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Stress incontinence: Kegels are probably making you WORSE.
Stress incontinence is leaking with a cough, sneeze, laugh, bend or running. One of the most common times we see patients with this is in the postpartum period. Often, leaking appears during pregnancy and remains through the postpartum period or begins after birth. Risk factors for stress incontinence are leaking in pregnancy, having more than 1 baby, having a baby 37+ weeks gestation and constipation. So, if you are pregnant and leaking, it is a great idea to book an appointment with me during your pregnancy to “rehab” your pelvic floor prior to having your baby. Another tip-off that you should see us when you are pregnant is leaking after your 1st (or 2nd) baby, as multiparity (more than 1 pregnancy) is another risk factor.
You might be thinking a cesarean will prevent stress incontinence… but studies show that rates of incontinence are similar for vaginal deliveries and for cesarean for obstructed labor. Cesareans performed without labor do have lower rates of stress incontinence (Groutz).
Even in those who have never been pregnant, incontinence ranges from 5.56% in low-impact exercise to 80% in trampolining athletes. The amount of training influences leaking symptoms (Leitner). Women who are active and leak may not be leaking if they were sedentary, and we know that exercise, running and jumping also strengthens the pelvic floor. We suggest my patients exercise just shy of the point of leaking and slowly build over time.
With stress incontinence, the problem is that the core canister is not working properly. Think about the core as a can of coke. When the cap is on, that can is super strong. When the cap is open, the can is not strong and is very easy to smash. When you leak, your can of coke has the cap open! Almost always people think that it is because their pelvic floor is weak. That CAN be true. But, did you know that a study found that runners who leak had similar pelvic floor strength to runners who did not leak. The difference was actually their HIP strength.
The core canister involves:
- the mid back
- ribs and rib angle
- diaphragm
- pelvic floor
- hips and glutes
- front core strength
- back core strength
... and alignment and breath connecting the whole core canister.
A huge reason we see contributing to leaking is the pelvic floor is tight and weak? So next time you hear to "just do your kegels," know that this CAN make your problem worse. It is optimal to get examined by a pelvic floor physical therapist (like us!) who can look at your body holistically and look at the whole body to get to the root cause of your core canister issues. A great pelvic floor physical therapist will assess whole body movement as well as assess your pelvic floor with an internal muscle assessment.
Come see is in person in Richmond's Fan District or West End OR join our virtual programs for whole body solutions to your pelvic floor problems