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Are You Doing Kegels Wrong?

It’s the best exercise to strengthen your pelvic floor muscles, but many women are doing them wrong.

Photo credit: Getty Images

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Dear Doctor,

I’m 33 and an avid “Kegelcizer.” I’ve been doing Kegel exercises since having my daughter two years ago because I thought they’d keep things strong “down there.” But it doesn’t seem to be working—I still leak urine when I cough and jump! Aren’t I too young for this? A friend of mine mentioned pelvic floor rehab. What is that exactly and should I give it a try?

“Leaky Leah”

 

Dear Leaky Leah:

As a physical therapist who specializes in pelvic floor rehabilitation, I can tell you that stress incontinence—which is an involuntary loss of urine during physical activity—can happen at all different ages. In our practice, we see teenagers all the way up to 80-year-olds.

While there can be many causes for stress incontinence, it’s often due to weak pelvic floor muscles. And you are correct that a physical therapist who is trained in pelvic floor rehab can help you strengthen those muscles.

When I meet with a new patient, one of the first things I do is an internal evaluation of the pelvic floor muscles so I can evaluate whether or not she is actually able to find her pelvic floor muscles and recruit them properly. We all hear that buzzword “Kegel” all the time, and like you, a lot of women say they do them regularly, but doing Kegel exercises isn’t as simple as it may seem.

A Kegel involves contracting your pelvic floor muscles, which means you pull up and in with your vagina as though you were trying to stop the flow of urine. But many women overcompensate and do things like contracting their bellies, holding their breath or squeezing their butt cheeks really tight.

If you’re doing any of these things, you’re not really isolating the pelvic floor muscles correctly and so you’re doing extra work for nothing. Even worse, some women bear down, and that can actually further weaken your pelvic floor muscles.

By the way, if you’re sitting on the toilet, you should not be stopping your flow while you’re urinating. That’s the worst time to be doing a Kegel, because you’re retraining your brain to do something that it’s not supposed to do while urinating.

The other thing I will do at that first visit is give women a bladder diary and ask them to chart for a couple of days how often they are urinating, how long they urinate for and how much urine they’re voiding. The diary also includes the foods and drinks they consume, which may be possible bladder irritants, and when/how much they are actually leaking. This can help us uncover problems that can be addressed during rehab.

What we often see is that some women are urinating too often. I call that “JIC-ing” for “just in case.” We don’t want to be hassled with trying to find a bathroom when we’re out so we go just in case. But, if you’re constantly emptying your bladder, it never gets full enough to give your brain the signal that you need to go to the bathroom. Another reason that women “JIC” is because they think that by going to the bathroom frequently during the day, they will leak less. However, there is always a residual amount of urine left in the bladder after voiding, so regardless of whether or not we go to the bathroom, we are going to leak with any increase in intra-abdominal pressure or with exertion if there is pelvic floor muscle weakness.

Of course, the flip side of that, which happens a lot with teachers and nurses, is that a woman will ignore the signal that her bladder is full, and so her bladder will actually over-expand. And over time, the stretch receptors in the bladder that tell your brain that it’s time for you to pee will be less sensitive, leading to voiding dysfunction, urinary incontinence or pelvic pain.

The most important thing to keep in mind right now is that you’re not alone, and you don’t have to suffer with this problem anymore. With physical therapy—which involves teaching you to do Kegels more effectively through the use of manual therapy techniques, core stabilization exercises, biofeedback or electrical stimulation—you can strengthen your muscles, retrain your bladder and improve your quality of life.

“If you’re sitting on the toilet, you should not be stopping your flow while you’re urinating. That’s the worst time to be doing a Kegel, because you’re retraining your brain to do something that it’s not supposed to do while you’re urinating.”
Nancy Silva-Mullins, pelvic health physical therapist
Nancy Silva-Mullins, pelvic health physical therapist | Photo credit: The Well

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Published July 31st, 2018

We hold the key to a rapid recovery. And we want to share it with you.