Rather than being hilariously funny, stress incontinence can be frustrating, inconvenient, and even embarrassing.  Stress incontinence is an involuntary release of urine that occurs when downward pressure is put on the abdomen during activities such as sneezing/coughing, laughing, exercising, or having sexual relations.  This is the most common type of urinary incontinence in women, and can be common in men following prostate surgery.  The good news is that with treatment stress incontinence can likely be managed.  A 2007 study showed that pelvic floor exercises can result in better control of the bladder with coughing, laughing, sneezing, or exercising in up to 70% of women. (Lentz, GM, 2007)

Treatment options for stress incontinence include:

1. Exercises
2. Lifestyle changes – (Read my blog from last week, “Control issues”)
3. Medications and/or injections
4. Devices (pessaries) and/or Surgery

Exercises and life-style changes are typically the first line of defense and recommended before considering medications and/or surgeries.

Before I discuss some great exercises for improved bladder control I’d like to give you a brief overview of the anatomy of the pelvic floor and urinary system.

• Bladder – The bladder wall is made up of the detrusor muscle that contracts to expel urine, and remains relaxed as it fills.  This is a smooth muscle so is not under voluntary control.
• Urethral sphincters – There are 2 of these, the internal and external sphincters.
  • The internal urethral sphincter is a continuation of the detrusor muscle and is located at the base of the bladder and is also involuntary.
  • The external urethral sphincter is located just beyond the internal sphincter in women, and just beyond the prostate in men.  This muscle is a voluntary muscle, so we can voluntarily contract and relax it.
• Pelvic floor muscles – The primary muscles of the pelvic floor are the levator ani muscles which form a hammock that supports the bladder, uterus or prostate, and rectum.  These muscles attach to the tail bone, pubic bone, and the obturator internus which is a deep hip rotator muscle.
• Transversus abdominis (TVA) – While this muscle is not actually part of the urinary system or pelvic floor anatomy it is worth mentioning.  The TVA runs side to side across the front and side of the abdominal wall and is the deepest of the abdominal muscles.  (For more information on the TVA, see my blog post “Accessing the Core.”)

Now that you are familiar with the muscles involved in bladder control here are some fun facts  (At least I think that they are fun!):

• The pelvic floor and the TVA work in synch with each other.  When one contracts the other automatically contracts.
  • If you aren’t sure how to contract the pelvic floor, engage the TVA by pulling your belly button up and back towards your spine and that lifting you feel between your tailbone and pubic bone is your pelvic floor!
• When the pelvic floor is weak the “hammock” sags allowing the neck of the bladder to drop down too low decreasing the effectiveness of the sphincter muscles in controlling the release of urine.
  • Strengthen your pelvic floor, and your sphincters can work more effectively!
• The external sphincter and the detrusor (bladder) muscles work in opposition to each other.  When on contracts the other relaxes.
  • Engage your pelvic floor or TVA to relax your detrusor (bladder) muscle.  Gotta go really bad, but no bathroom in sight?  Do 3 quick contractions of the pelvic floor and buy yourself some time!

5 exercises to help combat stress incontinence:

1) Kegels

• First practice finding your pelvic floor muscles.  You can do this by stopping urination midstream.  If you do this successfully you found the right muscles.  (Do not make it a regular habit to stop urination mid stream.  This can lead to other problems.)
• Start out lying on your back and tighten your pelvic floor muscles and hold for 5 seconds, then relax for 5 seconds, repeat 5 times.  You can gradually increase up to a 10 second contraction, 10 second relax, and 10 repetitions.  Repeat 3 times a day.
• Begin practicing in different positions – sitting, standing, squatting, and standing on one leg.
• Also practice quick kegels – contract 1-2 seconds, relax 1-2 seconds.  Practice while coughing, sneezing, lifting, and laughing.

2) Belly scoops

• Begin lying on your back with both knees bent.  Breathe out and scoop your belly button up and back toward your spine, keeping your belly button scooped breathe in, breathe out, and on your next inhale relax your belly.  Repeat 3-5 times.
• You can progress this to lying on your back legs lifted up toward the ceiling, on all fours, sitting, standing.

3) Clamshell – Lying on your side, with both hips and knees bent about 45 degrees and legs stacked on top of each other, keep the feet together and lift your top knee up only as far as you can without your pelvis rolling back, then lower the knee.  Repeat 10-30 times on each side.

4) Knee squeezes – Lying on your back with your knees bent, or sitting up, place a pillow or 8” ball between your knees.  Squeeze both knees into the pillow/ball, hold 3 seconds, and then relax.  Repeat 10-30 times

5) Walking – Walking helps tone almost all of the exercises involved in your bladder control.  As I have mentioned before this is almost the perfect exercise for most people!

As always, inform your healthcare practitioner of any changes in your health status, and check with them before starting any new exercise program.  Oh, did I mention that both Yoga and Pilates are great practices to help strengthen your pelvic floor and core, and that your favorite physical therapist can work with you one-on-one to help you determine the best way to improve your bladder control?

“I am thankful for laughter, except when milk comes out of my nose.”  ~ Woody Allen

Lentz GM (2007). Physiology of micturition, diagnosis of voiding dysfunction, and incontinence: Surgical and nonsurgical treatment. In VL Katz et al., eds., Comprehensive Gynecology, 5th ed., pp. 537–568. Philadelphia:  Mosby Elsevier.

Katey Hawes, owner and founder of Posabilities, Inc.., is a physical therapist, registered yoga teacher, and yoga therapist.

You may find her at Facebook.com/posabilities4u, Twitter @Posabilities4u, and Google+.