I did my Kegels, I’m still leaking…Do they even work?

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Kegel:   /ˈkāɡəl/

Noun

“denoting exercises performed by a woman to strengthen the pelvic floor muscles, involving repetitions of both sustained and rapid voluntary contractions of the muscles and used especially to treat urinary incontinence and improve sexual function”

There is usually a lot more to solving incontinence than purely contracting one specific group of muscles. In most cases, reducing the amount of leakage you experience will be helped by strengthening your pelvic floor (performing Kegels), however some do not find success with this approach. This post is meant to serve as a guide so that you can further problem solve the issue if Kegels aren’t working for you.

Some factors to take into consideration are:

1. Is strengthening the pelvic floor appropriate for your type of incontinence? 
   1. One of the very first considerations is whether or not you should even be doing Kegels. There are some causes of incontinence, that will get worse with repetitive Kegels. 
   2.  There are times when incontinence is caused by pelvic floor muscles that are too tight, and are unable to contract and relax correctly. In this case Kegels will make your incontinence worse. 
   3. If you perform kegels and notice a worsening of symptoms than you should discontinue the exercise, and seek to further problem solve. 
   4. There are times when incontinence is not caused by pelvic floor weakness or tightness, but rather an effect of poor bladder habits, and bladder retraining is what is most appropriate to stop incontinence
2.  Are you performing the Kegel correctly?
   1. I am often surprised at the number of women who believe they are doing a Kegel by contracting the pelvic floor muscles, but are in fact contracting different muscles.
   2. Some cuing to determine if you can appropriately perform a Kegel is:
      1.  squeeze as if you are cutting off your flow of urine (I don’t recommend doing this often, but just a few times, to see if you can squeeze the right muscles won’t hurt anything).
      2. squeeze your rectum as if you are holding back gas
      3. squeeze as if you are thinking of gripping a tampon in your vagina
   3. These cue’s should help you to activate the pelvic floor musculature and avoid activating compensatory muscles such as your glutes, and hip adductors.
3. Are you using the correct exercise prescription for your Kegels?
   1. One of the biggest mistakes I see when women begin using Kegels to improve incontinence is poor exercise grading. 
   2. Many times, the pelvic floor is too weak to begin Kegels in the standing or seated position. In these positions not only does the pelvic floor have to support your pelvic organs, but it muscle contract against gravity. Performing these exercises while laying on your gravity eliminates the pull against gravity, and reduce pressure from the pelvic organs..
   3. This is an exercise that ideally is performed more than 1x/day (I usually recommend shooting for 3 times).
   4. Another consideration is that the pelvic floor has both strengthening and endurance type muscle fibers, so it is important to exercise these muscles in both ways.
      1. Not only should you be performing quick contractions, but you should be working to incorporate long holds for 10-20 seconds if your muscles can sustain a contraction for this duration. 
4. What else are you doing besides Kegels
   1. Incorporating exercises to strengthen the abdominals, hip adductors, glutes, and hip abductors can help improve pelvic floor functioning, so adding Kegels to your strengthening routine should help expedite your results. 

Staying consistent with your Kegel exercises should yield some results. It is helpful to track your incontinent episodes to make sure you are improving, as sometimes it feels like it isn’t getting better. Having hard numbers written down, may help you to realize your progress, and motivate you to continue your strengthening regimen.