**6.2 Advice and guidance on pelvic floor exercises**

Pelvic floor exercises improve contractility and coordination of pelvic floor muscles. An assessment of pelvic floor strength should be done in women with stress incontinence The pelvic floor musculature consists of slow twitch fibres, which are involved in posture, and a smaller element of fast twitch fibres, which are used during exertion such as coughing. Slow twitch fibres are trained with long sustained repetitive pelvic floor exercises whereas fast twitch fibres are trained with fast powerful contractions. If the pelvic floor musculature is weak, then a pelvic floor exercise improves the muscle strength and endurance and in turn less mobility of the bladder neck on straining and coughing and subsequently lesser degree of incontinence. The pelvic floor exercise are conducted as 3 sets every day of 8–12 contractions. Slow velocity contractions sustained for 6–8 seconds each. The response usually notable in 3–4 months. Additional measures such as weighted vaginal cones and pudendal nerve stimulation may be used [3, 16].

It is important to realise the limitation of pelvic floor exercise in patient with stress incontinence as it helps more the patients mild and moderate leakage with approximate improvement of 30–40% in their symptom profile after completion of 3–4 months course. Further management is needed if no improvement is notable beyond this period [16].
