While bladder control problems occur twice as often in women, men too experience involuntary loss of urine, particularly after prostate surgery.

But most men will seek medical treatment much sooner than will women. Why? Perhaps because women are used to “bodily fluid loss” as a normal part of life, such as during menstruation and childbirth. Wearing pads and changing clothes because of an “accident” are outside a man’s realm of experience.

Whatever the reason, men who learn to correctly exercise their pelvic floor muscles are not as likely to experience incontinence in their later years. Physical therapists can help men as well as women with a program of exercises to improve bladder control.

Treatments for urinary incontinence can include:

• Education about the bladder, pelvic floor muscles, and normal emptying techniques

• Bladder retraining and timed schedules for urinating

• Exercises to strengthen the pelvic floor muscles

• Vaginal weights to strengthen the pelvic floor muscles

• Medication to treat infection, replace hormones, stop abnormal bladder muscle contractions, or tighten sphincter muscles

• Dietary modifications

• Surgery to correct the bladder position

If muscles are very weak, your physical therapist may also use:

1. EMG/biofeedback: The therapist places an electrode over the pelvic floor muscle and this “reads” the activity in your muscle. A wire connects the electrode to a TV monitor and you may watch yourself contracting the muscles (see Kegel exercises, page 10) on the screen. You learn how much to squeeze, when to let go, and how many exercises to do, and you can see yourself improve in a few weeks.

2. Electrical stimulation of the pelvic floor muscles: Gentle electrical stimulation over the pelvic floor muscles helps the muscles to contract and may also help the bladder to be less irritable. Most types of bladder control problems benefit from a customized intervention program that emphasizes strengthening the pelvic floor muscles. This is another area in which your physical therapist can help.

How Physical Therapists Help

Many physical therapists concentrate their practice in women’s health, and incontinence is one of the most common problems they treat. Physical therapists use a variety of methods to help their clients correct pelvic floor weakness. Your physical therapist will teach you how to strengthen your pelvic floor muscles, which may prevent the onset of incontinence or help to reverse the process. He or she will evaluate the extent of your incontinence, identify treatment goals, and make sure you understand how your treatment works—now and in the future. Physical therapists may also offer some tips on lifestyle changes that will help the bladder be less irritable. These suggestions include:

• Lifting and moving correctly

• Bracing the pelvic floor muscles when you cough, laugh, or sneeze

• Avoiding common bladder irritants

• Keeping a bladder diary to promote normal urinating habits

• Exercising correctly and avoiding improper sit-up techniques

How to Strengthen Pelvic Floor Muscles

Exercises to strengthen your pelvic floor muscles can help improve your bladder control. But these exercises are not easy to do correctly, unless you follow your physical therapist’s instructions.

First, identify your pelvic floor muscles by trying the following: Partially empty your bladder, then try stopping or slowing down the flow of urine. If you can stop or slow the flow, then you’re contracting (tightening) the right muscles? Use this technique about once a month, only to identify the right muscles and to see if you are improving.

Once you have learned how to contract the pelvic floor muscles, try doing these contractions, called Kegel exercises, throughout the day. Do them with daily activities, such as sitting in a meeting, while stopped in your car at a traffic light, or when talking on the phone. Hold the muscles contracted for about three seconds, 12 to 15 times in a row, making sure to rest for a few seconds between each exercise set. Do this at least three to six times a day.

If your pelvic floor muscles are weak, you may need to lie down while you exercise. As you feel stronger, you can go to a sitting position, and then do these exercises while standing. Your physical therapist will help guide you.

You should also vary these exercises: Contract your pelvic floor muscles and hold for 5 to 10 seconds. Or contract and release quickly. Or clear your throat or cough while holding the muscles contracted. You should do these exercises several times throughout the day. Remember that Kegel exercises are discreet. Nobody will notice that you are doing them.

Kegel Exercises:

Contract your pelvic floor muscles for three seconds, then relax the muscles for three seconds. Do this 10 to 15 times several times a day. Although shown here while lying down, these exercises can be done during a variety of daily activities, such as sitting in a meeting, while stopped in your car at a traffic light, or when talking on the phone.

How Early in Life Should You Begin Kegel Exercises?

Many women learn about their pelvic floor muscles and Kegel exercises during childbirth classes, but what about individuals who don’t have children or athletes who experience incontinence while exercising?

Perhaps the best time for a young woman to learn about the function of her pelvic floor muscles is when she is an adolescent or when she has begun menstruating. At this age, she will be old enough to understand where the pelvic muscles are, and she will be developing health habits for a lifetime that should include Kegel exercises as part of her regular exercise program for health and fitness.