What is urinary incontinence?

Urinary incontinence is defined by any involuntary leakage of urine. One out of three women tend to get urinary incontinence. "Pregnancy and delivery are the main causes of urinary incontinence in women," according to Caroline Chua, Senior Physiotherapist from Rehabilitation Department at KK Women's and Children's Hospital, a member of the SingHealth group.

What causes urinary incontinence?

Urinary incontinence is mainly due to the weakening of the pelvic floor muscles. Pelvic floor stretching and weakness occurs with childbirth and weight gain. Additionally, it can also be caused by changes in your hormonal system during pregnancy and menopause. 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.

What is the pelvic floor?

The pelvic floor is a sling of muscles at the bottom of the pelvic bone. The muscles support the pelvic organs and have a function in controlling 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.

How to perform Kegel exercises

With any exercise programme, there is a strength and endurance component.

Imagine that you are trying to stop yourself from passing wind and trying to stop your flow of urine mid-stream, both at the same time. The feeling is one of "squeeze and lift", closing and drawing up the front and back passages. This is what you need to do during Kegel exercises.

Types of Kegel exercise

Strengthening

  • Squeeze and lift the front, middle and back passages.
  • Hold it there for 6-8 counts (this depends on how long you are able to hold).
  • Repeat it for as many times as possible (up to 10 counts).
  • Do 3 sets daily, preferably in the morning, afternoon and night.

Endurance

  • Squeeze and lift the pelvic floor muscles, then hold it for as long as you are able to.
  • Do it once daily or every alternate day.

Coordination

  • This exercise is designed to train your reflexes so that your pelvic floor can react to quick situations like a sudden cough or squeeze. For this reason, when practising this exercise, you must be very fast!
  • Squeeze and lift quickly, then relax.
  • Repeat this exercise 10 times, 3 sets per day.

Important tips for practising Kegel exercises

Position of exercise

You can start a Kegel exercise in a simple position such as lying down or sitting. After practising in these positions for some time, you will be more familiar with the routine. You can then progress to practising the exercise –while you are standing or walking. When you master the exercise, you can practise it anytime anywhere, even while doing something else!

Exercise tip

Do not use the tummy, buttock and inner thigh muscles when performing a Kegel exercise. It is also important to breathe normally when you are exercising the pelvic floor.

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

Tips for mothers

After pregnancy, it is time to get back your muscle strength. So, start the Kegel exercise programme with strengthening. Allow yourself to recuperate for three days post-delivery before you start the exercise. This will ensure that you can feel the muscle and therefore do not practise the exercise wrongly.

After practising the strengthening exercise for 4-6 weeks, you can progress to endurance work. It is important to note that you should proceed to the endurance programme only after you have the ability to hold your pelvic floor for 8 counts. Similarly, after you can hold your pelvic floor for at least a minute during the endurance exercise, you can proceed to coordination work.

Tips for women of all ages

For maintaining your pelvic floor after regaining your strength, you might want to continue with the strengthening or the endurance workout at least once a day for the rest of your life.

Ref: T12