Urinary incontinence is defined by an involuntary loss of urine. It can happen during physical activity or exertion, such as coughing or running, which is known as stress urinary incontinence.

It can also occur with a sudden, strong urge to pass urine that is difficult to control, referred to as urge urinary incontinence.

Approximately 1 in 3 women experience this condition.

Urinary incontinence is mainly due to the weakening of the pelvic floor muscles caused by

• Hormonal changes (estrogen) during pregnancy and menopause
  
  
• Childbirth (normal and assistive vaginal delivery)
  
  
• Ageing changes
  
  
• Weight gain
  
  
• Constipation (straining to pass motion)

Thus, it is important to maintain a strong pelvic floor to prevent urinary incontinence. This can be achieved by performing pelvic floor exercises, sometimes referred to as Kegel exercises.

The pelvic floor is a sling of muscles at the bottom of your pelvis. These muscles support the:

• Pelvic organs (bladder, uterus, rectum) and
  
  
• Controls the emptying of the bladder and bowel

The pelvic floor muscles are also involved in enhancing sexual function. These muscles cannot be seen but you can feel them working, for instance when you hold on to your urine or wind.

Diagram is copyright of KK Women's and Children's Hospital.

Start in a simple position such as lying down or sitting and then progress to practising this exercise while you are standing.

Step 1: Imagine that you are trying to control passing wind and urine.

Step 2: Tighten the muscles around your back and front passages (anus, vagina, urethra) by “squeezing and lifting” from back to front and then “letting go” as you relax the muscles.

Step 3: Breathe normally during this exercise (i.e. avoid holding your breath) and avoid using your tummy, buttocks and inner thigh muscles by placing your hands on these areas to check.

Type 1: Strengthening

• Squeeze and lift your pelvic floor muscles and hold tight for 6 to 8 seconds (this depends on how long you are able to hold initially), then relax completely.

Type 2: Endurance

• Squeeze and lift your pelvic floor muscles and hold tight at long as you can, then relax completely
  
  
• Aim to hold for at least 30 seconds
  
  

Type 3: Coordination

• Squeeze and lift your pelvic floor muscles quickly then relax quickly
  
  
• This is to train your reflexes so that the pelvic floor muscles can react to sudden situations like a cough or sneeze

Perform any types of pelvic floor exercise 10 repetitions and 3 sets (in the morning, afternoon and at night) daily.

1. Pregnant women

During pregnancy, the aim of the exercise is to maintain muscle strength and function. Therefore, it is alright to just do the strengthening component of the pelvic floor exercises.

If you were already doing the strengthening exercise before pregnancy, you might want to add in an endurance component as well.

2. Mothers

After pregnancy, it is time to get back your muscle strength.

Allow yourself to recuperate for 3 days post-delivery before you start the exercise. This will ensure that you can feel the muscles and be able to practise this exercise correctly with no pain.

Start the pelvic floor exercise programme with strengthening for 4-6 weeks, then progress to endurance work after you can hold your pelvic floor for 8 seconds.

Similarly, after you can hold your pelvic floor for at least 30 seconds during the endurance exercise, you can proceed to coordination work.

3. Women of all ages

For maintaining your pelvic floor after regaining your strength, you might want to continue with the strengthening or endurance workout at least once a day from then onwards.