The Proper Way To Kegel
Verbal or written instructions alone don’t necessarily help patients know whether they’re doing Kegel exercises properly.
When we see patients for urinary incontinence, we provide education and instruction. We often recommend one to six sessions of supervised Kegel exercises with a female pelvic medicine and reconstructive surgery doctor, a pelvic floor physical therapist, or another provider who has expertise in pelvic floor disorders. While physical therapy or other medical visits usually are not covered by insurance for preventive purposes, they usually are once a problem develops.
In these appointments, your provider will describe how to locate and engage the pelvic floor muscles. The provider will gently press on the pelvic floor muscles with a gloved exam finger inside your vagina and ask you to squeeze the muscles. The muscles will be identified as described. Make sure youre not squeezing your stomach, legs, or gluteal muscles at the same time, and dont hold your breath.
Some patients benefit from holding a mirror between the legs to visualize the external anatomy during the exercise. When done properly, you should see the area between your vagina and anus lift toward your upper body.
Doing Kegel exercises regularly is key to strengthening the pelvic floor. We recommend women do 10 repetitions, holding each squeeze for 5 to 10 seconds, three times each day.
Will I Have Incontinence For My Entire Life
Sometimes incontinence is a short-term issue that will go away once the cause ends. This is often the case when you have a condition like a urinary tract infection . Once treated, frequent urination and leakage problems caused by a UTI typically end. This is also true for some women who experience bladder control issues during pregnancy. For many, the issues end in the weeks after delivery. However, other causes of incontinence are long-term and related to conditions that are managed throughout your life. If you have a chronic condition like diabetes or multiple sclerosis, you may have incontinence for a long period of time. In those cases, its important to talk to your provider about the best ways to manage your incontinence so that it doesnt interfere with your life.
A note from Cleveland Clinic
It can be embarrassing to talk about bathroom habits with your healthcare provider. This embarrassment shouldnt stop you from treating incontinence, though. Often, your healthcare provider can help figure out the cause of your bladder control issue and help make it better. You dont need to deal with it alone. Talk to your healthcare provider about the best ways to treat incontinence so that you can lead a full and active life without worrying about leakage.
Do Regular Kegel Exercises
Once you find your pelvic floor muscles, you can complete regular Kegel exercises to strengthen them. Simply contract your pelvic floor muscles, hold them for five to ten seconds, and relax them. The Urology Care Foundation suggests that you complete at least two sessions of Kegel exercises per day. Up to 30 contractions per session.
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Your Lifestyle Choices Matter
Hormones may be the root cause but our lifestyle choices and overall health can influence our health outcome.
Yes, the choices you make do affect your health in the long run, even if you didnt see the effect of your choices while you were making them.
What kind of lifestyle choices and overall health? If youre on medication, if youre obese, if youre a smoker, or if you have other medical issues all can lead to urinary incontinence.
But, as you can see, at least some of these are the result of decisions YOU make!
What Are The Symptoms
Adult incontinence isnt a condition its a symptom of another problem. There are five types of incontinence, and each manifests a little bit differently:
- Urge incontinence, also called overactive bladder: You often feel a sudden, intense urge to urinate. Sometimes you leak.
- Stress incontinence: A cough, sneeze, or laugh can make you leak urine.
- Overflow incontinence: Urine often dribbles out. You cant fully empty your bladder when you use the bathroom.
- Functional incontinence: You leak because a condition like arthritis or Alzheimers disease prevents you from getting to the bathroom in time.
- Mixed incontinence: You experience a combination of stress and urge incontinence.
In children, incontinence often stems from a health issue such as a urinary tract infection, kidney problem, or defect in the urinary tract. Sometimes kids continue to have accidents during the day and wet the bed at night after theyre toilet trained. Childhood incontinence often goes away on its own.
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Why Do Bladder Leaks Happen In Menopause
Bladder leaks are often only one piece of the pelvic health puzzle during menopause. Often, it is accompanied by vaginal dryness, pelvic pain, or painful sex. The #1 issue that accelerates pelvic pain and bladder leakage in menopause is declining estrogen levels. Estrogen is a critical piece of your pelvic health, and when your levels naturally dip during this time, your pelvic muscles weaken and your urethra thins, leaving you with less control over your bladder.
Other contributing factors include
- Being overweight, especially in your midsection
- Chronic constipation
- Drinking excess coffee or alcohol
Bladder leaks in menopause are the butt of jokes and on the list of things considered normal by many practitioners. But slapping on a panty liner is not the only solution!Here are some simple, practical tips to get bladder leaks to stop so you can get back to living your life with energy and zest, no holding back:
What The Caregiver Can Do
- Encourage or help the patient with appropriate skin care after using the bathroom. Use warm water and pat the area dry.
- Help the patient keep a diary that records specific foods or drinks that may affect how frequently the patient goes to the bathroom.
- Help the patient maintain a bladder or bowel plan.
- Encourage the patient to go to the bathroom at consistent time frames during the day, like after a meal.
- Encourage regular daily exercise, as permitted by the health care team.
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Can Incontinence Be Prevented
Different events throughout your life can lead to many of the things that cause incontinence. The muscles that support your pelvic organs can weaken over time. For women, these muscles can also be weakened by big life events like pregnancy and childbirth. However, in the same way you work out to build strength in your legs or arms, you can do exercises to strengthen your pelvic floor muscles. Doing exercises to strengthen your pelvic muscles may not prevent you from having any issues with incontinence, but it can help you regain control of your bladder. Maintaining a healthy body weight can also help with bladder control. Talk to your healthcare provider about the best ways to maintain strong pelvic floor muscles throughout your life.
Treatment For Urinary Incontinence
Today, there are more treatments for urinary incontinence than ever before. The choice of treatment depends on the type of bladder control problem you have, how serious it is, and what best fits your lifestyle. As a general rule, the simplest and safest treatments should be tried first.
Bladder control training may help you get better control of your bladder. Your doctor may suggest you try the following:
- Pelvic muscle exercises work the muscles that you use to stop urinating. Making these muscles stronger helps you hold urine in your bladder longer. Learn more about pelvic floor exercises and how to do them.
- Biofeedback uses sensors to make you aware of signals from your body. This may help you regain control over the muscles in your bladder and urethra. Biofeedback can be helpful when learning pelvic muscle exercises.
- Timed voiding may help you control your bladder. In timed voiding, you urinate on a set schedule, for example, every hour. You can slowly extend the time between bathroom trips. When timed voiding is combined with biofeedback and pelvic muscle exercises, you may find it easier to control urge and overflow incontinence.
- Lifestyle changes may help with incontinence. Losing weight, quitting smoking, saying no to alcohol, drinking less caffeine , preventing constipation and avoiding lifting heavy objects may help with incontinence. Choosing water instead of other drinks and limiting drinks before bedtime may also help.
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What Happens As Your Hormones Start To Decrease
Our hormones naturally decrease as we age , and for women, this decrease is what leads to menopause. The thing is, hormone decline can also result in incontinence.
The decrease in your hormones leads to your vaginal tissue becoming thinner and less elastic. On top of that, your muscles start to weaken including the pelvic floor muscles that help you control of your bladder. See the connection?
What Are The Symptoms Of Bladder Control Problems
Signs and symptoms of urinary incontinence can include
- leaking urine during everyday activities, such as lifting, bending, coughing, or exercising
- being unable to hold in urine after feeling a sudden, strong urge to urinate
- leaking urine without any warning or urge
- being unable to reach a toilet in time
- wetting your bed during sleep
- leaking during sexual activity
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How Do You Strengthen Your Bladder
To do Kegel exercises:
Other Treatments For Urinary Incontinence
Your doctor may recommend alternative treatment options, such as:
If you are experiencing urinary incontinence during or after pregnancy, know that youre not alone. Talk with your doctor we can help you get back to exercising, laughing, and sneezing without worrying about a accidental urine leakage.
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When To Consider Meds
If you have urge incontinence and have tried nondrug measures for several months but symptoms are still interfering with your quality of life, you might consider adding medication.
There is a role for these drugs, Hochman says, but typically only after trying safer treatments first.
How do they work? In some people with urge incontinence, the bladder muscles contract at the wrong time, causing the uncomfortable feeling of urgency and often leaks. Drugs used to treat the condition relax the bladder muscles, which can increase the storage size of the bladder and reduce the urge to urinate.
Based on analysis of the evidence by CR Best Buy Drugs, none of the drugs clearly works better than the others.
If you and your doctor conclude that one is worth trying, consider generic prescription extended-release oxybutynin. It costs about twice as much as the short-acting drug if youre paying out-of-pocket but offers the convenience of once-a-day dosing.
In addition, research suggests that it has a somewhat lower risk of side effects than other forms of the drug, including the OTC patch, as well as some other bladder drugs, including short-acting tolterodine.
Watch closely for side effects, particularly memory problems or confusion, which can be subtle, Hochman says. Because of those risks, our experts advise against the drugs for anyone diagnosed with dementia.
If symptoms havent improved after eight weeks, ask your doctor about adjusting the dose or trying a different option.
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According to the Urology Care Foundation, women are at greater risk for UI than men because they have a shorter urethra than men. As a result, any weakness or damage to the urethra in a woman is more likely to cause urinary incontinence. This is because there is less muscle keeping the urine in your bladder until you are ready to urinate.
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Begin By Talking To Your Doctor
What should you do if youre experiencing bladder problems? First, speak up. People often dont bring up issues of incontinence with their clinical providers, either due to embarrassment or because they feel there are no available options that can helpor that surgery may be the only option, says Tomas Griebling, M.D., professor of urology and senior associate dean for medical education at the University of Kansas School of Medicine. But the symptoms can almost always be eased, Hochman says.
So start by working with a general practitioner, who can determine whether there may be an underlying cause for your symptoms. Urgency, incontinence, and urinary frequency can be caused by urinary tract infections or kidney stonesor, in men, a prostate infection or prostate enlargement. Medication you take to treat other conditions, such as anxiety, depression, high blood pressure, insomnia, and pain, can also lead to bladder leaks.
Your doctor might ask you to keep a diary of how often you urinate, when you have leaks, and how much liquid you consume. That will help define the problem and pinpoint the triggers.
Other Types Of Urinary Incontinence
- Overflow incontinence This occurs when a person is unable to empty their bladder completely and it overflows as new urine is produced. It’s often found in people with diabetes or spinal cord injuries.
- Mixed incontinence You show evidence of more than one type.
- Functional incontinence This type of incontinence has less to do with a bladder disorder and more to do with the logistics of getting to a bathroom in time. It’s usually found in elderly or disabled people who have normal or near normal bladder control but cannot get to the toilet in time because of mobility limitations or confusion.
- Nocturia The need to urinate twice or more during the night, usually affecting men and women over the age of 60. In men, nocturia can be a symptom of an enlarged prostate.
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Am I At A Higher Risk Of Incontinence At An Older Age
Your body constantly changes throughout your life. As you age, the muscles that support your pelvic organs can weaken. This means that your bladder and urethra have less support often leading to urine leakage. Your risk for developing incontinence as you age might be higher if you have a chronic health condition, have given birth to children, went through menopause, have an enlarged prostate or have had prostate cancer surgery. Its important to talk to your healthcare provider over time about the risks of incontinence and ways you can manage it without interference to your daily life.
What Are The Symptoms Of Incontinence
The main symptom of incontinence is a leakage of urine. This could be a constant dripping of urine or an occasional experience of leakage. If you have incontinence, you might have large amounts or small amounts of leaked urine. You might experience leakage for a wide variety of reasons often depending on the type of incontinence you have.
You might leak urine when you:
- Exercise.
- Have an urge to urinate, but cant make it to the toilet on time.
- Have to get up in the middle of night to urinate .
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Medication For Stress Incontinence
If stress incontinence does not significantly improve, surgery for urinary incontinence will often be recommended as the next step.
However, if you are unsuitable for surgery or you want to avoid having an operation, you may benefit from a medication called duloxetine. This can help increase the muscle tone of the urethra, which should help keep it closed.
You will need to take duloxetine by mouth twice a day and will be assessed after two to four weeks to see if the medicine is beneficial or if it is causing any side effects.
Possible side effects of duloxetine can include:
- nausea
- constipation
Do not suddenly stop taking duloxetine as this can also cause unpleasant effects. Your GP will reduce your dose gradually.
Duloxetine is not suitable for everyone, however, so your GP will discuss any other medical conditions you have to determine if you can take it.
Causes Of Urinary Incontinence
Incontinence can happen for many reasons. For example, urinary tract infections, vaginal infection or irritation, constipation. Some medicines can cause bladder control problems that last a short time. When incontinence lasts longer, it may be due to:
- Weak bladder muscles
- Overactive bladder muscles
- Weak pelvic floor muscles
- Damage to nerves that control the bladder from diseases such as multiple sclerosis, diabetes, or Parkinsons disease
- Blockage from an enlarged prostate in men
- Diseases such as arthritis that may make it difficult to get to the bathroom in time
- Pelvic organ prolapse, which is when pelvic organs shift out of their normal place into the vagina. When pelvic organs are out of place, the bladder and urethra are not able to work normally, which may cause urine to leak.
Most incontinence in men is related to the prostate gland. Male incontinence may be caused by:
- Prostatitisa painful inflammation of the prostate gland
- Injury, or damage to nerves or muscles from surgery
- An enlarged prostate gland, which can lead to Benign Prostate Hyperplasia , a condition where the prostate grows as men age.
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Where Are The Pelvic Floor Muscles
During initial exam, I often use a clock visual to help women know where their pelvic floor muscles can be palpated. If you lie on your back, imagine the top of the opening of your vagina is 12 oclock and the bottom of the opening is 6 oclock.
The pelvic floor muscles are easiest to palpate at the 5 oclock and 7 oclock positions about even with where your legs meet your hips and approximately 3 to 4 centimeters above the vaginal opening.
These are the same muscles you contract when you try to stop the flow of urine midstream or if you were to tighten your vagina around a tampon. And these are the muscles you contract to do Kegel exercises. These pelvic floor muscle exercises were named after Dr. Arnold Kegel, who described them in the 1940s to help patients strengthen their pelvic floor muscles to treat urinary incontinence.