May 21, 2001 -- Many women cringe when they think of the embarrassment that can be caused by something as simple as sneezing, coughing, or sharing a laugh with a friend. The cause of this embarrassment is urinary incontinence, which affects millions of American women.
Although some women may associate the loss of bladder control with aging, the first symptoms of urinary incontinence can start soon after childbirth. This type of incontinence is caused by the stress and strain put on the muscles lining the floor of the pelvic cavity during labor. The muscles, known as pelvic floor muscles, are attached to the pelvic bone and act like a hammock, holding in your pelvic organs and helping the bladder hold urine. When they weaken, the result is a loss of bladder control and embarrassing accidents that can occur at random and inopportune moments.
But the situation doesn't have to be tolerated because in most cases, these muscles can be retrained to work properly. This is accomplished by a serious of simple exercises, called Kegel exercises, repeated five or six times a day.
In a study appearing in this month's issue of Obstetrics and Gynecology, scientists from Switzerland found that women who started doing the simple exercises two months after giving birth and did them for 12 weeks had significantly less urinary incontinence than women who did not do them. Nearly 60% of women who did the exercises two times a week under supervision reported great improvement in their ability to control their bladder muscles. In addition to the exercises, the women took part in a computerized training process to help them become aware of and control these muscles and electrostimulation, where a small electrical shock to the pelvic muscles through the vagina helps improve muscle strength.
According to researchers led by Sylvain Meyer, MD, up to 34% of women may experience urinary incontinence after vaginal delivery. Pelvic floor exercises used as part of a program of "pelvic floor education" could potentially reduce the rate of this problem by 60-90%, says Meyer, who is with the department of obstetrics and gynecology, Lausanne University Hospital in Switzerland.
Continuing to do the exercises for the rest of their life is crucial if women are going to keep the muscles toned and prevent further weakening, says urologist Nicholas Franco, MD.
"Gynecologists tell their patients they need to do the Kegel exercises, but I think where they fail is to spend the time showing them how to do it properly or to have a nurse or someone in the office show them how to do it," says Franco, head of female urology at Tulane University School of Medicine in New Orleans. "At the very least, check on them from time to time to see that [patients] are doing it right. Everybody knows about Kegels it seems, but not everybody does them the right way."
To perform a Kegel exercise, experts recommend that women first identify their pelvic floor muscles by starting and stopping urination. Once you have located the muscles, simply tighten and relax the muscle over and over.
Biofeedback and electrostimulation are especially useful for women who have trouble doing Kegels, says Paul D. Indman, MD.
"Some women don't have the muscle strength to even begin to do it," says Indman, a gynecologist in private practice in Los Gatos, Calif.
Once you are sure you're doing the exercises correctly, Franco says, it takes just a few minutes to do them before getting out of bed in the morning, after emptying your bladder, on your lunch break, while sitting at a red light, while watching TV, and before falling asleep at night.
"You have to do them at least four or five times a day in sets of five," he says. "That's about 20 or 25 contractions divided over the course of the day and it doesn't take much to do five contractions. It just takes a little discipline to do it every day."
For most younger women, Kegel exercises done correctly can strengthen pelvic floor muscles. For those who can't, Indman says surgery is an option, when a woman decides she's ready for it.