Have Kegels Let You Down?

Tammie Bigley, MSPT, Ascent Physical Therapy

The plight of a middle-aged woman

Virtually every woman has heard that she should do Kegels or pelvic floor contractions. These muscles stretch from the pubic bone in the front to the tailbone in the back and literally form the floor of the pelvic cavity and support the pelvic organs. The most common instruction to achieve a contraction of the pelvic floor muscles is to tighten them as if to stop the flow of urine. Exercise prescriptions vary from using vaginal weights to performing Kegels while at red lights and waiting in lines, and actually ceasing the flow of urine while sitting on the toilet. Doing this, a woman is told, will prevent urine leakage otherwise known as incontinence.

However, there are some holes in the process that can be addressed. First, 60% of women do not perform a Kegel correctly given the prescribed instructions. Half of those actually hold their breath and bear down in a manner that actually causes leakage. Therefore, it is imperative that the contraction is taught and performed correctly. Secondly, a contraction of the pelvic floor must coincide with the activities or movements that in fact cause the leaks. Few, if any, women leak at stoplights! Yet this is where it is practiced. In other words, practice contracting the pelvic floor before jumping or sneezing or coughing or whatever causes leaking. In health, this happens automatically. In dysfunction, which can occur after childbirth, due to painful periods, after abdominal or pelvic surgeries and with low back pain, the automatic contraction is delayed, diminished or even lost. Movement of the body starts before a stabilizing contraction of the pelvic floor and pressure goes down on the bladder causing a leak. Additionally, time and effort are a must. If limited strength of the pelvic floor is the deficit, it minimally takes 12 weeks of consistent exercise to have strength gains.

Unbelievably, incontinence is not even this simple. Doing a strong pelvic floor contraction correctly during activity still may not be enough! The continence puzzle has pieces beyond the pelvic floor that are rarely sought out. Factors that must be considered include, but are not limited to: posture, breathing mechanics and/or disorders, diet, hydration, anxiety levels, and medications. An important thing to remember when considering posture is that the bladder is on the bottom of the abdominal cavity. The closer the rib cage is to the pelvis, as with slumped posture, the less room there is for the abdominal contents and the more pressure there is on the bladder. One way to relieve the pressure is to empty the bladder. This can occur quite quickly by sneezing in a slumped posture. Poor posture may also contribute to poor breathing mechanics. The pelvic floor works with the diaphragm during inhalation to achieve appropriate intra-abdominal pressure to allow for a lifting of the rib cage and expansion of the lungs. If the pelvic floor is not coordinated with the diaphragm, the pressure is often gained by pushing the belly out. With pooching the belly out, pressure once again descends on the bladder. This may not be a primary mode of leakage for many women until she is out of breath and running in poor posture down a hill.

What is in the bladder also deserves consideration. Acidic foods and beverages can be irritating to the lining of the bladder. If the bladder is not happy with what’s in it, it’ll be happy to get rid of it whether a toilet is in sight or not. Coffee, tea, alcohol and orange juice are very common irritants. Less obvious are tomatoes and tomato-based products as well as spicy foods such as curry and hot peppers. So a woman is out of breath, running downhill in poor posture after drinking 3 cups of coffee. Maybe she shouldn’t drink anything before her run. Sadly, being dehydrated can irritate the bladder. The more concentrated and dark the urine, the less the bladder likes it. A good rule of thumb is to keep the urine a light yellow color.

Additionally, the autonomic nervous system amps up when a person is nervous causing increased tension in smooth muscle. The bladder is smooth muscle and is powered by the autonomic nervous system. This is not under voluntary control. Therefore, the more anxiety in life, not necessarily due to incontinence, the higher the possibility of an increase in urgency, frequency and leakage of the bladder. Some medications can have a similar effect. Daytime allergy medications, for instance, can make some people feel extremely jittery. These medications can mimic the physiological response of the autonomic nervous system. General deconditioning, age and obesity are all contributing factors to incontinence as well.

As this story unfolds, a myriad of pieces to the incontinence puzzle is presented. Is this character incontinent strictly because of pelvic floor dysfunction or weakness? Or is she incontinent because of the combination of insults she presents to her bladder and pelvic floor? When considering why YOU are incontinent or if you are liable to become incontinent, you must look at all of YOUR puzzle pieces. No two women have the exact same continence puzzle and therefore, one recipe or protocol to gain continence billed to work for all women is ludicrous. So, you will not find the exact answers in this article. You can only put into place the pieces that are relevant to your own story. It’s time to put your puzzle together! For more information contact Tammie Bigley, MSPT at Ascent Physical Therapy 885-9965