Incontinence? Kegels May Not Be the Answer

If you’ve ever dealt with incontinence then you were probably told to “do more kegels.” This is based on a solid idea: stress incontinence (leaking urine when doing activities such as sneezing, coughing, or jumping) is caused by weak muscle tone in the pelvic floor, and the way to make weak muscles stronger is with exercise. Many women have found this to be true for them. Effectively performed kegels can lead to huge improvements. But for some of us, this exercise just isn’t the cure-all we’ve been promised. Why do kegels make all the difference for some and don’t seem to help others at all? It turns out that pelvic floor rehabilitation is more complicated than you might think. Let’s take a look at a few reasons doing kegels may fail to help you and some potential solutions to pelvic floor problems, such as consulting a pelvic floor specialist.

A tight pelvic floor

The term “pelvic floor” refers to a group of muscles from your pubic bone to your tailbone (lower abdomen) that come together to create a sling that supports your pelvic organs (such as the bladder, the vagina, and the rectum). These muscles can become stretched and lax by things like childbirth, injury, or weight gain. When this happens, women experience a variety of problems, including stress incontinence, constipation, and even organ prolapse. Although many people, even doctors, assume that a little urine leakage is normal after childbirth, it’s actually a sign of pelvic floor dysfunction. What’s more, women who have never given birth can experience it too.

When pelvic floor problems are caused by muscle weakness, contracting those muscles can help them regain tone and strength. But some women experience problems not because their pelvic floor muscles are too loose, but because they are TOO TIGHT. Because these muscles are always at work, supporting the important pelvic structures, they never fully relax. This can lead to a hypertonic state, where the muscles have more tension than is healthy. Think of it like a tight muscle in your back, causing pain and making it harder to move.

If you have this tight tone in the pelvic floor then your muscles won’t have the strength they need to do the job. When a muscle is already partially contracted it doesn’t have much more power to exert. The fibers can only shorten so much. The result is a weak ability to respond to demands on the muscle, even though the muscle is working hard all the time. The best way to find out if you have a pelvic floor that is too tight is by contacting a specialist, that way you get the right diagnosis and treatment for your pelvic floor dysfunction.

Kegels may make it worse

If you think of that example of a painful, tight muscle in your back again, it makes sense that you’re not going to treat that achy muscle right away with strengthening exercises. The priority is to get the muscle tension to release using things like stretching and massage. THEN you can work at strengthening it, while also dealing with things that contributed to the problem, such as weak surrounding muscles and inefficient movements. If you have a tight pelvic floor then it works the same way. You need to get those muscles in a relaxed, supple state before you can work on strengthening them. Otherwise, the exercises are just tightening the muscles further and making them less functional.

Even if you are dealing with lax pelvic floor muscles and would benefit from kegels, it can be difficult to figure out the correct way to do them. One study showed that when a group of women was given verbal instructions on how to do kegels, less than half of them did it the right way, and 25% of them performed them in a way that could make urinary incontinence worse. If you don’t know what is causing pelvic floor problems or how to go about fixing the issue, you run the risk of exacerbating the problem. Always consult a medical professional when trying to diagnose and treat problems, especially concerning pelvic floor dysfunction.

What about weights?

You may have seen advertisements for weights that you insert in the vagina. These are usually sold with claims that they will solve incontinence problems, tighten vaginal walls, and generally cure any pelvic floor problem. So can weights be a helpful tool in addressing pelvic floor issues? Like so many other questions about pelvic health, the answer is “it depends.”

Hopefully, it’s clear that if you have a tight pelvic floor then you are NOT going to benefit from the sustained muscle contractions from using weights. But even if you’re working with lax pelvic floor muscles you should BE CAREFUL with weights. Just like when you’re strength training at the gym, it’s possible to misuse or overuse weights, causing more problems and even injury. Weights can be an effective part of pelvic floor rehabilitation, but they are best used with the guidance of a trained pelvic floor therapist. They can help you use the weights to target the right muscles and gradually increase the resistance to give you the best results.

Clearly, the one-size-fits-all advice to “just do kegels” is oversimplified. Without professional guidance, this kind of rehabilitation attempt can even be damaging. The assumption that all pelvic floor problems can be solved with kegels can be discouraging if it doesn’t help you. But with a qualified physical therapist, you can figure out what’s actually going on, and come up with a plan of action to make things better. We can help you find solutions that go beyond the kegel at Dynamic PT, so don’t hesitate to contact us!