Kegel exercises are named for Dr. Arnold Kegel, a gynecologist who had his patients doing pelvic floor contractions after childbirth to try and decrease incontinence. He did not "invent" the pelvic floor contraction, but in the US his name is the one we refer back to when we talk about strengthening the pelvic floor since we have named this exercise after him. I have found that there are many people who are well aware of these Kegel exercises (either from their physicians, friends, or just their own online research) and there are just as many who are not. Often I hear the whole "I've heard of that but have no idea what it is" response. Just as often I hear the "Yeah, I know I'm supposed to be doing those but have no idea how." I always reassure my patients that all of these answers are okay because honestly, we don't know yet if you need to be Kegeling until we sit and chat and go through an examination. So stop beating yourself up over not doing your Kegels. You may not even be ready for them and if you are, chances are you aren't doing them in the best way anyway.
Here's how your it works: If you come in to see me for urine leaking, there are generally (by generally I mean no one fits into a perfect mold) two overall reasons. Either your pelvic floor is (1) weak because it's just weak or your pelvic floor is (2) weak because it's actually tight. Now, admittedly these aren't super scientific explanations, but that's the gist of it. You can have that typical weakness that sometimes comes with pregnancy, childbirth, aging, high impact activities, lack of physical activity, etc. but you can also have weakness that is actually a result of a tight pelvic floor. See, your muscles have a "happy place." The little fibers that make up a muscle like to rest at just the right spot. They overlap each other in a way that lets them contract with strength but also stretch a bit when they need to. If the muscle fibers are resting in such a way that they overlap too much, then the entire muscle won't work well. So when you go to use the muscle, it won't have nearly as much strength as it needs to work right. Weak muscles can't compress the urethra (where your urine comes out) so when you go do sneeze, stand, cough, laugh, jump, shop, try and hold your pee as your key turns the lock, they can't work enough to keep you from leaking.
If your muscles are "just" weak, meaning they aren't tight but are just lacking enough strength to keep you from leaking, then you could definitely benefit from Kegel exercises. As Pelvic PT's we are trained to develop a personalized program just for you to get your pelvic muscles working well again. We are, after all, experts in exercise and movement science. Your home program is tailored to where you are starting now, so we work on exactly what you need. The best way to work on the pelvic floor is through long holds (which strengthen what I call the marathon muscle fibers) and also on the quick flicks (which work on the sprinter muscle fibers). For my marathon, I needed both. I needed the endurance fibers to be able to stay turned on for 5.5 hours but I also needed my sprinter fibers to turn on when I sneezed (#allergies) or "jumped down from a curb while crossing a street" (#gracefullystumble). We need both to get the most benefit. These are things I go over in a session and always write down on a sheet for homework. We then progress things as your body gets stronger over time and move from lying down to sitting to standing to even jumping or running depending on your desires.
The other side of the story are the patients who come in with leaking but also seem to have other problems as well. These often include constipation, pain with intercourse, trouble or pain with tampon use, history of trauma, history of abuse, or general pain in the pelvic region. These are usually signs that Kegels are going to take a backseat to pelvic relaxation. If you have tightened muscles in the pelvis, strengthening them won't be effective until we get the muscle fibers to their "happy place." You could Kegel all day long everyday and not see improvement. In fact, you could make things worse. So, we have to teach the muscles to relax, get them to their neutral starting point where they prefer to be before we can build up their strength. Sometimes, once the pelvic floor learns to relax again patients will notice less urgency to pee through the day or that they are better able to keep themselves from leaking when they sneeze. That's because the muscles are finally happier and can automatically work better even without training them to be stronger. Over time, once the muscles have found their happy spot, we begin the Kegels and can take care of the leaking. This tends to be a longer process than "just plain weakness" but more often than not, while fixing your incontinence you'll also fix some of the other issues like pain with sex or excessive straining to poop. So you are almost getting more bang for your buck! You can tell your levator ani muscles thank you for that little bonus.
Don't forget that peeing on yourself is NEVER NORMAL. It's not. It's not something that happens "because you are pregnant" or "because you've had babies" or "because you are getting older." Nope. Don't let anyone tell you that. It's not true. We don't have to live this way. We can go without Depends or extra large pads just so you can do your Christmas shopping. There's a better way, and that is retraining your pelvic floor muscles. Retraining can be a few sessions where you learn how to activate your pelvic floor and learn how to progress yourself through a home program or it can be weeks of pelvic relaxation and learning to get to the bottom of your tightness so you can start strengthening, but either way there is help and hope. You too can be like me, a three time marathoner with a goal of not peeing on yourself! Yippee!! Doesn't that sound awesome?? No? You're probably right. I should find a better hobby. But this last time I got pajama pants just for running 26.2 miles and it seemed like a great deal.
Anyway, back to the point here. It's time for us to DEMAND BETTER. Let's demand better from our physicians or healthcare providers. Tell them you will not accept leaking as part of your life and insist a referral to a Pelvic PT. PT's are experts in exercise prescription. Pelvic PT's get to take it to another level and teach you how to be an expert in your own pelvic floor so you can put the pads behind you. We can do better y'all. Spread the word and get the help you deserve. Your body is amazing and with some education and special attention it can work beautifully - even when you are pregnant, postpartum, a high intensity athlete, struggling to get back into exercise, or aging. (And for the men out there the same goes for you - even post prostatectomy). With all the money you'll save on pads or laundry detergent you could register for your first marathon... Or at least buy yourself a cute pair of "running shoes." You know, just in case. It won't hurt if they look cute with your yoga pants.
Dr Lacy Kells PT, DPT
The Physio Down Low
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