Recently we’ve focused a number of blog posts on women’s bladder and pelvic health issues, such as pelvic organ prolapse, UTIs and female leakage. Since then, we’ve received an overwhelming number of questions asking how to perform pelvic exercises to strengthen the pelvic floor. Keeping this organ, muscle and skeletal system healthy is essential for women of all ages.
Our guest blogger Lacey Savage, who is a licensed physical therapist at INTEGRIS Jim Thorpe Outpatient Clinics and an expert on pelvic floor dysfunction, answers your questions.
What are the pelvic floor muscles?
They are a group of muscles inside the bony pelvis forming a hammock-like structure. The muscles run from the pubic bone to the coccyx (tailbone) and attach to the sides of the pelvic bones. These muscles provide support to the pelvis, aid in sexual function, facilitate childbirth and allow urinary and fecal continence. These muscles are constantly (even when you sleep) contracting and relaxing to find a state of equilibrium. They contract just prior to movement to allow our arms and legs to move and to keep our core and posture stable. These pelvic floor muscles contract and relax involuntarily but are also able to contract and relax under conscious control. They work hard for our bodies every day yet most of us are unaware they even exist unless they are not functioning properly.
What is pelvic floor dysfunction?
In broad terms, pelvic floor dysfunction can be divided into two groups.
- Muscles that are too weak to contract properly, which causes urinary incontinence, fecal incontinence and can contribute to pelvic organ prolapse.
- Muscles that are too tight. This can lead to pelvic pain and also cause urinary incontinence as the muscles are not contracting and relaxing properly.
What do the pelvic floor muscles have to do with urinary incontinence?
The most common type of urinary incontinence is stress incontinence, which happens when you have leakage when you cough, laugh, sneeze, exercise, etc. As I mentioned, the pelvic floor muscles are always in a state of contracting and relaxing, though most of us are unaware this is happening. Activities like sneezing increase abdominal pressure, which puts pressure on the bladder and causes it to release urine. When abdominal pressure increases, the pelvic floor muscles are supposed to contract in order to shut the urethra off and prevent leakage. In many women these muscles are either not contracting automatically or are not contracting strongly enough to stop the leakage.
What non-surgical treatments exist to deal with incontinence?
The Kegel, or pelvic floor muscle contraction, is an exercise that strengthens and improves coordination of the pelvic floor muscles. It is the conscious effort of contracting and relaxing the pelvic floor muscles. The pelvic floor muscles are just like muscles anywhere else in the body – they can be strengthened with exercise.
How to perform Kegel exercises
This can be tricky. Unlike other muscle groups in the body, you cannot show someone how to do a Kegel and it’s impossible to tell if a clothed person is doing a Kegel correctly. If someone is doing it right, there should be no visible body movement.
Although you do not want to do Kegels while sitting on the toilet, you can use that time to see if you are doing the Kegel exercise correctly. When urinating, attempt a Kegel while in midstream. If your urine stream slows downs or stops completely you are using the correct muscles.
Make a mental note of how that contraction feels and where in your body you feel it so you’ll know you’re doing the Kegel correctly when you aren’t on the toilet. However, you should use this method for learning purposes only. It isn’t a good idea to start and stop your urine flow regularly, or to frequently do Kegel exercises when you have a full bladder. Incomplete emptying of the bladder may increase risk of a UTI.
- Think about trying not to pass gas and squeeze those muscles, which are the same group of muscles that are engaged with Kegels.
- You should feel like the muscles are squeezing together and lifting inside of the pelvis.
- Nothing on your body should be visibly moving.
How many Kegels should you do each day?
Typically I suggest 10 quick contractions (squeeze, relax) three times a day, and 10 endurance contractions (squeeze, hold squeeze for 5-10 seconds, relax) three times a day. Good, quality contractions are more important than the number of contractions you perform.
Advice for success
If you are having a difficult time doing a Kegel, I suggest doing it in a quiet place so you can concentrate on performing the exercise correctly. Once you can perform Kegels correctly and consistently, you can It’s important to remember these pelvic floor muscles need to squeeze together AND lift up inside the body to prevent or reduce urinary leakage. Most women are able to squeeze together but don’t squeeze hard enough to also lift. Think about an elevator: the muscles first squeeze together and shut like elevator doors but then also have to lift to go to a high floor.
To make the exercise more difficult, Kegels can be done standing and while performing other body movements. You can do a Kegel and hold the contraction while doing a side step, squat, or try a jumping jack. It takes more strength to hold a pelvic floor muscle contraction when the body is moving.
Don’t be discouraged if you don’t see results right away. According to the Mayo Clinic, Kegel exercises may take as long as a few months to have an effect on incontinence.
When to seek treatment from a pelvic floor physical therapist
- If doing Kegels consistently for 2-3 months is not improving urinary leakage
- Bladder pain
- Pain during intercourse
- Lower abdominal/groin/pelvic region pain that can be constant or intermittent