According to statistics, more than 50% of women in China are plagued by varying degrees of urinary incontinence, of which the peak incidence is 45-55 years old, stress incontinence is particularly common, the lighter in laughing, coughing or after strenuous exercise will leak urine, the heavier can not leave the urine pad every minute. With the gradual improvement of the material and cultural living standards of the country, people’s demand for quality of life is also increasing, as urinary incontinence on women’s work, social, sports, travel, sex life, etc. can cause varying degrees of impact, no doubt causing a great shadow on the patient’s psyche, and even lead to depression, becoming a lot of women’s friends of unspeakable problems. A. What are pelvic floor muscles? As we grow older, our experience is gradually enriched, our thinking is gradually mature, but our organism is gradually moving towards an aging process, with fine lines in the skin and sagging muscles. We can go to the gym to exercise, through professional, targeted equipment to reshape the muscles of different parts of the body and strengthen the strength. But there is a very hidden group of muscles in our body, this group of muscles is located in the pelvic floor, we call the pelvic floor muscles. These muscles are not visible and do not affect our aesthetic appearance, but they perform important physiological functions, including the control of important physiological processes such as urine storage – urination, stool storage – defecation and reproductive sex. The pelvic floor muscles can also become damaged due to many external factors as well as simply by ageing, but because they are invisible and intangible, it is not so easy to exercise this group of muscles. Second, what is the relationship between the pelvic floor muscles and urinary incontinence? Scientific studies have found that as we age, the pelvic floor muscles age very significantly. Usually from the age of 25, people’s pelvic floor muscles have started to go downhill, especially in women, with the long-term compression of the pelvic floor muscles by the huge uterus and fetus during pregnancy and the hard expansion of the pelvic floor muscles by the delivery of the fetus and placenta during childbirth, all of which can cause permanent damage to the pelvic floor. In addition, obesity, diabetes, some neurological pathologies and pelvic floor surgery (e.g. bladder surgery, prostate surgery, gynecological surgery and anal surgery) may damage the structure of the pelvic floor muscles, associated vascular and nerve innervation, thus affecting pelvic floor function. Once the physiological function of the pelvic floor muscles to control urine storage is impaired, it will inevitably bring about varying degrees of urinary incontinence – a pathological change. Studies have found that over 90% of stress incontinence is caused by relaxation of the pelvic floor tissues. The widely accepted theory of pressure transmission is that the proximal 3/4 of the posterior urethra is located in the abdominal cavity in normal women in a physiological state, and when coughing and other actions increase abdominal pressure, this increased pressure is transmitted to the bladder and urethra, increasing both bladder and urethral pressure, respectively. Because of the angle between the bladder and the posterior urethra (90° to 110° posterior angle of the vesicourethra), the increased pressure transmitted to the posterior urethra should be higher than the increased pressure of the bladder, and the two should cancel out so that 3/4 of the posterior urethra is closed and urinary incontinence does not occur. When the proximal urethra prolapses outside the abdominal cavity due to a defect in the supporting structures of the pelvic floor, and the increase in intra-abdominal pressure caused by daily activities is not transmitted equally to the bladder and proximal urethra (e.g., laughing or coughing), incontinence occurs when the increase in pressure in the bladder is significantly greater than the increase in pressure in the urethra. In short, it is like a dam that is no longer solid because of soil erosion around it, and then once it floods, it will be difficult to keep it from dripping. Third, how to treat urinary incontinence by exercising the pelvic floor muscles? In recent years, there are more and more means of treating urinary incontinence, but just as the best way to strengthen the body is to exercise, we believe that the exercise of the pelvic floor muscles is more worthy of promotion than injections and medication, or even surgical treatment. In the 1940s, Kegel, an American obstetrician and gynecologist, created the pelvic floor muscle rehabilitation exercise method for postpartum women with urinary incontinence, uterine, bladder and rectal prolapse, and reduced vaginal tightness, which is now known as the Kegel Exercise, which is most effective for mild to moderate anatomical stress incontinence, with a cure and improvement rate of 50% to 80%. In addition, this exercise is also useful for treating urge incontinence or mixed incontinence, as well as for male post-prostate surgery incontinence. However, in the course of daily practice we find that many patients do Kegel exercises inappropriately or inaccurately, which actually exercise the muscles of the thighs or abdomen, and therefore cannot achieve rehabilitation of pelvic floor function. For those patients who have difficulty in mastering the correct Kegel exercises, pelvic floor exercises under the guidance of biofeedback can often achieve better results. The biofeedback device monitors the activity of the pelvic floor muscles with the help of an electronic probe placed in the vagina or rectum, and converts the information into audio or visual signals to the physician and the patient, so that they can understand the status of pelvic floor exercises and develop a more appropriate exercise plan, as well as guide the patient to perform pelvic floor exercises correctly and independently and form a conditioned reflex. Biofeedback itself is not a treatment method, it is only a means to adjust the exercise and measure the response of pelvic floor muscle exercise. Biofeedback combined with pelvic floor muscle exercise is often used clinically to treat urinary incontinence, in order to further enhance the effect of pelvic floor muscle exercise. Running can exercise the muscles of the whole body and improve cardiorespiratory function; Kegel exercises can make the pelvic floor muscles do exercises well and improve the function of the pelvic floor; biofeedback is equivalent to a fitness coach and a treadmill, assisting us to complete the pelvic floor muscle exercises more efficiently and correctly. Fourth, when is the most appropriate time to start exercising the pelvic floor muscles? Medicine in the 21st century is facing three strategic shifts: upward shift of goals; downward shift of focus; forward shift of gates. Medicine is gradually moving from being disease-oriented to being health and quality of life oriented; from being hospital-based to being rehabilitation and home-based; from focusing on diagnosis and treatment of diseases to focusing on disease prevention and health promotion. Against such a background, it is inevitable to recall the story of the three magpie brothers. In the ancient times, the famous doctor Bian Magpie had two brothers. When he was asked who was the most skillful doctor, Bian Magpie replied, “My elder brother was the most skillful, he always stopped the disease before it happened; my second brother was the second most skillful, he could cure the disease with simple treatment every time when the disease was just a little symptomatic; and I was the worst, I always waited for other people to become very sick before I made a big cut or made a big mistake. I, however, was the worst, waiting for others to get very sick before I treated them with a big knife and strong medicine.” These words of the magpie are precisely the concept of tertiary prevention of disease, and the treatment of urinary incontinence through pelvic floor muscle exercise is permeated in each stage of this tertiary prevention. First, many people at risk for incontinence can perform Kegel exercises at home before incontinence has occurred, such as patients with multiple pregnancies, patients who have had pelvic surgery, and older patients, and in some hospitals in the West, all mothers are required to perform pelvic floor exercises after giving birth. Second, after the occurrence of urinary incontinence, patients should go to the hospital as soon as possible to the relevant specialized clinics, biofeedback-guided pelvic floor muscle exercise for mild and moderate incontinence is the most effective, many patients because they think it is not a major disease, or find it difficult to talk about unwilling to seek medical advice, and ultimately delayed the disease. Finally, even in some patients with severe incontinence, biofeedback-guided pelvic floor muscle exercise combined with electrical stimulation can still be effective and improve the quality of life of patients. Therefore, we can use pelvic floor exercises as a good way to prevent and treat urinary incontinence, both before and after the onset of incontinence. With biofeedback and Kegel exercises, the pelvic floor muscles can be exercised as well!