Helpful Information

Information prepared by our Continence Advisor - Marilyn Marshall RN RM CA

Some of these techniques may be difficult to perform until well into your Wave Brilliance therapy. This may be because of poor pelvic floor muscle tone. Do not dispair, you will find it much easier to locate the correct muscles by the end of your treatment.

The importance of pelvic floor exercise

When muscles are not used they become weak, reducing a person’s ability to perform normal tasks such as carrying, lifting and climbing stairs.  Regular exercise is the most important way of keeping muscles strong.

In women it is particularly important that strength is maintained in the pelvic floor muscles.

There are 2 pelvic floor muscles – The biggest one stretches like a hammock from the tailbone at the back to the pubic bone supporting the organs of the pelvis, the bladder, uterus and lower bowel.  The passages leading from these organs all pass through this muscular support. The other one is shaped like a triangle.

Consequences of a weak pelvic floor

Most of the time the pelvic floor muscles work automatically, keeping the bladder and bowel closed, but they can also be deliberately tensed and relaxed, for example when suppressing the urge to pass urine or controlling the need to have a bowel action or pass gas.

pelvic floor diagram 1.pngThe consequences of weak muscles in this area are often very embarrassing.  There may be leakage of urine (and sometimes faeces) during exertion such as jogging, coughing and sneezing, passing wind from the bowel and vagina, prolapse (sinking) of the uterus causing a heavy feeling in the vagina, and the problem of tampons falling out.

The resting tone of the pelvic floor muscles needs to be high enough to help the sphincter keep the urethra tightly shut against invading germs.  If the pelvic floor muscles are not supporting the local tissues properly, the blood supply to these tissues might not be as good as it should be.  A healthy blood supply is the tissue’s first line of defence against any infection or inflammation.

Why the pelvic floor muscles can be weakened
  • Pregnancy and vaginal child birth
  • Constipation or continually straining to empty your bowels
  • Continual heavy lifting
  • A chronic cough
  • Being overweight (Every kilo that you are carrying over and above what would be the normal body mass for you is placing an extra load on the structures of the pelvic floor.
  • Changes in hormone levels at menopause.  Oestrogen, a female hormone, is important to the pelvic floor muscles, the pelvic organs and assists in keeping the lining of the vagina and urethra thick.  The thickness of the lining keeps the urethra sealed after passing urine, much like a washer seals water from a tap.  Less oestrogen is produced after menopause and the lining of the urethra thins.  As a result, in some women the urethra does not close fully.  A chronic cough, constipation and being overweight all strain the pelvic floor and can eventually lead to stress incontinence
  • Hysterectomy or pelvic surgery
  • Lack of general fitness
  • Prostate surgery

How to perform Kegal manual pelvic floor exercises

It is claimed Kegel exercises can build up muscle tone by increasing the strength of the pubococcygeus muscles of the pelvic floor and, as a result it is beneficial in treating urinary incontinence in both men and women. Kegel exercise is an accepted treatment (mainly by physiotherapists) for pregnant women to fortify the pelvic floor for physiological stresses of childbirth. Some claim pelvic floor exercises are good for treating vaginal prolapse.  Others will attest that Kegals  are useful as a preventative measure for uterine prolapse in women and as a treatment for prostate pain and swelling as a result of  benign prostatic hyperplasia (BPH) and prostatitis in men. Kegel exercises may also increase sexual gratification whch you probably have already found if you have had treatment on the Wave Brilliance chair.

Do the exercises with your knees together lying down when you first begin to do Kegals.

Squeeze (lift up) the muscles for a count of 5 and relax for a count of 5.  If you find it easy to hold for a count of 5, try to hold for longer – up to 10 seconds.

Repeat but don’t overdo it. It is important to rest for about 10 seconds in between each contraction.

Work up to 8-10 repeats each time you exercise

Now do 5-10 short, fast but strong contractions, with no rest in between.  Theses are to be as hard as you can squeeze and as fast as you can squeeze.

Do your pelvic floor exercises at least twice a day - before you get up and before you go to sleep.

When you can achieve these exercises with you knees together, it will work the muscle more to do them with your knees apart

When you can achieve them while lying down, try doing them sitting and standing.  When doing contractions in the standing position, it is essential to get rid of any “trick” movements that might fool you into thinking that your exercises are being done well.  Stand with your feet wide apart and your toes turned in.  In this position, your bottom muscles cannot work very well.  In this way, any feeling that happens between your legs while you are trying to do a squeeze/lift/hold while standing up, is bound to be from coming from your pelvic floor muscle contracting.  The “trick” movements of your buttock and thigh muscles are eliminated if you stand this way.  When you have advanced somewhat with your pelvic floor muscle strength, it will not be necessary to stand this way to know that you are exercising effectively in standing. Using all 3 positions makes the muscles strongest.

Listen to music when you do the exercises, it will help to relax you.

Just before sneezing, lifting or jumping, squeeze your pelvic muscles tightly and hold on until after you sneeze, lift or jump

Please remember to be gentle and don’t push them too quickly.  You will take two steps forward and one back if you do too much too quickly

Once you regain control of your bladder, don’t stop doing the exercises, make them a life long habit.  Aim to do ten squeeze/lifts in a row, holding each one for 10 seconds. If you find your incontinence returns due to “forgetting” to maintain your exercises, you can always return for more Wave Brilliance treatment.

Warnings:

Stop your urine flow only once a week only as a test

Overdoing your exercises can cause muscle tiredness and temporary loss of control – don’t overdo it!

Expect little progress around your period time – don’t give in

Whenever you are run down, so is your pelvic floor – don’t expect miracles

Knack or Bracing Technique

With this technique you use a strong “squeeze and lift” that enables you to prevent urine leakage in situations where previous mishaps have occured..  It is the same feeling you will feel during treatment on the Wave Brilliance chair.

Use the “knack” and hold it tight before you cough or laugh if these situations cause small amounts of urine leakage.

If  leakage occurs before you lift something, then try a big squeeze, lift and hold before you lift.

If playing sport or running is a problem area for you, use the ‘knack’ before you serve in tennis, shoot  a hoop in netball, swing at the golf ball, or while you are running.  Always remember though, to keep breathing!!

The difficult time to use the ‘knack’ technique is prior to a sneeze, as this usually occurs spontaneously without prior warning.

  • Three methods to check for the correct muscles

    Try to stop the flow of urine when you are sitting on the toilet. Start the flow of urine, then stop it.  Its should “stop dead”, not just slow to a trickle. If you can you are using the correct muscles. (Don’t do this more than once a week.  It is to be used as a test only.  If you do it more often it may interfere with the complex reflex mechanisms that help with proper bladder function.)

    If your muscles are weak enough to allow urine leakage under stress (coughing or lifting) then usually they are not going to be strong enough for you to feel them contracting unless you are actually using your fingers.  Do this first in a supported half-sitting, half-lying position, propping yourself up on a bed is the best position for your first assessment.  This position helps to get rid of some of the downward forces that might be pushing on the bladder and pelvic floor. Moisten your first and second fingers of either hand, with saliva or lubricating jelly – do not use Vaseline or face creams as these can irritate the sensitive lining of the vagina.  Gently slide your fingers into your vagina.  Close your eyes and concentrate.  Pull up your muscles as though you need to pass water and can’t find a toilet anywhere.  Can you feel any movement?  If not: Imagine that you are trying to stop passing gas. Squeeze the muscles you would use.  If you sense a “pulling” feeling, those are the right muscles for pelvic exercises. Don’t worry that you are squeezing your back passage rather than your front…it’s impossible to work one without the other at this stage.

    While you are in this position explore these problem points, feel just what happens when you cough – feel the pressure down and the bulging outward.  Gently bear down as though opening your bowels and feel the downward movement:  this is exactly the opposite feeling to doing a pelvic floor contraction.  Now immediately squeeze and pull up – the feeling should be upward and inward with pressure around the back of your fingers.  Be careful to breathe rhythmically in and out as you try to contract your pelvic floor muscles.

    DON’T SQUEEZE OTHER MUSCLES AT THE SAME TIME.  Be careful not to tighten your legs or other muscles.  Squeezing the wrong muscles can put more pressure on your bladder control muscles.  Do not bear down.  Just squeeze the pelvic muscle and DON’T HOLD YOUR BREATH, breathe slowly and deeply.

    Repeated coughing or sneezing (eg flu or hay fever) can set your program back dramatically – don’t be discouraged.


    Importance of drinking 6-8 glasses of water each day

    Dehydration, or the loss of fluid from the body, can produce tiredness, difficulty concentrating, headaches and in the long term, increases the risk of kidney problems.  Two contributing factors to dehydration are heat and humidity.  Escaping to your air-conditioned office or house will not help, because being in air-conditioning or moving in and out of the environment, can lead to dehydration.

    60% of your fluid intake should come from what you drink and you should generally drink more than 1.2 litres of water (or 6-8 glasses) a day. Carbonated soft drinks can be filling, and contain on average 9 teaspoons of sugar, and they can also irritate your bladder.  The best way of replacing fluid is by consuming good old fashioned water.

    Spread your drinking across the day by having one glass of water every hour.  Avoid excessive caffeine, by having a water stop instead of a coffee break.  For every cup of coffee consumed, you need to drink two glasses of water to compensate.  Have a water bottle or water jug on your desk and finish it before you go home.  Carry a water bottle in your car.

    Water is the basis of all body fluids, including digestive juices, blood, urine, lymph and perspiration.  All cell processes and all organ functions depend on it.  It’s essential as a lubricant – as the basis of saliva, mucous secretions throughout the body, and the fluids that bathe the joints.  Water is needed to keep food moving through the intestinal tract and to eliminate wastes.  It helps prevent constipation (especially if eating a large quantity of high fibre foods) and it can help reduce the tendency for stone formation in the urinary pathways.  Water also helps regulate body temperature.

    The body loses and needs to replace, under average circumstances, two or three litres of water every day.  Loss of water occurs constantly by way of exhaled air, which accounts for the loss of about 600mls of water daily.  Loss of water through perspiration accounts for 600 – 1200mls daily.  If you’re exercising or doing physical work in the heat, the loss can be much more.  When the body begins to get short of water, heat cramps may occur, or as with some of us, leg cramps during the day or night.  In addition, insufficient fluid intake, or dehydration, often results in a lack of perspiration, causing a rise in body temperature.

    You will not always feel thirsty, if your body needs fluids.  During physical activity you may become significantly dehydrated before you feel thirsty.  In unusual circumstances, as with diarrhoea, vomiting or haemorrhage, there is a sudden excessive loss of water causing you to become thirsty.  Also, when you drink, your thirst will feel quenched long before your fluid loss is replenished.

    An average of two litres daily goes out through urine.  Because of a “tricky” bladder, however, some people will limit their fluid intake, thereby reducing the flushing action through the urinary tract and often resulting in a low-grade bladder infection, which only makes their bladder problem worse.