Pelvic floor exercises for incontinence

For years women who experienced urinary incontinence have been told that they have a weak pelvic floor, and that the answer to their leaking was to either wear pads every day or do kegels at every stop light. Although more and more women are learning about pelvic floor therapy, there are still far too many who don’t know that pelvic floor therapy can help reduce (and eliminate) leaking, and that there is a lot more to pelvic floor therapy than just kegels. In this blog post I’m going to discuss the different types of urinary incontinence, why it happens, why kegels aren’t the solution, and how pelvic floor therapy can help.

What are the different types of urinary incontinence?

There are a few different types of urinary incontinence, so lets begin by defining the most common types of urinary incontinence I see in my office.

1 - Stress urinary incontinence. Stress urinary incontinence is when leaking occurs due to increased stress or pressure. This can be due to things like coughing, sneezing, or breath holding, which increase pressure in the abdomen and down onto the pelvic floor muscles.

2 - Urge urinary incontinence. Urge urinary incontinence is when leaking occurs after a sudden and intense urge to urinate. This typically happens due to mixed signals between the brain and bladder that the bladder is full and you need to make it to a bathroom ASAP. Triggers can include things like walking past a bathroom, putting a key in your door when you get home, or pulling into your driveway.

3 - Mixed urinary incontinence. Mixed urinary incontinence is a combination of stress and urge incontinence.

Why does urinary incontinence happen?

Like most things in PT - it depends! Here are a few reasons why urinary incontinence may occur.

1) With urge urinary incontinence, it is typically a nervous system and habit problem. Lets say you get home every day and use the bathroom as soon as you walk in the door. Your body learns that when you put your key in the door, you’re about to go pee. Over time your brain learns to signal your bladder that it is time to go. In some cases, this urge can get intense. For some people, that intense urge can lead to leaking prior to making it to the bathroom.

This doesn’t mean your pelvic floor is functioning fine and it is only a brain problem. If there is muscle tension or disconnect, it can contribute to urgency as well.

2) With stress urinary incontinence, you may also have a weak or tense pelvic floor. Imagine your pelvic floor is a trampoline. If you cut a few of the springs off of your trampoline, it won’t be able to respond to the impact of you bouncing on it. If you pulled the springs tight and that trampoline was very taut, it would be like jumping on concrete and would not absorb the force of impact well.

Now imagine you cough, sneeze, or jump. Your pelvic floor muscles should absorb the force down to support your pelvic organs through that pressure. If the muscles are tense or disconnected (like our trampoline example above), your bladder won’t be well supported and you may leak.

3) Stress urinary incontinence may also be caused by weakness or poor force absorption through the hip or foot, or poor biomechanics at the rib cage. If your foot or hip are unable to absorb force well, your pelvic floor will take more force, which may lead to leaking if the impact is too much. If you have tension or poor mechanics in your rib cage, it will affect how your diaphragm and core work which will also impact your pelvic floor’s ability to function (I talk more about the relationship between your rib cage and pelvic floor in this blog post).

Why kegels don’t fix urinary incontinence

If you don’t know what a kegel is, it is a contraction of your pelvic floor muscles. Imagine you are peeing and you squeeze your muscles to stop the flow of urine. You can also imagine trying to stop gas and urine at the same time.

If your pelvic floor is weak and disconnected, learning to connect your brain back to your pelvic floor intentionally can be helpful to get them back online. However, it should not be the only exercise you’re doing and you need to progress quickly. You also should be coordinating your breathing, core muscles, and pelvic floor - not just contracting the pelvic floor alone.

Besides just contracting the muscles, it is important to look at the alignment of the pelvis and make sure the muscles are in a position where they can functionally support your pelvic organs. If your pelvis is rotated on one side all the time, squeezing the muscles over and over is not going to provide a long term solution.

Additionally, kegels really aren’t functional. Just like you don’t walk around telling your quad to squeeze with every step, you shouldn’t have to intentionally activate your pelvic floor when you are moving, jumping, or exercising. Your pelvic floor muscles should be responsive, so we need to train them in functional positions with functional movements rather than just doing isometric contractions.

If your pelvic floor muscles are tense, squeezing them over and over is of course not a good solution. So if you are leaking due to a tense pelvic floor, your muscles need to learn to lengthen and then move through their full range of motion. And if you are leaking due to your foot, hip, or rib cage, those areas need to be addressed for full resolution.

If you are leaking due to urgency, it is important that your nervous system and habits are addressed. There are a lot of little tricks that can help reduce urgency in the moment, and help you re-wire your brain to eliminate urgency.

How can pelvic floor therapy help with urinary urgency?

As you can see by now, there are a lot of different factors that can contribute to urinary leaking! A pelvic floor therapist can evaluate you to determine all of the root causes of leaking, provide you with lifestyle recommendations, as well as recommend the best movements and exercises to help you find long term relief.

I highly recommend finding a therapist to work with you and find the best solutions for you. However, here are a few of my favorite exercises that I often prescribe to patients who experience incontinence to get you started.

1) Back expansion breathing. If you hold tension in your mid back, low back, or glutes, this exercise will be helpful for you! Check it out here.

2) Breathing with TA bracing. Reconnecting your breath, core muscles, and pelvic floor is step one! Check it out here.

3) Quadruped hip rotation. Your deep hip rotators work closely with your pelvic floor muscles. If they are tense and guarded or weak, this exercise can help! Check it out here.

If you are in the Memphis area, I would love to help you find the root cause and long term solution so you can be dry and confident! I also work with patients virtually from anywhere. You can schedule with me here.

If you’re interested in learning more about stress urinary incontinence, check out my free PDF download “Yes, You Can Run, Jump, and Lift Without Peeing Your Pants” here.

Blog post written by Dr. Alexis Hutchison, PT, DPT, OCS