On a practical level, having a pair of reusable incontinence pants is a great tip to help you manage symptoms of incontinence- they’ll absorb light leaks and dribbles, and keep your comfy all day too. But is there more that you can do, to resolve or even prevent incontinence? Luckily, yes. In this guest post, we asked Anja to discuss exercises that help with urinary incontinence.
Anja Brierley Lange is the author of the best selling book, Teaching yoga for the menstrual cycle - an Āyurvedic perspective. She is an experienced yoga teacher and āyurvedic practitioner (BSc, PGDip) and has specialised in female anatomy and physiology. Anja offers classes, workshops and consultations online and in person. Learn more on yogaembodied.com including online courses about the pelvic floor and menstrual cycle awareness.
What is urinary incontinence?
Urinary incontinence is when we unintentionally leak urine. Perhaps you experience incontinence when coughing, sneezing or laughing. Perhaps when exercising or lifting heavy weights, groceries - or children! These symptoms are referred to as stress incontinence. Urge incontinence is when the urge to pee happens so quickly that we don’t have the time to find a loo, or we feel the urge to go after we’ve just been.
Other causes of incontinence can be additional pressure such as during pregnancy as well as obesity, during the postpartum period and due to trauma or surgery. Some medical conditions, medications and injuries can also affect our continence.
According to the NHS it is “estimated that between 3 and 6 million people in the UK may have some degree of urinary incontinence", and it's more common in females than males- although both are affected.
It is common. But it is not normal. Because there are things we can do to support our pelvic floor and awareness of when and why it happens to us. Having a check-up with your GP and a specialist physiotherapist is a good place to start to determine why you experience incontinence.
Exercises to help with urinary incontinence
Once you have established the cause of urinary incontinence you can make a plan. If it is due to pelvic floor weakness, tight muscles in the pelvis- or both- you can incorporate exercises and awareness into your routine. Grab a pair of period proof leggings (perfect for catching any sneaky leaks or dribble that might occur while you workout) and you're ready to go!
First, you need to become aware of the pelvic floor. When I teach people about their pelvic health I always start with awareness. In my Sacred Pelvis online course, I use three steps: Awareness, Release and Stability. This is what I’ll share with you here.
Sit in a comfortable seat. You can sit on a chair or firm surface. Slide one hand towards one of your sitting bones. Those are the big rounded bones you sit on. They are part of your pelvis. And part of your pelvic floor is attached to them. Ideally, you want to touch the area between the two sitting bones. Or any part of the pelvic floor, or vulva if you have female anatomy.
Notice the musculature in the area. Does it feel tight or strong? Does it have any give or buoyancy? How does it feel to touch?
Resting your fingers on the inside bit of one of the sitting bones (as if you were sitting on the palm of your hands) imagine you can breathe into this area. Every time you inhale imagine the space expanding. As if the sitting bones move slightly apart on an inhale. Just like the lungs expand when you breathe in. And notice the muscles slightly engage and the sitting bones moving towards each other when you exhale. A similar expansion and engagement as the lungs and respiratory diaphragm.
So the first exercise is to simply breathe! But with awareness. Have a look at this video to explore.
You might be aware that you are holding some (or a lot) of tension in the pelvic floor. Read our previous blog What Causes a Weak Pelvic Floor to learn more about why. Releasing tension is not always an easy journey. But it is extremely important when it comes to your pelvic health and to prevent urinary incontinence.
These poses can be done to release any unnecessary tension and create mobility and ease.
If you are comfortable with squatting then this is an excellent pose to bring mobility to and to release the pelvic floor muscles. You can add support underneath the heels so you can truly relax into the pose.
Legs on a chair
Lie down on your back and swing your lower legs onto a chair or sofa. Your knees are bent so the lower legs can rest on the chair. Hips are flexed at around 90 degrees while you simply relax on your back. This is the perfect pose to bring awareness to your breathing and the connection to the pelvic floor. And to fully release any unnecessary tension here.
Wide legged half forward bend
Stand with the legs wide apart, the outer edges of the feet parallel or the toes pointing slightly in. Keep the spine neutral as you hinge from the hip joints. Extend to reach for a chair or table. Once here imagine the sitting bones widening away from each other and the tailbone releasing.
Once we have an awareness of the pelvic floor muscles and understand how to release tightness we can begin to create some stability and strength. In an ideal world where we are in good mental and physical health and actively moving around a lot the pelvic floor should really know how to engage and relax automatically. But most of us aren’t, so here are some ways to experience how to engage and relax the pelvic floor muscles.
The pelvic floor consists of two different types of muscles called the fast twitch and slow twitch muscles. The fast twitch muscles are the ones that should engage quickly when we sneeze or cough. Whereas the slow twitch muscles create support and tone in general. They make sure you can hold urine during the night or day until you can find a toilet!
Engaging the pelvic floor
When we engage the pelvic floor muscles we must have a sense of lifting in and up. Never bearing down such as the sensation of trying to push poo or pee out.
Try this: Imagine drinking a thick smoothie through a straw. Try to inhale through this imaginary straw as if you were drinking the smoothie. Now notice any sensation in the pelvic floor muscles. Are they lifting in and up? Eventually, they will if they aren’t already. Try this exercise sitting, standing and lying down and notice how it may feel different.
Engage and release
Now you know this sensation let’s try some more variations.
Notice if you can engage these muscles with the exhale and relax with inhale. Slowing down the breath and the movements. Continue for a few breaths.
Next, keep the breath nice and relaxed but engage and release the pelvic floor muscles super quick. Like little pulsations. And then relax completely.
Again try this both sitting, standing and lying down.
This movement naturally contracts and stretches the pelvic floor - and we can choose to use the breath to bring more awareness too.
Start on the hands and knees. Arch the back by lifting the sitting bones and imagine the sitting bones widening and the pelvic floor relaxing. Look forward as you inhale in the position.
Continue this movement with the awareness of the pelvis and pelvic floor.
Lying on the back with the knees bent and feet flat on the floor. Keep the spine and pelvis in a neutral position. On an exhale feel a gentle engagement of the pelvic floor and lift the pelvis into a bridge pose
Keep the pelvis reasonably neutral meaning, it won’t be a deep backbend but rather more awareness of finding pelvic stability. Slowly inhale to release the pelvic floor and return to the starting position. Repeat 3-7 times.
Now it’s up to you. Notice how you naturally engage and relax the pelvic floor muscles throughout the day.
Can incontinence be reversed with exercise?
Pelvic floor exercises are a great way to strengthen the muscles that support the bladder, and this can ease the symptoms of incontinence. If these exercises don't seem to be helping, speak to your doctor for more advice.
How do you exercise your core for urinary incontinence?
Strengthening the core muscles is part and parcel of pelvis floor exercises. Follow Anja's guidance by focusing on the breathing, drawing in your navel towards the spine and holding while you continue to breathe. Repeat often.
How can I stop incontinence in old age?
There are lifestyle changes you can make now, to protect your pelvic floor health in the future. Maintaining a healthy weight and exercising regularly- of course, including pelvic floor exercises!- will help massively. Speak to your doctor for advice if you need to lose weight.