of muscular endurance in that area. I can currently hold a contraction for about 5 seconds and have been told that we’re aiming for 2 minutes.

I found that I was good at identifying and contracting the right muscles while able to see them on the ultrasound screen, but am having trouble without that aid. I find myself activating my pelvic floor okay when I start the contractions and then as I fatigue I notice that I am recruiting my abdominal muscles and bearing down on them which causes me to lose control slightly.

Does anyone have tips on how they manage to effectively engage their pelvic floor when doing the exercises?

Further, I have noticed that I have been wetting myself slightly more since starting. Is this something that you experienced before your continence started to improve?

Thanks in advance for your assistance.

 

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I started physical therapy shortly after surgery. I was able to voluntarily (with some effort) stop urine flow midstream, so my therapist said I had identified the right muscles and there was no need for ultrasound. Still I had daytime incontinence when standing and not concentrating, so I did contraction exercises (Kegels) faithfully. I can't say that the exercises made the incontinence worse, but I wasn't getting better which was frustrating.

Things changed when my therapist gave me the metaphor of the "pelvic brace" to think of when doing the exercises. This "brace" includes not only the sphincter muscles surrounding the bladder opening, but also the lower abdominal muscles near the pelvis. The idea is to pull those in so that you imagine your abdomen flattening against your lower spine. I contract both the sphincter and lower abdomen muscles in different exercises separately, together, and alternating, never more than 10-20 seconds. I was told that the muscles need to periodically relax and extensive holding can be counterproductive. I've never heard of holding for 2 minutes.

I exercise the pelvic brace in a variety of ways: sitting, standing, lunging (stepping forward, bending at the knee and holding for 5 seconds), doing hip abduction (spreading thighs while constrained with an elastic band), and hip adduction (closing thighs on a captured ball or pillow).

I'm 69 and 4.5 months post radical robotic prostatectomy and I would say I'm 95% continent. I wear the thinnest Depends pads (like feminine menstrual pads), often for more than 24 hours with little leakage. There's hope. Good luck.

 

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@DowntonAlley thanks so much for your detailed response and advice. Congratulations on such a successful recovery, too. My daytime issues are quite new and I have been told that they stem from a gradual weakening in muscular endurance following a series of reconstructive surgeries three years ago. I consider myself lucky that I’ve started with about 95% daytime continence and am hoping to rehab to 100%. Thankfully I’ve been able to get away with shields and light guards. I’ll try your advice re the pelvic brace!

 

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I also have urinary incontinence and have looked all over the internet for ways to help manage my pelvic floor muscles. After speaking to a friend (who also has a similar problem) she recommended trying out some pelvic floor exercises as they really helped her. I decided to give it a go and noticed some huge changes but it took a while to get there. I recommend watching this video that really helped me out - clickable text

 

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@LucyJenson554 thanks Lucy, I seem to have the hang of them now. I just took a while to work out that I was indeed contracting the muscles properly without the ultrasound.