Researchers are finding differences in the pelvic floor and abdominal muscle activity between continent and incontinent women. (Smith et al 2007). When muscles around the abdominal cavity contract, (External Oblique and Rectus Abdominis) pressure is increased inside the abdomen. This downwards pressure requires Pelvic Floor Muscles (PFMs) to simultaneously contract to maintain continence eg when sneezing or dancing. Pelvic floor and abdominal muscles contract at the same time in continent women. This study shows women with incontinence have increased activity in their External Obliques, leading to greater PFM activity than in continent women. This finding challenges the belief that incontinent women have less PFM activity.

The authors believe the increased activity of External Obliques of incontinent women may contribute to incontinence and these women may perceive an abdominal contraction (or Valsalva manoeuvre) as a pelvic floor contraction. They suggest decreasing abdominal muscle activity or retraining coordination of both groups, to help reduce incontinence.

This diagram helps explain the different abdominal muscle action observed between continent and incontinent women. I find my clients with incontinence benefit from initially isolating and learning the gentle action of their Pubococcygeus (PC) muscle without External Oblique activity, before learning to control and strengthen the entire pelvic floor group.  The next step involves training the PFMs to work in coordination with trunk and other body muscles.

So when doing PFM exercises, ensure you know the correct action first before going for strength. Some Incontinent women will benefit from learning to relax their waist and chest wall muscles initially while learning to recognize the action of their PC. Aim to contract this muscle first instead of stronger abdominals and avoid strengthening an incorrect action.