hey everybody it's doctor jo and my good friend doctor jen,
and today we're going to show you some exercises for stress incontinence. so let's get started.
so doctor jen, tell us a little bit about you and stress incontinence.
well i am a pelvic floor physical therapist. so what that means is i specialize in treating men,
women, and children with bowel, bladder, sexual complaints, or pain in the pelvis. one of the
most common diagnoses that i see in my practice is stress urinary incontinence. and what that is is
that is involuntary leakage of urine with any sort of increase in intra-abdominal pressure. so think
cough, sneeze, laugh, lift, jump. what happens is we create tension in the system or the core,
and our muscles are not able to hold that back. so the true core is made up of respiratory diaphragm
at the top, or our breathing muscle, pelvic floor at the bottom those are the muscles
that wrap around the urethra, the vagina, and the anus. deep transversus abdominis are kind of the
the innermost layer of the abdominals, and then multifidus in the back. so these muscles all work
beautifully together rhythmically to stabilize the spine and pelvis, support our organs,
and prevent us from leakage. but sometimes those muscles can become weak, uncoordinated,
tense or tight, and then all of a sudden we start jumping and a little bit of leakage or a little
bit of urine can come out beyond our control. so i want to show you my top five exercises to
help minimize that. awesome. who knew so much was involved in all of that. it's intense. so
the most foundational exercise to help you manage the intra-abdominal pressure created with exercise
is actually breathing. it's not a very sexy exercise, it's not anything wild or crazy,
but if you can master this, you'll find that most of your leakage will already improve. i always
tell my patients if air is not coming out here in the form of breath, it's coming out down below. so
what i typically see is patients will jump rope or do a box jump, and they're holding their breath,
and so the pressure comes out down below and a little bit of urine will come out as well.
so it's very very important that you're able to master diaphragmatic breathing, and everything
we do from here on out is a basic progression. so what i'd like for you to do is i'd like for
you to lie down with your knees bent and your back comfortably supported. one hand on the belly and
the other hand on the chest. and what i'd like for you to do is imagine that as you inhale through
the nose, you feel your belly fill up with air, and then the chest moves slightly. long exhale. i
do love for the breath to be audible. that way we know that the air is coming out here with physical
activity. so again to master the breathing inhale, belly gets big, feel the chest rise slightly,
long exhale. perfect perfect. minimal movement of anything else, no accessory muscles, just abdomen
fills up as the diaphragm comes down, chest rises slightly, long exhale. do you have a preference
through breathing out through your mouth or through your nose? i do i prefer in through the
nose and out through the mouth, so we always tell people smell the flowers, blow out the candles.
inhale through the nose belly gets big, chest starts to rise, long exhale through the mouth.
perfect usually have patients do this for about two minutes. it will one calm the nervous system
help you kind of bring your focus to the pelvis, but also it's the foundation of now
the co-contracting that we're going to progress to. okay so we talked about respiratory diaphragm,
pelvic floor, deep abdominals, and low back muscles. what i want to focus on
is with your exhalation, with the effort, we're going to pair an exhale,
but we're going to start firing up the transversus abdominis and the pelvic floor.
so i like for you to place your hands kind of on the inside of those hip bones.
and before we pair the breathing, let's find the deep abdominals by gently drawing belly button in
towards the spine. so minimal movement of the spine and pelvis occurs. okay you can
release. gently find belly button in towards the spine or imagine pulling your hip bones together
and then release. the pelvic floor lives inside the body, so we won't see any movement.
but we also shouldn't see any compensation of the thighs or the buttocks. so for the pelvic floor, i
want you to find the urethra or the anus, imagine that you're going to stop from passing gas or
releasing urine and let go. nothing too exciting to see. if we see dr joe squeezing, and clenching,
and breath holding--all wrong. it's it's a moot point. don't even practice the exercise. okay
it should look like nothing is happening. so here is the hard part. how do we get all of those
muscles working together? so i'm going to talk you through, and i'm going to cue you. we'll start abs
and breath, so inhale belly gets big, exhale pull belly button in towards the spine, feel the lower
abdominals contract with that exhale, and release. inhale belly gets big, find those lower abs,
stabilize the spine and pelvis with the exhale, beautiful, and let go. let's add pelvic floor.
that was awesome! that was not a toot, that was a gurgle. It's the colon movement by
compressing the abs. i love it. where do you think we should start over? that's that's fine,
um. we're just gonna leave that in! yeah, I think we should. we got a little movement. yeah that's
the point. that's the point. oh my gosh, and then i was like oh no it's too quiet. shoot.
inhale belly gets big, exhale, draw belly button to the spine, squeeze pelvic floor, fabulous,
long exhale, and release. imagine if you could do this, and i know it's slow motion, but imagine if
you could do this with every activity: a box jump, a deep squat. if you can find your stability,
exhale, with every effort, you've already managed the pressure. it's come out here. and i'm lifting
from the bottom, and most of the time this will completely eliminate incontinence. and so let's
start adding some movement with it. okay, so same rules apply. i'm going to sound like a broken
record, but i really want you guys to be able to get this. inhale sets up the exercise. belly gets,
big exhale, belly button to the spine, pelvic floor lifts as the hips come up. now we're getting
a glute bridge staying stable here, and come on down. fabulous. so we're starting the foundational
movement of hip of hip hinging or getting our glutes firing to support the posterior pelvis.
and this will be great to progress to squats and lunges those kind of things. so let's work through
that a few times. we're going to try about five repetitions and i'll continue to cue doctor jo.
inhale belly gets big. exhale pull belly button to the spine, lift from the bottom hips come up,
and then come back down. fabulous. inhale belly gets big, exhale tummy tight lift from the bottom,
closure come up. i love it ,and come back down. here's number three. inhale belly gets big,
feel the deep abdominals tighten as you exhale, lift pelvic floor holding back gas or urine,
hips come up, and then come on down. let's do it one more time. inhale belly gets big,
exhale pull the tummy tight, lift from the bottom hips come up, and then come on down.
perfect. all right so exercise number four we're going to change our position a little bit.
one thing that i think is really important is people might find these exercises and do
them all in the same position. and what the core needs more than anything is to be challenged and
to have exercises that are diverse in different positions. so the core loves variety. if you
just practice lying down, trust me you won't leak when you're lying down. awesome. but
that's not when you're exercising. we're up, and we're moving, and we're transitioning.
so the next position is quadruped or on hands and knees. so whenever you're ready,
go ahead and take it to all fours. this is also called tabletop position. okay and what i don't
want is i don't want this big arch or sag in your low back. i don't want you super rounded,
but what i want is a nice neutral spine. okay. and again focusing on setting up the exercise with
that maximal range of motion of the diaphragm. what i want dr jo to do is i want her to let
her belly sag as she inhales, without moving the spine. beautiful. so inhale belly gets big, exhale
pull belly button to the spine. beautiful. again minimal movement, nice stability, and i'm still
using my hands underneath. i know you won't be able to do that, but i can feel that contraction.
let's pair it with the pelvic floor. inhale belly gets big, that's it. pull belly button to the
spin. pelvic floor lifts, and hold, and release. so let's add opposite arm, opposite leg. and the
reason i love that is because it's a reciprocal pattern. okay oftentimes people will leak with
running, walking those kind of things. and let's train the brain to fire the core with opposite
arm opposite legs. so the foundation is core stability. nothing moves here. the hip will move,
and the arm will extend, but only after we set the exercise. are you ready? i think so. inhale inhale
belly gets big, exhale pull those ab tight, pelvic floor lifts, arm goes up, leg goes back. can you
feel closure at the bottom, and then bring it back. beautiful. beautiful. inhale belly gets big,
exhale through your mouth as tummy gets tight, pelvic floor lifts, arm goes out, leg goes
behind you. beautiful. and then come back. you should feel closure like you're holding back
gas or urine. you should feel a subtle tension in your abdominals and then once you you've set the
exercise, we move our arms and legs. let's do two more. inhale belly gets big, exhale
pull belly button to the spine as the pelvic floor lifts, arm goes up, leg goes back. hold
and come back down. other side inhale belly gets big, exhale drawing the abs in close
the openings of the anus and urethra as our leg and our arm go in opposite directions,
and then bring it back in. beautiful. so for each of these, you can sit back onto your heels, each
of these about five to ten repetitions and you can progress from breathing five beautiful breaths,
co-contracting the glute bridge, quadruped opposite arm opposite leg, and then now we're
really going to get to the fun kind of bounding or introducing some real strain to the core. so we'll
we'll start in standing. okay so for this last exercise in standing, i want you guys to challenge
yourself on one leg or something called single leg stance. so running, plyometrics, box jumps,
lunges, oftentimes require stability on one leg. and i want you guys to find your core. connect
with your breath on one leg, and then we're going to add like i said some pressure to the system.
so for set up, what i'd like for you to do is stand on one leg. we're going to do both, so it
doesn't matter, and i want to make sure that we have a soft bend in the knee because we're going
to do some absorption or some landing. and then i want your rib cage to be nicely over your over
your pelvis. so not that arch or that rounding but just a good position of rib cage over pelvis. once
you find your balance, again we inhale and set up the exercise feel belly button come towards the
spine, pelvic floor lift as you stabilize on one leg, this is excellent, excellent. she's got great
balance, she's able to stay in for quite some time. let's practice again. inhale belly gets big,
exhale through the mouth as tummy gets tight, pelvic floor lifts, we've set it,
beautiful. what we're going to do next time is we're going to add some bounding. so you can put
your leg down if you'd like, but all she's going to do, big or small, you can start small and work
your way different directions, different impact. but what i'd like for you to do is the same thing,
and then you're going to bound to your side. okay. so single leg stance. nice position of rib cage
over pelvis. inhale belly gets big ,exhale find your core tummy tight, pelvic floor lifts, bound.
and then rest. put the other leg down. let's go the other way. okay.
so standing on that right leg. soft bend in the knee,
but set the exercise. inhale, exhale, pull abs in, lift pelvic floor, blow out as you bound,
and then put your foot back down. listen so what she did is, as she did the impact,
blew out through her mouth, and then supported from the bottom and the sides. which will minimize
leakage. okay let's practice one more time on each side just so everyone can see. soft bend in
the knees, rib cage over pelvis, inhale belly gets big, exhale pull tummy tight, lift, blow out here
we go bound. i love it. and then foot goes down. if you don't know what to do with your hands,
you can take them and do what you did when we were lying down and place them on the inside of
your hip bones. you can feel the lower abdominals contract. so standing on the right. soft bend,
inhale expansion, exhale tummy tight, squeeze pelvic floor, blow.
beautiful. that is the last exercise i have for you guys, but once you can do the core,
the breath, and movement, you can incorporate it into all of your tasks. again those higher level
fun exercises. if you're just leaking simply when you go from sit to stand, post surgery,
aging, weakness, you can do that same thing. inhale belly gets big,
exhale squeeze the core, lift from the bottom, and then you can stand up.
hopefully that helps with your your symptoms of leakage. and you can see that as i got to my last
couple ones, with each round it got easier for me to do, so make sure that at each step
you're accomplishing it and doing it correctly before you go on to the next progression. right,
right. and it happens quickly you guys. this is brain retraining. it's not necessarily
muscle strength, it's using your brain to find the appropriate muscles and then perform the exercise.
so play around with it and you'll find that your symptoms can improve pretty quickly.
all right. so there you have it, if you'd like to see some more awesome videos with doctor jen,
we've made a playlist for you. you can click on it up there. and don't forget to subscribe by
clicking down there. and remember be safe, have fun, and i hope you feel better soon.