Why Kegels Don’t Fix Incontinence
Ask anyone what to do about urinary incontinence and they’ll likely say “do Kegels!” Yet, ask anyone suffering from urinary incontinence - especially postpartum - if they’ve been doing Kegels and you’ll likely hear an exasperated “yes! And it’s only helped a little bit.” Before moving further into a discussion about why this is the case, we want to bring up a couple of important safety notes. First, urinary or fecal incontinence (not being able to hold urine or stool) that comes on suddenly is an emergency, especially if accompanied by back pain. If you experience a sudden onset of this type of incontinence, you should seek immediate medical attention. Second, incontinence can be a sign of more serious medical conditions and this post is only intended to be a discussion of the type of incontinence that arises in the absence of these other conditions. This post is not intended to be a substitute for medical advice, and if you have further questions you should contact your healthcare provider, or make an appointment with us to learn about your particular case. Now, let’s get to the details. Kegel exercises work the muscles of the pelvic floor - a complex, multilayer group of muscles who’s main job is to support your pelvic organs and keep them (and their contents) inside your body. Did you know that the pelvic floor muscles are technically part of your core? (That’s why sit-ups and crunches are actually not the best exercises for building a strong core, but that’s a discussion for a different post….) So. If your pelvic floor muscles are strong from doing all those Kegels, why does urine still leak out? Well, those muscles have to attach to bones and other solid tissues in order to do their job. (Just like your bicep muscle in your arm attaches to the bones of your shoulder and forearm in order to move your elbow and shoulder). If the alignment of those bones is altered due to Structural Shift, that may cause the pelvic floor muscles to contract inefficiently or unevenly, resulting in altered function (AKA urine leakage). Additionally, symmetry and balance is important for optimal body function, therefore, if the muscles that oppose the actions of the pelvic floor muscles (the gluteus muscles, mainly) are not strong enough or are not being used properly due to deconditioning, the pelvic floor muscles can actually become relatively hypertonic. This process throws off the whole balance of your pelvic structure. Unfortunately, as urine leakage continues, most patients think they need to do even *more* Kegel exercises, thus resulting in a vicious cycle. This is one of the reasons why patients can have urine leakage AND painful penetrative sex, pain when inserting a tampon or menstrual cup, painful erections, and other sexual dysfunction. It’s not that the muscles of your pelvic floor aren’t strong enough, it’s that the structure of your pelvis isn’t allowing them to work efficiently. To make things even more complex, some patients who had perineal tearing or an episiotomy during childbirth can develop scar tissue that further alters the function of the pelvic floor muscles. (Scar tissue that affects this area can also develop after pelvic or abdominal surgeries of any kind, and as a result of endometriosis and prostate surgeries). What does all of this mean? Are there answers? Absolutely. The first step is to be evaluated by a chiropractor who focuses on structural correction. This will help you learn whether structural shift is affecting your pelvis and contributing to the problem, and if so, to what degree. From there, an exam from a pelvic floor physical therapist is in order to assess the health of the pelvic floor muscles and the presence or absence of scar tissue. Between these two providers, an individualized treatment plan should be crafted to address your specific structural and muscular issues to restore balance and function to the pelvis - ultimately helping you live a life less burdened with the constant worry that comes with incontinence. Additionally, we would be remiss not to mention preventive measures. Like any other health concerns, you know what they say - an ounce of prevention is worth a pound of cure. An easy way to help prevent this issue is to incorporate squats into your fitness routine. It’s important to keep good form in mind so that you properly activate the gluteus muscles in order to receive maximum benefit. Squats are generally safe before, during, and after pregnancy, however if you develop any signs or symptoms of premature labor, discontinue squats and ask your birth care provider when it’s safe for you to resume them. Kegel exercises are still beneficial for many people, however, if you’re having incontinence accompanied with painful penetrative sex, pain when inserting a tampon or menstrual cup, painful erections, or other sexual dysfunctions, you might consider temporarily discontinuing them and seeking advice from a pelvic floor physical therapist. For more information about your particular case, book a complimentary consultation with our team to learn your options.