More than 200 million people worldwide live with incontinence, a term used to describe the involuntary loss of urine from the bladder or faeces from the bowel. In Australia alone, more than 4.8 million people have bladder and bowel control problems, with 13 per cent of men and 37 per cent of women in the general population reporting urinary incontinence.
It’s even higher for older members of the community, with hormonal shifts in the menopausal years impacting women and the growth of the prostate leading to the onset of bladder issues in men. Other factors such as a history of pregnancy or vaginal birth, pelvic surgeries, hysterectomies or operations on the prostate can cause the pelvic floor muscles to weaken.
Equally, a history of chronic constipation or frequent heavy lifting can also put additional strain on the pelvis and weaken the pelvic floor further. One way many people can ease incontinence is by practicing pelvis floor exercises to strengthen the pelvic floor and help prevent the development of incontinence or prolapse.
Women can strengthen the pelvic floor muscles by imagining they’re holding the flow of urine, holding in wind and trying to squeeze, pull up and hold the muscles in that area. Someone experiencing leakage with coughing or sneezing should typically start seeing improvements after six weeks of pelvic floor exercises.
“The actual real strength changes, where we start to see the muscle hypertrophy or growth can take as long as three months,” Annabelle Citroen, Continence and Pelvic Floor Physiotherapist for the Continence Foundation of Australia, tells Starts at 60. “The evidence tells us for the primary conditions we treat, one being the stress urinary incontinence, that it can take six months to see a really good change to the point of cure, and as long as 12 months.”
Pelvic floor exercises for men differ slightly as they have a visual tool to aid in pelvic floor exercises.
“For men, the advantage is they have a visual tool externally,” Citroen says. “When they stand in front of a mirror, if they’re thinking of imagining trying to stop the flow of urine or trying to hold onto wind, they should see the scrotum will lift up and the penis will retract. They’re external visual cues to help males know they’re on the right track.”
For both men and women practicing these exercises, there should be no form of baring down or straining, which can cause further problems. Instead, people should focus on pulling the muscles skywards. Exercises should also be completed three times a day and consistency is the key.
“As a general guide, you’re better of starting with a shorter squeeze for perhaps two or three seconds, making sure there is a rest period of at least the same length of time, often a little bit more. For example, five seconds,” Citroen says. “We’re aiming to get to around 10 repetitions or when the muscle is starting to show signs of fatigue to actually start to prompt some change in the muscle.”
It’s important to realise that pelvic floor exercises won’t cure all forms of incontinence or bladder issues.
“There are groups of patients where it would be amiss to just prescribe pelvic floor exercises without looking at other possible causes,” Citroen says.
This includes patients who have difficulty empty their bladder or cases where people leak as a result of their bladder overfilling.
“Those cases we would usually avoid prescribing pelvic floor exercises and further investigations are needed,” Citroen adds.
Health experts often use pelvic floor exercises as a first line of defence for people living with stress incontinence. This is where coughing, sneezing, laughing or any high-level activity causes leakage.
Pelvic floor exercises can also assist those suffering from bowel incontinence, provided health professionals identify that a patient’s muscles are weak and there’s nothing in the digestive tract that requires medical attention. They can also help patients with urgency leakage, where there’s a sudden urge to go to the toilet.
Anyone experiencing incontinence or dysfunctions of the bladder and bowel should always visit a GP to check there are no underlying issues. Patients may be referred for a full continence assessment to help them with specific exercises.
Similarly, the Continence Foundation hotline, 1800 330 066, can provide help and assistance over the phone.
“Ultimately, no leakage is normal leakage,” Citroen says. “To go and start that conversation usually means things can be investigated sooner, the outcome will be better and it won’t take so much work to get to a point where the condition is improved.”