If you or someone you care about is experiencing pelvic floor associated pain or incontinence, then it is likely that you have heard about pelvic floor exercises or ‘Kegels’. If you haven’t, pelvic floor strengthening exercises are designed to help improve the ability of your main pelvic floor muscles to contract and keep our passages shut to help reduce leaking throughout day-to-day life. These exercises are great because they can help to improve our confidence in social situations, can help to reduce pain levels and manage other symptoms. However, this also means that unfortunately, a lot of people living with incontinence are given a generic flier with pelvic floor exercises or might just be told by family to do some Kegels. Whilst this might be beneficial for some, all exercise no matter if It’s our pelvic floor, or legs or arms, needs to be prescribed on an individual basis to best help improve individual health concerns.
There are unfortunately many reasons why someone might have pelvic floor dysfunction or incontinence symptoms. This could be due to previous experiences during childbirth, side effects of pelvic cancers and treatments, chronic coughing or sneezing, menopause, constant heavy lifting, or those who feel constantly stressed. Although some of these risks are female dominant, pelvic floor issues can affect anyone regardless of their gender, age, or race.
For these reasons individualised exercise programs are important as generic pelvic strengthening advice will not help all people with pelvic floor dysfunction and in some cases, can make your symptoms a lot worse. Below I have outlined a few common reasons why people may not be experiencing relief from their symptoms even when doing pelvic floor specific exercises.
1. Over activating accessory muscles
As the pelvic floor muscles are inside and cannot be seen, people often have difficulty identifying the correct muscles to contract when doing pelvic floor exercises. Getting our technique correct is super important because if pelvic exercises are completed incorrectly, they have the potential to increase our pain and incontinence symptoms. There are a few signs that the exercises are not being done correctly and these include;
- Tensing the thighs
- Scrunching the shoulders
- Holding the breath
- Squeezing the buttocks
- Lifting the eyebrows
- Curling the toes
2. Hypertonic (overactive) pelvic floor
Some people with incontinence issues have OVERACTIVITY of the pelvic floor muscles. This means that the pelvic floor muscles receive too much input from the surrounding nerves and are unable to relax which can lead to symptoms of urgency and frequency.
If someone has an overactive pelvic floor, pelvic floor strengthening exercises can increase symptoms and lead to increased tightness of the surrounding muscles. In this case, the person should work with a professional to encourage relaxation of the pelvic floor muscles and surrounding hip musculature as a part of their treatment.
3. Posture, previous injuries, muscle aches and pain
Whilst no-one has perfect posture, the way our body is loading itself throughout movements such as standing, sitting, and bending can place different amounts of force on different structures within our body. This can also happen if we have a sore hip or foot or another previous injury which has the potential to directly affect the function of the muscles which make up the pelvic floor. For these reasons, it is important that we assess whole body movement from the head to the toes to help identify ways to improve our muscle function to further improve incontinence symptoms.
4. Not removing stressful triggers or breaking habits
Stress is a huge contributor to pelvic floor dysfunction. Therefore, it is important to see if there are any triggers (both physically and mentally) which lead to an increase in symptoms.
When someone has incontinence symptoms, they tend to also start developing habits to help improve or manage their symptoms. Whilst some of these habits can be helpful in the short term, they can lead to further issues later in life. Some habits such as going ‘just in case’ before heading out somewhere can interfere with the cues our brain sends to the bladder leading to increases in frequency and urgency. In a similar way, it is important to make sure that you continue to drink lots of water. Whilst a lot of people with incontinence may not want to drink water for fear or needing the toilet more, becoming dehydrated can damage our bladder and bowel function leading to more symptoms later. Addressing these habits, as well as any others you might have been important to help improve our overall pelvic floor health.
5. Toilet posture
Straining on the toilet can worsen pelvic floor symptoms later by increasing intra-abdominal pressure on the pelvic floor. I have placed a few tricks to help improve your toilet posture to improve your pelvic floor health below.
- Sit on the toilet properly and do not hover over it.
- Lean forward, keeping the back straight.
- A small footstool may be required to firmly position your feet, so your knees are higher than your hips.
- Gently push, keeping your stomach bulged forward.
- When finished, firmly pull up the muscles around your anus (back passage). This helps to fully relax the pelvic floor and anal sphincter muscles.
Time to get some help?
If you think you might need further help addressing your symptoms, not sure if you’re doing exercises properly or simply not sure where to start, then it is time to call in a professional.
Exercise Physiologists who specialise in pelvic health can help to check technique, progress exercises from sitting or lying down to standing and moving around for better relief throughout the day. They can also identify further areas which may contribute symptoms such as posture, issues with the muscles surrounding the hips and other medical health conditions which may affect or require adjustments to your rehab plan.
Author: Maddie Warner, Accredited Exercise Physiologist
