"How to control incontinence - pieces of the puzzle"

Tasha Mulligan MPT Health Pro

    The road to resolving incontinence is usually not a one step process. There are several pieces of the puzzle that must be addressed in order to take back control of your bladder. One of my previous blogs described a 2 step Kegel that includes elevating your pelvic floor. This is one very important piece of the puzzle, but it isn't the only one.



    There are actually 3 key components to successful pelvic floor rehabilitation and they include:

    1. Daily practice of a 2 step Kegel contraction.

    2. Consistent practice of neutral spine posture.

    3. Regular strengthening of your entire pelvic basket. (Your pelvic basket is made up of your transversus abdominus, your multifidi, your hip rotators, your glutes, and your inner thighs.)

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    The 2 step Kegel contraction is important to strengthen your pelvic floor muscles and to build their endurance to better support your pelvic organs. Neutral spine posture, which was also thoroughly described in a previous blog entry, is an important piece of the puzzle because when we assume optimal posture we actually put our pelvic floor muscles at the perfect length/tension ratio. When we have this light tension in our pelvic floor muscle fibers, they are better able to react and contract as needed throughout our daily activities. It is important to hold this posture throughout your day to give your pelvic floor the best chance to successfully keep you continent.


    The third and final piece of the puzzle is regular strengthening of the entire pelvic basket, which includes several muscles of your low back, lower abs, inner thighs, and hips. All of these muscles stabilize our core or the very center of our body and maximize performance of our pelvic floor. Just like every step we take, every overhead reach, and every breath requires the coordination of several muscles, so does the maximum contraction and function of our pelvic floor.


    I often equate the dependence of one pelvic muscle on another to a basket weave. If you are carrying around a basket full of goodies and the front of the basket is too weak to hold all the contents, the entire basket will fail. Our bodies operate the same way, so if our transversus abdominus or lower abdominals are weak on the front of our pelvic basket, we may tend to stand a different way to compensate and this puts more pressure on our lower back and our pelvic floor, leading eventually to failure of the basket. The same is true if our glutes are weak, then the sides and back of our pelvic basket are weak, and will eventually fail.


    As we age, as we deliver babies, as gravity takes effect, and as we experience hormone changes, we have to make an effort to strengthen all of these muscles that enclose the front, back, and sides of our pelvic basket. I want to close this blog entry today with 4 specific exercise examples targeting each muscle that encloses our pelvic basket. Keep in mind that strengthening these muscles is one important piece of the puzzle, along with the 2 step Kegel, and optimal posture that will help strengthen your pelvic basket and resolve your incontinence.



    Glute/heel squeeze and Multifidi extensions

    This combination exercise recruits our deep hip rotators and the small stabilizers in our back called the multifidi. Both of these muscle groups are very important to our PF muscle function. (3 x 8)


    To begin, position yourself on your stomach with your forehead on your hands. If you have discomfort in your low back lying on your stomach, simply place a pillow under your hips to decrease your extension.


    In this position, bend your knees slightly, lifting your feet approx 12 inches off the ground and turn your toes out so that just your heels are in contact. In this position, first squeeze your buns tight and then squeeze your heels together to recruit those deep hip rotators. You can feel how the addition of the heel squeeze intensifies the contraction in your buns. You can work to a rhythm of "squeeze, squeeze 2, 3, and relax, and squeeze, sqeeze, 2,3, and relax," and so on for 8 reps.

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    When you reach 8 then relax your legs down so your knees are straight and we are going to perform 8 contractions of our multifidi muscles, the small muscles in between each vertebrae of our back. You are going to simply rotate your pelvis, increasing the arch in your low back, and give a slight lift of your buns toward the ceiling. Keep in mind this movement is a very subtle rotation, so we shouldn't see your hips leave the ground and there shouldn't be a big movement of your back. As you attempt this exercise, you should feel your PF automatically tighten up as you rotate your pelvis, as these muscles work hand in hand. You can work to a rhythm of "rotate and lift, relax, rotate and lift, and relax," and so on for 8 reps before switching back to another set of glute/heel squeezes.


    Hands and knees transversus abdominus lift and hold

    Our next exercise teaches us how to activate our transversus abdominus. This lower abdominal muscle activates and draws our belly button in every time we perform a PF contraction.


    To begin, position yourself on your hands and knees. In this position, draw your belly button up and in as if hollowing out your mid section. This should not involve any movement of your back, just your midsection cinching up as if being tightened by a belt or a corset. Hold our abdomen drawn up and in for a full 5 count, while continuing with a steady breathing pattern before you release. You can work to a rhythm of "draw it up and hold, 2,3,4,5 and relax, and draw it up...and so on for 8 reps.


    Bridge with adductor squeeze (2 x 8)


    This exercise works your lower back, your glutes, your inner thighs, and your pelvic floor. All of these muscles enhance our PF contraction. To begin, position yourself on your back with your knees bent, squeeze your buns tight, press through your heels, lifting your buns up. At the same time, squeeze a pillow tightly between your knees for a 3 count. Continue to a rhythm of "bridge up and squeeze 2, 3, and down, bridge it up and squeeze 2, 3, and down...and so on for 8 reps. (x 8)



    Samari squats

    Our last exercise takes us to a standing position. This time we will be coordinating the contraction of your inner thighs, your glutes, your transversus abdominus, and your PF.


    To begin, stand with your feet wider than shoulder width apart with your toes pointing out. With all the weight on your heels, bend your knees, lowering yourself down until you feel a stretch in your inner thighs. (If you can't keep all your weight on your heels when you are down in this position then we need to get your feet out a little wider.) When you reach your stretch position, press through your heels pushing yourself back up, actually visualizing yourself zipping up your legs from the ground up by digging your heels in to the ground as if we're trying to pull them together. Zip up your inner thighs pulling them tight and finally tuck your 2 sit bones under, squeezing your buns tight and elevating your PF. Hold for a count and lower slowly. Notice as we lower that our knees point out in the direction of our toes and all the weight stays on our heels and as we zip back up, pressing through our heels, we don't lock our knees out. We always leave a slight bend in our knees as we pull our thighs toward each other and tuck our sit bones under. A quick note on this exercise before we begin, if you have knee pain with this exercise, simply stop your squat before the onset of pain and press back up. You can work to a rhythm of "take it down to a stretch, press it up, zip it up, and squeeze, take it down to a stretch, press it up, zip it up, and squeeze, and so on for 8 reps. (3 x 8)


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    For a more thorough instruction on all of these exercises and more, you can refer to www.hab-it.com. The information in this blog is designed as general guidelines for rehabilitating your pelvic floor, therefore, if you experience pain or are unsure of your positioning for the exercises described, please see a women's health physical therapist in your area. You can find a list of physical therapists at www.apta.org.

Published On: December 14, 2009