Freedom from urinary incontinence: How can pelvic floor exercises help?

In this informative article for patients, highly respected consultant urological surgeon Mr Rajesh Kavia shares his expert insight on the power of pelvic floor exercises to help improve symptoms of urinary incontinence. The revered specialist also details which surgical treatment options are indicated for severe urinary incontinence in both men and women.

How do pelvic floor exercises help with urinary incontinence?

To improve symptoms of urinary incontinence, a strong pelvic floor is essential as this holds everything in place. Pelvic floor exercises strengthen the muscles down below which is very important for patients who have had children or those with a weak pelvic floor due to chronic constipation.

What does pelvic floor exercise entail?

Performing pelvic floor exercise is actually quite simple. One way to think about it is to imagine you need to pass wind and you’re in a situation where you shouldn’t be doing so. If you imagine trying and hold it in, that action is a pelvic floor exercise. You should aim to perform that squeeze and hold inwards for up to ten seconds.

Much like other types of exercise, you may only be able to perform the squeeze for four or five seconds at first and you can gradually build up to ten seconds. You should perform this squeezing exercise with ten repetitions and aim to do this three times a day. You could perhaps do so at breakfast, lunch and dinner time or you can download an app to remind you. Apps can be very helpful for this, particularly because they provide a timer so that can be sure you are performing the exercises correctly and in a proper structure.

To strengthen the pelvic floor, two types of exercises can be performed, one being slow and the other fast which is particularly beneficial for women. This helps with overactvity because it improves the signalling going up to your brain and back down again, known as the pro-continence reaction. Pelvic floor exercises are beneficial for all patients and the NICE guidelines state that they should be performed regularly for at least six weeks to three months before pursuing any active treatments for incontinence.

Are there any surgical options available for those with severe urinary incontinence?

There are two types of urinary incontinence: stress urinary incontinence and urge incontinence. Before going ahead with any procedure, we always go through the British Association of Urological Surgeons (BAUS) information sheets and the guidance that’s available from NICE (a decision making tool) with our patients so that they are fully informed.

To treat stress incontinence in women, there are various options once all conservative measures have proven unsuccessful. One type of procedure is known as bulking, where a substance such as Bulkamid is injected into the water pipe. The data suggests that bulking works for a number of patients but is not likely to be successful if your incontinence is very severe. For the majority patients nowadays, however, bulking is a good choice as it’s the low risk option and can be performed as a day case procedures under local anaesthetic or sedation. Also, if the bulking is unsuccessful, this doesn’t stop us from going ahead with more invasive procedures.

If a patient’s incontinence is very severe or they are seeking a more invasive operation, there are two main procedures that I and most of my colleagues would offer. One option is an autologous fascial sling, which involves taking a segment of the rectus fascia (tissue from just above the pubis) and using this as a sling to hitch up the urethra and tighten things up. The other option is what we call a colposuspension, which can be performed using an open, laparoscopic or robotic approach. In this type of surgery, we essentially use the vaginal tissue to strengthen the urethra.

These types of surgical procedures are far more invasive and as such require more recovery time and have additional risks associated. This will always be discussed with you as a patient and you will be provided with all the necessary tools and information in order to make a decision about your treatment in conjunction with your consultant. If your incontinence is serious, there are other procedures available, like the artificial urinary sphincter, but this is only offered in highly specialist units.

For men, the available treatment options are slightly different as bulking agents don’t seem to work as well for them. There are sling and artificial urinary sphincter procedures but these are complex surgeries which need to be discussed with the individual patient in detail.

To learn more about the causes of urinary incontinence and the recommended lifestyle modifications to help manage symptoms, you can read Mr Kavia’s other expert article on the topic.

If you wish to schedule a consultation with Mr Kavia, you can do so by visiting his Top Doctors profile.