In the past Kegels were the golden ticket to stopping incontinence.

The idea of squeezing the muscles that control the bladder opening was revolutionary. And for many still is.

Unfortunately, Kegels do not address every reason why you may be peeing your pants. That can be very frustrating, especially when it’s recommended by a trusted medical professional.

I want this article to help you understand why Kegels are usually not enough and what else needs to be taken into consideration to improve your bladder control.

What is incontinence?

Incontinence is when you leak any amount of pee involuntarily. There are several forms of incontinence and the two most common are:

• Stress incontinence - involuntary loss of pee when pressure is placed on the bladder

• Urge incontinence - involuntary loss of pee after an urge to urinate

Stress incontinence is very common after having a baby when you cough, sneeze, laugh, lift, run, jump, etc. But it can happen any time in your life, regardless of if you have children or not.

Urge incontinence can be triggered by several things, including bladder irritants, not drinking enough water, hearing or seeing something that you associate with going pee (running water, pulling into your driveway or unlocking your door), miscommunication between your bladder-brain-pelvic floor, and muscle trigger points.

These types of incontinence have many overlapping treatment methods, but usually in different time lines.

What are Kegels?

Kegels are a form of pelvic floor exercise that contracts just the muscles around the urethra (bladder opening) and vagina. The muscles that should stop the flow of pee when going to the bathroom. Most Kegels are taught using the verbage “squeeze like you are trying to stop pee as hard and for as long as you can.”

Why doesn’t this work?

This is a big question that I’m going to try to break down for you, because there are many scenarios as to why Kegels don’t work for everyone.

First, Kegels may not work because you are doing them wrong.

If you have never been checked by a Physical or Occupational Therapist trained in pelvic floor assessment and treatment your body may not be responding the way you want it to be. Having an internal pelvic floor exam helps determine if you are:

• contracting at all

• contracting the correct muscles (the pelvic floor versus your inner thighs or glutes)

• holding your breath while contracting

• bearing down or pushing out while contracting

Another very important aspect of this exam is determining if you are relaxing your pelvic floor between contractions. As I mentioned before the emphasis of Kegels is to contract “as hard and as long as possible.” This does not take into account the muscles need to relax and lengthen. It would be like shrugging your shoulders and never letting go. After a time your muscles will functionally shorten and won’t be able to contract any more, thus rendering them almost useless. This leads into the second reason why Kegels may not be working for you.

Second, your pelvic floor may be tight or restricted in some way, not “loose.”

When your muscles are not capable of shortening and lengthening they are not able to contract or relax without help. This happens when the muscles are:

• tense or tight from over use or poor posture

• scarring and tissue restrictions bind the muscles

• joint and bone alignment change the length of the muscle or alter the nerve communication to the muscles

Since Kegels are focused on contracting the pelvic floor muscles, these issue will need to be addressed first to get the most effective contraction. And in some cases your strength is masked by the change in tissue and when the restriction is eliminated the control of your bladder improves. This brings us to the next reason why Kegels may not work for you.

Third, you may be putting more pressure into the pelvic floor than it can handle.

Your pelvic floor is part of a whole pressure system that works with your respiratory diaphragm and abdominal muscles. These muscles balance each other out to manage your intraabdominal pressure by contracting or relaxing on demand.

This happens naturally with internal forces like breathing or sneezing, coughing, laughing. When you inhale your pelvic floor and abdomen lengthen. When you exhale your pelvic floor and abdomen shorten. When you cough/sneeze/laugh your pelvic floor and abdomen contract and pull in to rebound from the pressure being forced downward.

It also happens when you put external forces or pressures on your body, like when you pick up a heavy object or child. The extra weight is placed on your body and your pelvic floor and abdomen will contract more to support your pelvic organs.

Unfortunately, sometimes your pelvic floor isn’t strong enough alone to withstand certain pressures. And doing Kegels alone doesn’t train for the amount of force placed on your pelvic floor. This means you need to do exercises that are more functional, like squats, that incorporate your whole pelvic-core system. Coordinating your pelvic floor, abdomen and breathing ensure your are trying to do a Kegel while bearing down into the pelvis while holding your breath or squeezing your abdomen.

Bearing down into your pelvic floor while holding your breath leads us to the next reason why kegels may not be working.

Fourth, your toileting habits may be reversing all your efforts.

Going to the bathroom is one of the roles of the pelvic floor. While you pee or poop your pelvic floor relaxes and opens. However, your habits can alter this role, thus your exercises may not improve your bladder control until these are addressed.

Here are some bad habits to avoid:

• Rushing to the bathroom every time you feel an urge, especially if it has been less than 2 hours since the last time you’ve gone

• Going to the bathroom just in case, frequently. This trains your bladder to not fill fully before signaling the need to go increasing your frequency and reducing your bladder capacity.

• Rushing and pushing to pee.

• Holding your breath and bearing down to poop

• Constipation. Hard and dry poop is hard to pass increasing the need to bear down.

Take your time, take some breathes and relax. Making sure you drink enough water and eat plenty of fiber through out the day to have soft and formed poop. Then using proper pooping mechanics to relax the pelvic floor helps you avoid these issues. Creating good habits help maintain the proper functioning of the pelvic floor, which brings us to the last reason Kegels may not be working for you.

Fifth, your pelvic floor may not know how to translate Kegels into the moment of need.

Your pelvic floor has an involuntary component that works on demand. So you don’t need to think about using the pelvic floor all the time. How does this translate to bladder control and Kegels? On demand control of the pelvic floor means it contracts and relaxes depending on the need. For example:

• when your bladder signals the need to pee, the pelvic floor will contract slightly [with out you feeling it] until you are ready to pee, then it relaxes when the bladder contracts or

• when you cough or sneeze putting pressure into your pelvic floor, again the muscles contract without you needing to tell it to, preventing pee, gas or poo from coming out.

Unfortunately, sometimes this action is lost because of poor toileting habits, altered breathing patterns, pregnancy, birth or other injury. Even though Kegels train the muscles to contract, they don’t translate to the on demand function. Specific exercises are needed to retrain your pelvic floor to reestablish on demand contraction or relaxation.

What can you do?

A great place to begin is to start a bladder diary. This takes a 24 hour snap shot of your bladder habits including:

1. what and how much your drink [really any fluids like soup too]

2. every time you go to the bathroom to pee or poop and how much

   • count the seconds of the flow

   • note it if the flow is slow, fast or regular

   • note what your urge felt like prior to going from nothing (just in case) to very strong

   • what was your poop like -hard, soft, liquid

3. any time you leak pee

   • how much

   • what were you doing

Writing down your habits for 3 to 5 days helps you determine what to do next, like seeing a PT or OT who specializes in pelvic floor dysfunction. We can help you:

• coordinate your pelvic-core and breathing

• address tension, scarring or other restrictions

• fine tune your Kegels and exercises to your functional needs

• retrain your pelvic floor to match your on-demand needs

• learn proper bladder and bowel habits including fluid & fiber intake and

• address any other physical limitation that may be inhibiting your bladder control

To learn more about your own pelvic floor download my free self assessment for the 3 steps of deeper understanding.