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Bladder Habits - Pelvic Floor Health

The following blog is written by Dr. Elizabeth Shah, a PTIS member and licensed physical therapist who specializes in pelvic health.


Hello PTIS community,


As I’ve been talking to patients recently, I am reminded that most persons do not have a lot of awareness regarding the muscles of the pelvic floor and how these tissues relate to bladder health. So, below is a discussion about a typical issue relating to bladder control, and how one might begin to address it at home.


When one is unable to control the leakage of urine from the bladder, it's described as "urinary incontinence." There are many different reasons why a person might be incontinent. Today, I‘m going to talk specifically about one type of incontinence.


As you can see in the picture below, borrowed from the Continence Foundation of Australia, the pelvic organs are supported by the pelvic floor muscles. These muscles are designed like a sling, and do the following:

  • Gently tighten when needed to maintain bowel and bladder control

  • Lengthen and release when needed to urinate or have a bowel movement

  • Support the pelvic organs

  • Aide in sexual appreciation

Stress urinary incontinence happens when the muscles of the pelvic floor are weak and unable to maintain enough tension when one sneezes, coughs, or laughs. This causes urine leakage.

When we have weakness in the pelvic floor muscles, it can be helpful to work on strengthening. A kegel exercise is a strengthening maneuver that can help improve muscle control. Before one can kegel, it helps to see if one can feel the muscles and the surrounding tissue.


Try this at home:

  • Lie on your back with your knees bent and propped on comfy pillows.

  • Think about the part of your body that you urinate and have bowel movements from. For persons with a uterus, there are three holes.

  • Can you tell where those holes are? Can you feel the rectum, the vaginal opening, and the tube from the bladder (the urethra)?

  • Can you try to relax these openings, and pretend to let go like you were going to pass gas and/or urinate?

  • Can you squeeze the rectum to prevent passing gas? Can you squeeze the urethra as if not to urinate

  • If you can squeeze these muscles, can you picture lifting them as well? A popular image to think about is imagining that you are pulling your rectum to your belly button.

If you can feel those actions, you can try to do a kegel. It is important when working these muscles that you are good at both the squeeze/lift action AND the letting go action. Breathe out as you tighten and lift the rectum, the vaginal opening, and the urethra ("don't pass urine or gas and lift"). Breath in and let go. Try this 10x a day to build your coordination and muscle awareness in the region.

Ultimately, stress urinary incontinence is something that can be made better with time and care. Physical therapists are uniquely qualified to aide in the retraining of muscular function and control in the pelvic region. So, if you find yourself curious about how to improve your continence, we at PTIS encourage you to find a PT in your community with a specialty in pelvic health and seek care today!

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