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.
