Stress Incontinence - More than just kegels!
Stress incontinence is defined as urinary leakage that occurs with some kind of physical stress, such as laughing, coughing, sneezing, jumping, running, lifting, changing positions, etc. According to an article in the American Journal of Obstetrics and Gynecology (Viktrup, 2014), 30% of women still have stress incontinence five years after a vaginal delivery. They also found their risk of incontinence at five years to be greater if they had stress incontinence at 3 months postpartum. Physical therapy has been proven time and again to be especially effective against stress incontinence. This type of urine leakage is very common but completely preventable! Don’t let five years pass by when you could take action now.
Typically, stress incontinence is due to weak pelvic floor muscles. Your pelvic floor is made up of the muscles that span from your pubic bone to your tailbone and surround your urethra, vagina, and rectum. They function to stop the flow of urine, gas, or feces, to support the pelvic organs (bladder, uterus, rectum), and in sexual function they contract with stimulation and orgasm to increase blood flow to your sexual organs. If these muscles are weak, you may have trouble stopping urine from leaking when there is an increase in intrabdominal pressure, such as with coughing, sneezing, or laughing. You may also have trouble stopping the passage of gas or fecal matter, and even have less intense orgasms or be unable to orgasm.
So, if these muscles are weak, we need to strengthen them, right? That’s what kegels are for.* But do you really know how to do them? Some studies show over 60% of women don’t. Here are a few important points for properly doing kegels:
Isolation: to isolate your pelvic floor, you want to think about a zipper going from your tailbone to your pubic bone like you’re trying to stop the flow of urine or the passage of gas; without squeezing your butt, tightening your abs or your inner thighs. If you get good at this, then you can also think about pulling up and in, like you are sucking water up your vagina through a straw.
Relaxation: equally as important is the relaxation after doing a pelvic floor contraction, or Kegel. If you were doing a bicep curl, you would move through the whole range of motion of your arm as you did the exercise. You wouldn’t just go up and down a few inches. And if you stay up at the top, you wouldn’t be able to get a good strong contraction the next time. Yes, you need to be able to contract your pelvic floor all the way up, but also lower it down all the way each time. Spend as much time relaxing as you do contracting! A good way to make sure your pelvic floor is as relaxed as possible is to take a big belly breath, expanding your belly as you breathe in. (If you’re not sure how to do this, search “diaphragmatic breathing” on YouTube)
Quick and Slow: Something else to keep in mind is to work on both quick reactions and slower endurance contractions. Practicing both ways helps in more functional situations and utilizes all the muscles in our pelvic floor. Try holding as long as you can. However long you’re able to hold, this is a good starting point. Practice contracting and holding ten times and practice contracting and releasing ten times, repeat 3-4 times per day to start building strength. Don’t forget to relax after!!
With all that said, there is so much more than just kegels to having a strong and functional pelvic floor and maintaining urinary continence! Ultimately, doing kegels alone is not enough for everyone. Getting your pelvic floor stronger is part of the picture, but not all of it. You could have a strong pelvic floor but still leak when you cough because you’re not actually contracting your pelvic floor before you cough. Or maybe you can do it when you’re sitting but not when you’re standing. If you’re doing kegels and not getting better, you may be doing them wrong or you may need functional training for how and when to use your pelvic floor muscles to stop urine leakage. Alternatively, maybe your muscles are not weak at all, but are tight and unable to contract due to their shortened length. Thankfully, there are physical therapists that can help you with that. Dr. Sarah Shimanek, PT, DPT, WCS, PRPC with Revive Mama can help make sure you’re doing the kegels correctly and look at how you’re moving and using your pelvic floor to help guide you through the path to continence. According to a Cochrane Review from 2014, women undergoing physical therapy for stress incontinence were 8 times more likely than the control group to report they were cured, and 17 times more likely to report improvement in their symptoms. Whether you’re experiencing urine leakage months, years, or decades after your baby, physical therapy can help. It’s never too late. Women from 18 to 100 can and do go through pelvic floor physical therapy to improve their continence. Contact us to schedule an appointment today. Or if we’re not local for you, visit www.pelvicrehab.com for providers in your area.
*PLEASE NOTE: If you’re experiencing pain of any kind in your pelvis, vagina, rectum, hips, or lower abdomen, please seek out physical therapy before doing kegels. If you’re urinating frequently or have very strong urgency with urination (“gotta go!”), your pelvic floor may be tight and kegels may not be the right answer for you. You need to seek out a physical therapist to find out.