Exercise your Pelvic Floor Muscles - download the Squeezy App
13 July, 2016
Pelvic floor muscle exercises in cystitis and overactive bladder
Pelvic floor muscle exercises have been proven to be very effective in improving pelvic floor weakness and are the first line treatment for stress urinary incontinence (leaking when you put stress on your bladder, such as coughing). How useful are they if you have a problem such as interstitial cystitis, overactive or painful bladder?
We know that the urgency connected with overactive bladder can be considerably helped by a good, strong pelvic floor contraction as it helps the bladder muscle (detrusor) to relax. However, there is some debate about the possible risks of overdoing pelvic floor exercises and aggravating symptoms of painful bladder, for example.
Any exercise performed too often, without adequate preparation or recovery, can have adverse effects. Have you ever felt the ache after a high-impact aerobics class or a long walk when you are not used to it? Some people recommend doing lots of pelvic floor exercises (sometimes 200 contractions in one sitting!) or using gadgets that work the muscles fast and furiously. Exercises and gadgets all have their place but as a guideline, women with bladder, bowel and pelvic floor muscle problems should exercise around six times a day. Women without problems should do around three sets a day, as should men who have symptoms.
A standard set of exercises includes strong, long squeezes of ten seconds, repeated ten times and then ten fast squeezes. However, not everyone can do this and you should work up to it if your muscles feel weak.
It is crucial to learn to relax your muscles too – imagine tensing your shoulder muscles for several hours and the headache you would probably end up with! This relaxation is thought to be extremely important for people with certain conditions such as bladder pain, repeated bladder infections, cystitis, pelvic or vulval pain and perhaps overactive bladder. When we examine people with these conditions we often find a degree of tension in the pelvic floor muscles and difficulty letting the muscles go. Imagine your muscles to be a lift in a block of flats. You want the lift to start at the ground floor and travel up to the top (let’s say floor ten), then when you are ready you want the lift to go back to the ground floor again. Overactive pelvic floor muscles whizz up to the tenth floor but may only come down to floor five because they cannot let the tension go.
Why does this matter? It can cause aches or muscle fatigue. This may mean the muscles can’t work as well when you need them (for example, running for the bus). It may also interfere with normal bladder emptying, which means you may not empty fully when you go to the toilet. This can be an aggravating factor for infection and may add to the symptoms of bladder pain and overactive bladder.
What can you do about it? Make sure you focus on letting the muscles relax as much as possible after every squeeze. For women who find this hard we sometimes suggest a longer relaxation phase between squeezes and fewer of the long holds, as these build up more tension in the muscles and may make it harder to let go.
It is important to feel confident with your pelvic floor muscles and how to exercise them. If you have any concerns, see a pelvic physiotherapist (ask your GP or consultant, or visit www.pogp.csp.org.uk).
There are also Apps to help. The one often recommended by physiotherapists is Squeezy, which costs £2.99, is NHS endorsed and has an audio-visual guide to help you squeeze and relax. You can set reminders and personalise your exercise programme plus it will fit with a detailed programme that a physiotherapist may give you. Have a look at www.squeezyapp.co.uk for more information or visit the App store or Google Play.
Senior pelvic health physiotherapist