If you leak urine when you sneeze, cough, or just can’t quite make it to the bathroom on time, you’ve probably either performed Kegels (pelvic floor contractions) or thought about doing them. That’s because everyone believes weak pelvic floor muscles are to blame when urine leakage is an issue. But there may be other factors at play, so Kegels are not always the answer.
Let’s talk pelvic floor. It’s made up of a group of muscles that form a sling or a bowl within the bony pelvis. These muscles help support the bladder, uterus in women, prostate in men, and the rectum. Their primary function is bowel and bladder control. The muscles of the pelvic floor are always “on” so we don’t leak urine or feces. They have to switch “off” to allow urination or a bowel movement.
Shutting “off” can be difficult for some people because they have overactive pelvic floor muscles. In this case, the muscles of the pelvic floor become very tense and can’t respond like they are supposed to. These tense, tight pelvic floor muscles can make urination a bit difficult AND they can cause urine leakage when the system is challenged with something like jumping on a trampoline, coughing, or sneezing. Tense, tight muscles don’t function very well.
Herein lies the problem with Kegels. They can contribute to the tension in those pelvic floor muscles. So for someone with an overactive pelvic floor, doing Kegels can make symptoms worse and even create other issues like constipation, stool leakage, painful intercourse, pelvic pain, and even UTI-like symptoms.
Here’s an example of how Kegels can actually make things worse: a woman complains of urine leakage with laughing, sneezing, and jumping on the trampoline/jumping jacks (sound familiar?). She then sees her doctor, describes what is happening, and is instructed to do Kegels. After several weeks, she starts leaking urine when she is walking. Just WALKING. She decides to try pelvic floor physical therapy to get help. An assessment reveals that she has pelvic floor tension and a decreased ability to voluntarily contract the pelvic floor muscles. She has what I call “a high, tight pelvic floor”. Her pelvic floor muscles are overactive and cannot shut “off”. So when she started doing Kegels, the urine leakage worsened because the Kegels created even more pelvic floor tension, which made it more difficult for her muscles to do their job.
The same thing is common in female athletes (runners, weightlifters), postmenopausal women, and evenyoung women in their 20s. The common link in all of these cases is pelvic floor tension or overactive muscles. Chronic pelvic floor tension can lead to a myriad of problems from urine leakage to painful intercourse to constant, chronic pelvic pain. The prescription? Pelvic floor relaxation (which involves pelvic floor physical therapy and patient education), NOT Kegels.
Leanne Johnston is a Doctor of Physical Therapy and has been treating pelvic floor dysfunction since 2007. She treats both women and men and is very passionate about helping her patients overcome issues that impact their quality of life.
