Discharged with "keep them up" and no dose. Keep up what, exactly?

Finished in December, discharged with a genuinely warm "you have done brilliantly, just keep them up", and I have been quietly floundering ever since.

Keep up what though. The whole programme, which took me about twenty minutes a day and was built around a review that no longer exists? Some reduced version of it? The last set she gave me, forever? I asked at the time and got "whatever you can manage", which I understand is kind and realistic but is also not a dose.

Two months in I have drifted from the full thing to something I do in the car park before work when I remember, and I cannot tell whether that is sensible maintenance or the start of the slide back. Nobody is measuring anything any more so I have no way of knowing until it goes wrong.

The car park before work when you remember is exactly where I was at month three, and I would gently say that "when I remember" is the bit that decides it, not the number of squeezes.

What worked for me was giving up on the idea of a maintenance programme entirely and attaching it to something that already happens whether I am motivated or not.

Mine is the kettle. Kettle goes on, sets get done, twice a day, every day, and I have never once had to decide to do it because I never had to decide to make tea. The full twenty minute version was gone within a month of discharge and I have made my peace with that. Something reliable and smaller beat something ideal and occasional by a distance that is not close.

The other half of it, which nobody told me either, is knowing how to get back in. Find out at discharge whether you can refer yourself back, and whether there is a time limit on it. Much easier to ask while you are still a patient.

Same question here from the men's side and the same non answer. Mine was "keep doing them" with no numbers attached, and I had numbers all the way through the first four months.

I have kept a version going for over a year now. What I notice is that it slips in exactly the weeks I am busiest, which are also the weeks I am most likely to notice a problem and blame the wrong thing.

The direct answer is that there is a stated maintenance instruction in the guidelines, but it is a direction rather than a dose, and I would rather tell you that plainly than invent a number.

What is actually written. NICE NG123 recommendation 1.4.7 says to continue an exercise programme if pelvic floor muscle training has been beneficial. Recommendation 1.7.5, which is about prolapse, says that if the programme is beneficial, advise women to continue pelvic floor muscle training afterwards. NG210 recommendation 1.6.20 says the same thing again. So the guideline position is continue if it worked, and there is no separate maintenance prescription with a different number in it. The only dose figure in either guideline is the training dose in NG123 recommendation 1.4.5, at least 8 contractions performed 3 times per day, and I want to flag something about it that is usually left out: that recommendation carries a 2006 tag, meaning it was carried forward unchanged from the older guideline and was not re-reviewed in the 2019 update. It is the guideline dose. It is not fresh 2019 evidence, and anybody presenting it as such is overselling it.

What that leaves you with is a genuine gap between the evidence and your kitchen, and the gap is not a secret. A review of adherence in this field concluded that adherence was inconsistently monitored and inadequately reported across the trials, which is a polite way of saying we know the training works and we know rather less about what people actually did at home while it was working. So when you ask what the maintenance dose is, the honest answer is that the trials mostly did not measure that well enough to tell you.

Which is why I would push back slightly on the framing of the question. The variable that predicts whether people keep it going is not the number of contractions, it is whether the routine is attached to something that already exists in the week. Lindsey's kettle is a better answer than any prescription I could write here, and I say that as the person who writes the prescriptions.

Two practical things. First, benefit does not collapse the moment the appointments stop, so please do not read a drifted fortnight as the whole thing undone. Second, if symptoms come back or change, that is information rather than a verdict, and the response is a reassessment rather than doubling the sets, because more is the wrong direction entirely if a floor turns out to be overactive rather than weak. Keeping it up after discharge goes through what should have been established at that last appointment, including the re-referral route Lindsey mentioned.

What I cannot tell any of you is what your own maintenance should look like, because it depends on what was found, what changed, and what you are asking your body to do. That belongs with whoever discharged you, and "what should I be doing in a year" is a fair question to ring and ask even after discharge.

Reporting back six weeks later, mostly to say that the boring answer won.

I attached it to brushing my teeth, morning and night, and stopped trying to reconstruct the full programme. Some days that is all I do. The tick chart is gone and I have not missed it.

The bit I have not solved is Gerry's point about it slipping exactly when I am busiest. Teeth still get brushed in a bad week, so in theory the sets do too, but in practice I catch myself doing a rushed version and calling it done. Not sure that counts and not sure it matters.