Women's Health Matters

Text Size
Jump to body content

Coping

Urinary incontinence can be an embarrassing and emotionally difficult condition. If left untreated, it can lead to social isolation and depression. Women living with incontinence may find themselves avoiding work and social situations because they are worried that they may have an "accident." Urinary incontinence can be treated and, in most cases, controlled; sometimes it can be cured.

You can play an active role in your own treatment. There are a number of non-medical methods that may help improve your bladder control. These methods do not involve surgery or medication, and pose little or no risks of side effects.

Rehabilitating pelvic floor muscles | Bladder retraining | Dietary changes

Rehabilitating Pelvic Floor Muscles

The pelvic floor muscles are located at the bottom of the pelvis. They are shaped like a sling, and attach to the pubic bone in the front and the tailbone (sacrum and coccyx) in the back. These muscles support the bladder and form the sphincter that surrounds the urethra and controls urination. Pelvic muscle contractions prevent urine from leaking during activities that put pressure on the bladder.

One reason women are more likely to experience urinary incontinence is because of the physical changes that occur during pregnancy and childbirth. Childbearing can stretch and weaken the pelvic muscles that hold the bladder and uterus in place. Pelvic floor muscles can be strengthened using one or a number of techniques, such as Kegel exercises, vaginal cones, electrical stimulation and biofeedback.

Kegel Exercises

Kegel exercises are the cornerstone of non-medical treatment for incontinence. They were developed in 1948 by Dr. Arnold H. Kegel, a California gynecologist. Since then, Kegel exercises have become the first treatment option for women with stress incontinence.

When done correctly and consistently, these exercises strengthen the muscles that support the bladder and urethra. Studies show that up to 80 percent of women who do Kegel exercises see an improvement in their bladder control. Some women with mild symptoms will see results within weeks, others may have to wait a few months.

Kegel exercises may be used alone or in conjunction with biofeedback, vaginal weights or electrostimulation. These exercises also strengthen the pelvic floor muscles and improve your awareness and control of the muscles. The key is to find the correct muscles. It takes concentration and practice to locate the pelvic muscles.

To find your pelvic floor muscles, lie on your back with your knees bent and your feet flat on the floor. Squeeze and lift your rectal and vaginal muscles, just as you would if you were trying to hold in gas or urine. You should feel your muscles contract inward and upward. Your abdomen, thighs and buttocks should remain relaxed and not move. If you insert one or two fingers into your vagina, you should be able to feel the muscles contract. Another common way to find the pelvic muscles is to try to stop the flow of urine when you’re on the toilet. However, once you are able to contract the proper muscles, you should avoid doing these exercises while voiding.

Start by contracting the muscles for just a couple of seconds at a time. Gradually increase the length of time you hold the contraction for. Increase the duration and number of contractions until you are able to do 30 to 50 10-second contractions a day.

Some women may have trouble contracting the right muscles. A physiotherapist, nurse or physician can teach you how to contract and relax these muscles. In some cases, you may need to use biofeedback or electrical stimulation to learn how to do this. Once you are comfortable doing Kegel exercises, you can do them anywhere, at any time, while sitting or standing.

Starting or Enhancing Your Exercise Program

When you are able to contract and relax the pelvic muscles, as described on the Kegel exercises page, you can begin an exercise program. Programs involve contracting the pelvic muscles for a few seconds in a series of exercises. These exercises should be done several times a day. An experienced health professional can recommend how and when to do the exercises. It is important that once you get the hang of them, you continue to do the exercises to maintain your muscle strength.

Electrical Stimulation
Stimulating the pelvic muscles with a low-grade electrical current can be a useful addition to Kegel exercises. The electrical current stimulates and contracts the muscles, much the same way that Kegel exercises do. It is used to help women who can't contract their pelvic muscles voluntarily.

Electrical stimulation can be done in a clinic or at home. Treatment sessions usually last about 20 minutes and should be done every one to four days. There are no side effects to electrical stimulation, but you should avoid this treatment if you are pregnant or use a pacemaker. Note that this treatment may not be covered by your provincial health plan.

Biofeedback
Biofeedback teaches you how to control your pelvic muscles and bladder. Using a probe or electrodes attached to the skin, biofeedback machines measure the electrical signals when you squeeze your sphincter and pelvic floor muscles. This information is shown in a graph or lights. These visual queues teach you to identify and control the muscles you use to urinate. A large proportion of patients (about 75 percent) find that biofeedback improves their symptoms, and an additional 15 percent report that it cures them. Note that this treatment may not be covered by your provincial health plan.

Bladder Retraining

Going to the bathroom too frequently can cause bladder problems. Because your bladder is a muscle, it needs exercise to stay toned and strong. It gets this exercise by stretching as it fills and contracting as it empties. If you are continually going to the bathroom, your bladder is not getting a chance to fill, and its capacity may decrease. Over time, your bladder muscle can lose its tone and strength and be unable to hold as much urine.

You can retrain your bladder. You and your health-care provider can set up a schedule which gradually lengthens the time between bathroom trips. When successful, bladder retraining increases your bladder capacity, allowing it to hold more urine for longer periods of time. It is an effective method for treating overactive bladder. As many as 75 percent of women with overactive bladder find their conditions improve by using bladder retraining methods.

When starting a bladder retraining program, you might aim to urinate once every hour, or once every two hours. The goal is to eventually void no more than once every three to four hours. When you feel the urge to urinate, wait until the urge passes. At first, you may only be able to wait a few minutes or less, but as you practise, you will be able to increase the amount of time.

Dietary Changes

For some people with overactive bladder, simply modifying what they eat and drink each day can solve the problem.

People with urinary incontinence often want to reduce the amount of liquid they drink because they want to decrease the number of trips they have to make to the bathroom and the number of accidents they have. In fact, reducing your fluid intake can cause more problems than it solves. A better option is to choose your liquids wisely and drink more at the start of the day and less before you go to bed.

Adults should drink a total of 60 oz (six to eight cups) of fluid each day. Limiting these fluids will not eliminate your incontinence. It can lead to constipation, which can increase your risk of incontinence. Cutting back on fluids can also cause dehydration. Your body will produce less urine, but the urine will be very concentrated with a dark color and a strong odour. This can irritate your bladder and support the growth of bacteria, which, in turn, can cause bladder infections and further aggravate your incontinence.

Here are some tips to limit the aggravating effects of fluid on your incontinence:

  • Drink throughout the day, rather than drinking large amounts at one time (e.g. drink one cup every two to three hours).
  • To prevent nighttime voiding, decrease fluids after dinner or stop drinking at least two hours before bedtime.
  • Choose liquids from the list below.
  • Avoid alcohol and caffeine.

Avoid foods and drinks that irritate your bladder or increase the amount of urine your body produces. Caffeine, which is found in drinks such as coffee and colas and foods like chocolate, is a diuretic and a bladder irritant. Consuming too much caffeine will make you urinate frequently. Spicy and acidic foods can also irritate the bladder.

Drink:

  • water
  • apple juice
  • grape juice
  • cranberry juice

Avoid or decrease your intake of:

  • alcoholic beverages
  • caffeinated drinks and foods
  • carbonated, caffeinated beverages
  • tomatoes, tomato-based products and other acidic foods
  • spicy foods
  • artificial sweeteners (like those found in diet drinks)

 

Jump to top page

This website proudly supported by:


Urinary Incontinence

Medical Description

Diagnosis

Coping

Treatment

FAQs


Discussion Groups

Share knowledge and talk about your gynecological health-related experiences with other women.

Gynecological Health Discussion Forum

  • A publication of:
  • Women's College Hospital