You know it well – the doctor says you should do Kegel exercises, the physiotherapist says you should train your pelvic floor, even the media have started talking about the importance. Now it's not even just the women being addressed, men have to get started too.
However, pelvic floor training can be an uphill battle! How do you do it right? It's boring! You forget it! The excuses can be many. Nevertheless, it is important if you want to avoid a future with incontinence.
So what is incontinence? Do you just pee your pants all the time? Do I need to wear a diaper? Can I no longer be active? As a physiotherapist, you get many questions and concerns when you meet women and men who feel they have started to 'leak'. It is known that pregnant women must make a great effort to maintain the ability to squeeze to hold the urine. Likewise afterwards to regain previous function. The situation is just that anyone can have problems, especially as we get older.
I am a physiotherapist, 36 years old, and have incontinence problems myself. Why so young? In my case, it is mainly due to my first birth and then subsequent challenges and surgeries. For others, it can be about age, repeated heavy physical strain, overweight, or something completely different.
My best and first advice to everyone is; Seek help.
Seek expertise from either your doctor or another professional if you are unsure how to get started.
Kegel exercises sound easy peasy for most people. The reality, however, is that many do not contract correctly. The pelvic floor muscles, which function as a single muscle, only produce a very small movement, but with enormous significance. The people I have met over the years tend to tighten their buttocks or stomach when they contract, precisely because it can be so difficult to get the feeling of when you have really "got" that little annoying muscle.
Many believe that they can train the muscle when they go to the toilet – because if you can stop the stream, then it's good. Here is something very important for me to point out, that this should ONLY be done to check your ability, and only occasionally. You must definitely not use this situation to do your Kegel exercises, as it can cause you not to empty your bladder sufficiently – and then you face a completely different challenge.
Remember therefore – toilet visits are for peeing, and take your time so the bladder is emptied.
Another thing I often encounter is that people do not ''pull themselves together'' or remember to train the pelvic floor. Everyday life is filled with many other important things, and pelvic floor training therefore requires that you either lie down, sit, or stand still. At least if you are starting from scratch. Later, you can and should also be able to keep track of the activity. This will be possible to achieve for many who do not have internal injuries or specific problems.
Effective rehabilitation of the pelvic floor unfortunately does not happen overnight – I would guess that on average you should expect at least 3 months of daily effort.
In the beginning, frequent short sessions. Over time, as endurance and strength are achieved, you will be able to train in longer sessions and therefore fewer times a day.
Patience – oh yes! It requires patience and willpower. Now it almost sounds like a completely overwhelming task, but really it is no different than if you have broken a foot, where you have to rehabilitate your muscles when the cast comes off. The difference is just that the large muscles are easier and faster to train.
As I often say, ''Rome wasn’t built in a day, and a little is always better than nothing''. I wish there was an ''easy fix'', but when it comes to our body and physique, it rarely exists.
My second-best advice over time has always been to get your training and exercises into a system. Whether it is a reminder on your phone, set times every day, or similar – just get it into a fixed routine.
My own experience is that I can easily get tens of thousands of thoughts and completely forget to contract. Control is the keyword. Control over your pelvic floor muscles. You need full awareness to contract and full sensation to release again. Some can only hold the contraction for a few seconds before the strength of the contraction fades, and that should preferably not happen. You need to be in control of when you contract and release and from there calmly increase your endurance and contraction. Pelvic floor training also involves other muscles in the pelvis, but it all has to start with control of the pelvic floor muscle itself.
Some people feel the squeeze best when lying down – others when sitting. The position does not matter much as long as you have the feeling and control.
It is a good idea to train in different positions. Lying down, you have no weight on the muscle, which you do in a standing position.
Then there are some who cannot feel the squeeze at all, feel no movement, no control – nothing happens! Again, best advice, seek help.
There are physiotherapists with experience and specialized training specifically in pelvic floor training, often referred to as ''gyn-phys''. Besides what they can achieve with their knowledge, guidance, and physical help, there are several aids on the market that can support rehabilitation.
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