Stress incontinence, or leaking urine with exertion (think running, jumping, sneezing, lifting, coughing, laughing) is a common problem effecting many women and men. It can be a very frustrating and embarrassing issue to do deal with and often times causes those suffering from SUI to avoid certain activities they love. In this blog post we will discuss how you can overcome your leaking, without doing kegels and why kegels may not be the (only) answer.
Kegels, or an isolated contraction of the pelvic floor muscles (i.e. squeezing the muscles as if you are trying to stop the flow of urine) are often prescribed by doctors because it is a simple exercise that can be done anywhere. While most of the time doing Kegels is harmless, there are times when at worst, doing Kegels can be detrimental or at best just unhelpful.
Why Kegels Aren’t Always the Answer
The pelvic floor muscles, pictured below are a group of muscles that sit at the bottom of the pelvis and form a bowl to support our pelvic organs in addition to providing support and stability to our pelvis. The pelvic floor muscles do not work in isolation from other muscles of the body including the glutes, abdominals and diaphragm, which is why training the muscles in isolation (i.e. doing Kegels) doesn’t always yield favorable results.
To illustrate this further, think about what it takes to do a pull up. The biceps, lats, traps and even abdominals have to engage in order to do a successful pull up. If we only train each of those muscles in isolation, we may get stronger and a little closer to doing a pull up, but in order to successfully get our chin above the bar, we must actually practice the movement, using all of those muscles together. The same is true of the pelvic floor and training activities that someone may be experiencing leakage with.
Other limitations of doing Kegels include not addressing the root cause of the problem, increasing tension or pain in muscles that are already overactive or poor techinque. However, rest assured there are other strategies for overcoming leaking.
3. Alternative Solutions
Breathing and Core Coordination
Many people who come to me for help with leaking actually have a really strong pelvic floor. They can do a Kegel, and even hold it for 5-10 seconds, yet they still leaking with coughing sneezing and running. This is because they have a poorly coordinated breathing and core engagement patterns. Instead of the pelvic floor and abs engaging together, they actually over engage their upper abs which puts immense pressure downward and their pelvic floor simply cannot overcome this pressure.
They may also have a poor breathing pattern, where instead of letting their ribs and belly relax on the inhale and draw in on the exhale, they do the opposite. Suck in on the inhale and push out on the exhale. This breathing pattern does not align with the pelvic floor and therefore the pelvic floor has to work even hard to maintain continence.
Below is a simple breathing and core engagement exercise to try:
Postural Alignment with activity
Poor posture – and this means slumping over OR standing up too straight can negatively impact the pelvic floor. The pelvic floor muscles work best when the ribs and pelvis are in a neutral position. This means we are not arching our back and sticking our chest out (what most people think is “good posture”), nor are we rounding forward and tucking our bottom too far under.
TO assess your posture, look at yourself in the mirror. Imagine you have headlights on your hip bones and ribs. Are the lights pointing down, up or straight ahead? Ideally we want the lights to be pointing straight ahead. It may taking some trial and error to find this neutral posture and it may feel weird to you at first, but thats okay.
During running or jumping trying to lean forward slightly, thinking “nose over toes” also helps clients get into a more neutral position.
Decrease Demand of the Task
Back to our pull up example. If we can’t do a pull up, but want to, we may train the pull up movment by making it easier, either with assistance from a band or a machine in order to gradually build up our strength. We can do the same thing with our pelvic floor.
If you leak when jumping rope, and it usually takes about 50 jumps before you start leaking, we can break this task down into smaller chunks to build up our strength and endurance. Perhaps instead of 50 jumps, we do sets of 15, with 10 seconds rest between until we can complete a total of 100 jumps without leaking. Then we can increase to sets of 20-25 with 10 seconds rest between until we can complete 100 jumps. You see the pattern.
Another way to decrease the demand of the task is to simply focus on being quiter and lighter on your feet when it comes to running and jumping. When we land with a hard and loud impact, that force is translated up through our legs and absorbed by our pelvic floor. When we land soft and quiet, we are using our leg muscles to accept that force, with less jolting to the pelvic floor.
When to Seek Professional Help
Seeking help from a pelvic floor physical therapist is the best way to overcome your leaking. A pelvic floor specialist can help identify the root cause of your issue and help you understand if and when you should be doing Kegels. Many women do benefit from doing Kegels, but it is rarely the ONLY thing someone needs to work on.
Many times, leaking can indicate a deeper issue of poor stability, breathing patterns, core weakness or movement patterns. It can also be linked to issues at the hip or lower back and a professional will be able to help you address any other related issues as well.
Conclusion
Overcoming leaking is possible with the right guidance and commitment to change. Kegels are one option that can be great, especially for someone who has limited time to commit to doing exercises, however changing breathing and posture may also be needed in addition to Kegels. If you suffer from pelvic pain or tension, then Kegels are likely not the best option for you.
As always seeing a pelvic floor physical therapist in durham is the best way to ensure you are doing the right exercises for your body and addressing the root cause.
If you’re suffering from leaking, contact us today to learn more about cost, availability and how we can help you get back to the activities you love with confidence.
