Bladder Control Exercises: Pelvic Floor Training for Women and Men

01Types

Types of bladder leakage

• Stress incontinence: leaking when coughing, sneezing, laughing, lifting or exercising.
• Urge incontinence: a sudden, intense need to pass urine, sometimes not reaching the toilet in time.
• Mixed incontinence: a combination of both.
• Overflow incontinence: frequent dribbling due to incomplete emptying, more common in men with prostate enlargement.
• The NHS describes these types and their treatments.

02Find

How to find your pelvic floor muscles

• Imagine you are trying to stop yourself passing wind and stop the flow of urine at the same time.
• You should feel a lift and squeeze inside, without tightening your buttocks, thighs or tummy.
• Women may feel the vagina tighten and lift.
• Men may feel the base of the penis draw in and the testicles lift slightly.
• Do not routinely stop the flow while passing urine, as this can interfere with emptying; it is only a one-off way to identify the muscles.
• Keep breathing normally.

03How

How to do pelvic floor exercises

• Slow holds: squeeze and lift, hold for up to 10 seconds, then fully relax for 10 seconds. Repeat up to 10 times.
• Quick squeezes: squeeze and release quickly, up to 10 times.
• Do a set at least three times a day: lying, sitting and standing.
• Start with what you can manage, such as 3-second holds, and build up.
• Make sure you fully relax between squeezes.
• Results usually take around three months of regular practice.

04Knack

The “knack”: squeeze before you sneeze

Tightening the pelvic floor just before and during a cough, sneeze, laugh or lift helps prevent leaks. This technique, sometimes called “the knack”, becomes automatic with practice. Combine it with regular exercises for best results.

05Women

Bladder control exercises for women

Pregnancy, childbirth, menopause and ageing can weaken the pelvic floor. A Cochrane review found that women with stress urinary incontinence who did pelvic floor muscle training were substantially more likely to report cure than those who did not, and training also helped women with mixed incontinence. Supervised programmes with a pelvic health physiotherapist tend to work better than leaflets alone. Pelvic floor tightness can also cause bladder symptoms; see pelvic floor stretches.

06Men

Pelvic exercises for men

Men can have bladder leakage after prostate surgery, with prostate enlargement or with ageing. Pelvic floor exercises are commonly recommended before and after radical prostatectomy and for post-void dribbling, where squeezing the pelvic floor after urinating helps empty the urethra. A Cochrane review of conservative management for incontinence after prostatectomy found that the benefit of pelvic floor training over usual care was uncertain, although many men recover continence over the first year. A pelvic health physiotherapist can teach the correct technique.

07Urge

Bladder training for urgency

• Keep a bladder diary for three days, recording drinks and toilet trips.
• When you feel an urge, stop, stand or sit still and squeeze your pelvic floor quickly several times.
• Distract yourself and wait for the urge to pass before walking calmly to the toilet.
• Gradually increase the time between toilet visits by 15 minutes every week or so.
• Aim for every three to four hours during the day.
• Bladder training usually takes at least six weeks.

08Habits

Habits that help bladder control

• Drink six to eight glasses of fluid a day; do not cut back too much.
• Reduce caffeine, alcohol and fizzy drinks, which can irritate the bladder.
• Avoid constipation with fibre, fluids and activity.
• Lose weight if you are overweight.
• Stop smoking, as coughing strains the pelvic floor.
• Avoid going “just in case” too often.

09Help

When exercises are not enough

If symptoms do not improve after three months of regular exercise, see a doctor or pelvic health physiotherapist. Options include biofeedback, electrical stimulation, vaginal devices, medicines for overactive bladder, and surgical procedures for stress incontinence. Treatment depends on the type of incontinence and your preferences.

10Cases

Three common situations

• Leaking when running after childbirth: daily pelvic floor exercises and ideally assessment by a pelvic health physiotherapist.
• Rushing to the toilet many times a day: bladder diary, bladder training and less caffeine.
• Leaking after prostate surgery: pelvic floor exercises and follow-up with your urology team.

11Apps

Staying on track

• Link exercises to daily habits, such as brushing your teeth or waiting for the kettle.
• Use a reminder app; some are designed specifically for pelvic floor training.
• Keep a simple log of sets completed each day.
• Continue exercises long term, even once symptoms improve.
• For diastasis recti and core recovery after pregnancy, see diastasis recti exercises.

12Summary

Key points to remember

• Pelvic floor exercises are an effective first treatment for stress leakage in women.
• Do slow holds and quick squeezes at least three times a day.
• Bladder training helps urgency.
• See a doctor if there is no improvement after three months.