How to perform a proper pelvic floor contraction for the prevention of urinary or fecal incontinence.

By Steven Lavender
https://theptpractice.nyc

This article is written with the intention of providing the reader with basic information about what the pelvic floor is, how to initiate contractions and gain control of the muscles and how to progress that exercise through graded exposure back to functional meaningful activities with reduced or no leakage.  If you have questions ask a pelvic floor therapist for advice.  Remember don’t do anything you think might hurt you or you don’t feel comfortable doing.

The muscles of the pelvic floor ly like a hammock or sling between your tail bone and your pubic bone.  They are important because they have several important functions.  One of the main functions is the support of all organs and tissue above them.  Secondly, the muscles regulate the passage of urine and feces from your body when needed and prevent unwanted leakage of urine or stool at other times.  They also contribute to sexual activity by producing erections and performing contractions during orgasm.  Some of the muscles of the pelvic floor are under your conscious control and some are not.  The basic muscle activity that prevents leakage is the ability to lift and squeeze.

Many people are under the misapprehension that doing Kegel exercises alone will help minimize urinary or fecal incontinence.  IT WON’T.  Being able to contract your pelvic floor maximally is not the goal! It is only part of learning control of the muscles of your pelvic floor and not functional in any way.  The goal is to learn how and when to contract and relax your pelvic floor muscles so you can perform a large variety of activities without leakage and without extraneous effort. The strength and endurance of the contraction will depend on the amount of control needed to support your body and stop leakage during a specific activity.   The control of your pelvic floor muscles is like a dimmer switch, not an off and on switch!!  Meaning it is a moving and changing amount of contraction that is graded up or down under your control in order to perform a function without leakage.

Please remember that practicing pelvic muscle control in isolation is only preparation for you to integrate that learned control in your daily activities.  Otherwise, it is useless to you.  Pelvic floor control implies the ability to control muscle contraction from the barest of contractions used in quiet standing to a full contraction used when lifting or moving heavy objects.  The goal is mastering control of the pelvic floor muscles from gentle to strong contraction and back again.

The direction of muscle activation for persons wanting to control leakage of urine and feces is in and up. That is, abdominals are drawn in and pelvic floor muscles are drawn up. Not out and down.  If you are bearing down as in having a baby or having a bowel movement you are going in the wrong direction.  If you feel activation of outside muscles like you gluteal muscles or adductor muscles you are trying too hard and not activating your internal muscles correctly.

So how do you start?  If you are just beginning and have very weak muscles and cannot feel muscle activity in your pelvic floor then start by lying down on your back or side.  With some imagination and persistence, you can try a variety of things to initiate a contraction. You can try to initiate a contraction by imagining you are trying to stop yourself from passing gas.  You could imagine you are drawing your tailbone up through your body to your belly button.  You could think that you have an open zipper running from your anus to your belly button and you need to zip it up.   If you still can’t find those muscles stand in front of a mirror naked from the waist down and try to lift the testes or withdraw your penis without touching them and only using your internal muscles.  In an ideal situation, the testes should rise and lower and the penis should bounce or shorten.  If the organ does this you have used the muscles.  Now all you have to do is repeat the activity ‘till you can do the contraction with your pants on and away from the mirror.

Once you can find and activate the correct muscles then you can play with the strength and endurance of the contraction.  For example, start by lying down and contracting as muscles as high as you can and then let the contraction relax back to baseline.  Then try only doing half of that contraction and relaxing back to baseline.  Then play with how long you can hold the contraction.  Start with a gentle contraction and hold for a couple of seconds and build up from there.  Try doing a low-level contraction and holding for five and then ten seconds.  Then build up as you can and hold from ten seconds to twenty seconds before relaxing down to the baseline. 

Now you have the ability to find the muscles and alter the amount of contraction and the duration of contraction you can then progress by to more functional movements.  Gently activate your pelvic floor muscles and move from lying to sitting while engaging the muscles. Use the amount of contraction necessary to stop possible leakage not 100 % effort. Then try activating the pelvic floor muscles in sitting and moving to standing while controlling leakage.  Again, only use the amount of pelvic floor contraction necessary to do the job. If you have control over leakage move on to marching en place while activating the muscles only to the level you need to control leakage. Then try walking, running, jumping…. and so on until you can perform an activity that would have once caused leakage with no or less leakage.

The way to success, in this case, is simply graded exposure to increasing complex activities performed with progressively better pelvic floor control.