Although it is not a normal part of aging, urinary incontinence often occurs in older adults due to a number of contributing factors. Incontinence severity can range from occasional leakage with a cough, sneeze, or laugh (stress incontinence – when abdominal pressure exceeds the ability of the sphincter and associated muscles to hold back urine flow) to a loss of a large volume of urine
(urge incontinence – when the urge to urinate comes on quickly and is so strong the individual cannot get to the toilet in time). Pelvic muscle weakness is a component of both stress and urge incontinence.

When treating stress and urge incontinence, pelvic muscle exercise (PME) is a conservative, non-invasive, initial treatment approach. CMS guidelines require four weeks of PME prior to the introduction of therapeutic pelvic floor electrical stimulation for Medicare beneficiaries. Typically the Kegel (pelvic floor) exercise is performed along with exercises for other associated muscle groups which may facilitate activation of the pelvic floor. ACP’s Continence Improvement Clinical Solution follows evidence-based practice guidelines and starts with four weeks of PME. The research that supports this approach includes:

• There is evidence for the widespread recommendation that pelvic floor muscle exercise helps women with all types of urinary incontinence, especially stress incontinence.¹
• Pelvic floor muscle training appears to be an effective first-line intervention for improving urinary symptoms and quality of life of women presenting with urinary incontinence.²
• Pelvic floor muscle training (PFMT) can improve urinary leakage, nocturia, pelvic floor muscle function, and quality of life in women with overactive bladder symptoms.³

Examples of Pelvic Muscle Exercise (PME) and Facilitatory Pelvic Muscle Therapeutic Exercises May Include:⁴

• Kegel Exercise
• Transverse Abdominis Exercise
• Hip Adductor Exercise
• Obturator Internus/Abductor Exercise

• Pelvic Floor Activation Exercise
• Gluteal Exercise
• Abdominal Exercise
• Core Stabilization Exercise

Electrical Stimulation to Assist with Exercise

If an individual has difficulty feeling and contracting muscles during PME and facilitatory pelvic muscle exercise, patterned electrical neuromuscular stimulation (PENS) can be added prior to or during exercise to assist with neuromuscular re-education for improved strength and coordination.

References:
1. Price N, Dawood R, Jackson SR: Pelvic floor exercise for urinary incontinence: a systematic literature review. Maturitas. 67(4):309-15, Dec. 2010.
2. Fan HL, Chan SS, Law TS, Cheung RY, Chung TK: Pelvic floor muscle training improves quality of life of women with urinary incontinence: a prospective study. Aust N Z J
Obstet Gynacol. 53(3):298-304, Jun 2013
3. Fitz F, Sartoiri M, Girao MJ, Castro R: Pelvic floor muscle training for overactive bladder symptoms – A prospective study. Rev Assoc Med Bras. 63(12): 1032-1038, Dec 2017.
4. ACP Continence Improvement Clinical Solution.