The floor of the pelvis is made up of layers of muscle that stretch like a hammock from the tail bone at the back to the pubic bone in front. The pelvic floor muscle has an important role in bladder and bowel control and sexual sensation.

We have control over the pelvic muscles. Like other muscles in the body, exercise strengthens them when they are weak. The pelvic floor muscles can be weakened by:

¥ pregnancy and childbirth

¥ continual straining to empty your bowels (constipation)

¥ persistent heavy lifting

¥ a chronic cough (such as smoker's cough or chronic bronchitis or asthma

¥ being overweight

¥ change in hormone levels at menopause (change of life)

¥ lack of general fitness

The Benefits of Pelvic Floor Exercises

It is important for women of all ages to maintain pelvic floor strength. Women with stress incontinence, that is, those who regularly loose urine when coughing, sneezing or exercising, especially should learn these exercises. For pregnent women, this helps the body to cope with the increasing weight of the baby. Healthy, fit muscles prenatally will recover more fully after the birth.

As women grow older it is important to keep the pelvic muscle strong because at menopause the muscles may change and weaken. A pelvic floor exercise routine helps to minimise the effects of menopause on pelvic support and bladder control.

How to Contract the Pelvic Floor Muscles

The first thing to do is to correctly identify the muscles that need to be exercised.

1. Sit, or lie comfortably with the muscles of your thighs, buttocks and abdomen relaxed

2. Tighten the ring of muscle around the back passage as if you are trying to control diarrhoea or wind. Relax it. Practice this movement several times until you are sure you are exercising the correct muscle. Try not to squeeze the buttocks.

3. When you are passing urine, try to stop the flow mid-stream, then restart it. Only do this to learn which muscles are the correct ones to use, and then do it only once a week to check your progress.

4. If you feel comfortable, another way to check that you are using the correct muscle is to place one or two fingers in your vagina then squeeze the pelvic muscles. Squeezing the muscle will grip the fingers. If the muscles are very weak you may not feel much of a grip until you improve with exercise. Strong muscles will produce a squeezing and drawing up effect.

Doing Pelvic Foor Exercises

1. Tighten and draw in and around the rectum and vagina and the urethra all at once, lifting it up inside. Try and hold this contraction as you count to five then release and relax. You should have a definite feeling of "letting go".

2. Repeat ("squeeze ands lift") five times, with a ten second rest between each contraction.

3. Now do five short, fast, but string contractions.

4. Do this exercise at least 5 times every day.

While doing the exercises:

DO NOT hold your breath.

DO NOT push down instead of squeezing and lifting up.

DO NOT tighten your tummy, buttocks or thighs.

Making the Exercises Part of your Daily Routine

Once you have learned how to do these exercises, they can be done during everyday activities such as showering, driving, or watching TV. Make them part of your daily routine. The benefits of the exercises will continue ONLY as long as you do them! Use it or lose it! You should expect to have to do these exercises regularly for three months before any improvement in your urine loss occurs.

Other Things you can do to Help your Pelvic Floor Muscles

¥ reduce the lifting of heavy loads

¥ avoid constipation

¥ seek medical advice for hay-fever & asthma to reduce sneezing/coughing

¥ keep your weight within the right range for your height and age

BLADDER TRAINING

Bladder training is a way that you can try to help yourself to reduce the symptoms of urgency and frequency of urination. The basic idea is to try and re-educate your bladder so that it is more comfortable when it is filling and lets you go for a longer time before you need to spend a penny. Some useful motto's are "mind over bladder" and "I am no longer going to be a slave to my bladder".

Most people who have urgency and frequency are spending a penny every hour or even more frequently. The basic idea is to gradually lengthen the time that you can spend between going to the toilet over about two weeks duration, and to reestablish control of the bladder by voiding by the clock (set intervals) when you choose to, rather than by when the bladder wants to. Bladder training involves:

1. A positive attitude! I can and will retrain my bladder. You will need lots of willpower, and all the support and encouragement you can get from family and friends.

2. Start the program on a weekend at home when you will not have other distractions.

3. On day 1 decide the clock interval at which you will go to the toilet (usually one hour). Using this as an example, every hour you will go to the toilet (whether or not the bladder wants to- remember you are in control!). Use the bladder diary to record these times and the amount of urine passed. At night sleep as usual, and recommence bladder training next day.

4. On day 2 the interval is increased by 15 minutes, so that you go to the toilet every 1 1/4 hours (75 minutes). As the interval is increased the bladder will start to protest, however you have to tell yourself that under no circumstances will you let yourself go the the toilet until the clock says so! This may be difficult at times, and sometimes you may have to sit and just cross your legs. However the bladder spasm will pass. Even if there is some leakage do not give in (you can wear pads if this occurs).

5. On day 3 add another 15 minutes, so that you are now going every 1 1/2 hours (90 minutes).

6. This process continues each day, so that by day 7 you should be voiding every 2 1/2 hours (150 minutes).

The aim is to get to at least 3 hours interval, with the bladder being able to hold 400 mls.

Tips

1. Do not restrict the amount you drink as this can in fact make the bladder more irritable (a healthy intake is 1500mls per day). Do reduce the amount of irritating fluids to the bladder, eg. coffee, cola, and alcohol.

2. Each time you feel that strong urge to pass urine, try:

a. sitting down and applying firm pressure to your pelvic floor (crotch)

b. squeezing up those pelvic floor muscles until the feeling of urgency goes away

c. taking your mind off the sensation by thinking of something else, such as winning lotto and how you would spend all that money, or count backwards from 100 by sevens, or thinking of three Australian towns beginning with "a", then "b" etc.

3. There may be some "setbacks" such as when you are run down, have the flu or a urine infection, are anxious, or the weather is wet/cold/windy. This will only be temporary, so persevere!

4. If this program fails to produce any significant change over four weeks, some medication may be added temporarily to help you regain control of the bladder.

Good luck! You can do it.