Just Do Your Kegels!?

When suffering with urinary incontinence, how many times have we been told “Just do your kegels”. Now out of those times, how often has there been instruction on how to properly perform a Kegel? My guess? Not many. Not to say kegels are bad, but often it’s not as simple as just “doing them”. There are different aspects of the pelvic floor to consider when it comes to urinary incontinence.

Most of the time when thinking of urinary

incontinence, pelvic floor weakness is often assumed to be the culprit of, and a lot of the time it is, but pelvic floor muscle tension can also lead to the same result. When muscles are tight, they can easily become fatigued and struggle to perform their functions appropriately. In the case of the pelvic floor muscles, if they are working at full capacity when they don’t necessarily need to be, they can fatigue and give out when placed under pressure including with full bladder or laugh, cough, sneeze resulting in leakage. Another way increased muscles can cause leakage is by not being able to fully relax to let the bladder completely empty which can result in an involuntary bladder contraction/spasm leading to leakage that is often experienced without awareness or sense of cause. In these cases, performing kegels/pelvic floor strengthening exercises will only cause the symptoms to become worse. Instead, the plan of care should be stretching and relaxing the muscles and retraining them so they are able to work at their highest level of function when needed.

After ruling out muscle tension as the cause of leakage, another thing to consider is how to perform kegels effectively based on the specific type of incontinence. A thorough assessment of the pelvic floor muscle including strength and endurance are helpful in gathering a baseline and determine how to appropriately initiate exercises. However, before strength can be assessed, a person needs to know how to perform a Kegel/pelvic floor contraction appropriately which, as previously stated, isn’t always something that is instructed. Having a skilled pelvic floor physical therapist can guide you through how to perform a proper kegel/pelvic floor contraction so that exercises are beneficial. Once a proper kegel/pelvic floor contraction is established, there are a few aspects of the muscle to assess. The strength of the squeeze/kegel is important but the endurance (how long the squeeze can be held) and the coordination and/or responsiveness of the muscle to what the brain is signaling it to do are of equal importance to determine how to properly strengthen the pelvic floor.

The type of incontinence that is being experienced is also helpful to consider when implementing exercises as each one requires a different aspect of the muscle to function at the appropriate time. In the instance of purely stress incontinence (leakage with coughing, sneezing, running, jumping, etc.) when the muscles need to perform a quick/strong contraction to stop leakage, performing quick back and forth kegels can be beneficial. However, in the case of urge incontinence where the muscles have to hold for a length of time to get you to the bathroom, those types of kegels won’t necessarily help. Focusing on improving the endurance of the muscles by working on increasing the length of time a contraction can be maintained will allow for improved control of urinary urges and reduce leakage. Sometimes a person is only experiencing one type of leakage, but there are other times when a combination of the types of leakage can be present which is why, in most cases, a having a combination of exercises that focus on all aspects of muscle strength is most effective. 

It can be a very difficult to tell on your own whether your pelvic floor muscles are weak or tight and can be challenging to figure out where to start with stretches and/or exercise. Fortunately, there are pelvic floor physical therapists out there who have an in-depth understanding of the pelvic floor who can help develop an individualized plan based on the symptoms that are presented and their assessment of the muscles. 

~ Dr. Kelsey Crosby