Can pelvic floor exercises make incontinence worse?
If you’re one of the millions of people who leak a little when you sneeze, cough, or jump, or find that a few drops of urine come out before you can make it to the bathroom, then you may have wondered what you need to do to solve the problem.
Urinary incontinence (or urine leakage) is something I treat every day in my clinic, so of course I’m going to recommend working with a qualified Pelvic Floor Physical Therapist if that’s something you struggle with. Ps: you may have also heard this called "stress incontinence", but for the purpose of this blog, we'll stick to urinary incontinence as a whole.
But in this blog, I’ll address a question I often get asked which is “Can pelvic floor exercises make incontinence worse?”
The surprising answer is that “yes, they can!” Keep reading and I’ll go over why that can be the case and what to do instead.
What is the pelvic floor and what are the pelvic muscles?
First, let me start with a quick overview of the pelvic floor so that we’re all on the same page.
Here’s a picture of the muscles of the pelvic floor.
Image Credit: Pelvic Global, LLC & Pelvic Guru, LLC
As you can see, the pelvis is shaped like a bowl and the pelvic floor muscles sit at the bottom of that bowl.
In this picture, the organs are removed so that you can more clearly see the muscles, but in reality, our bladder, uterus, and rectum sit within the bowl (in female bodies…in males, you’d simply swap the uterus for a prostate gland).
Because organs sit on top of the pelvic floor muscles, that means that the pelvic floor muscles have an important role in supporting those organs.
So if there’s a problem with the pelvic floor muscles, you can see where we might start to have problems that affect the nearby organs as well, such as bladder problems.
There can be many different reasons why the pelvic floor muscles might stop performing well, but the top 3 issues I tend to see in my clinic are that
the muscles are too weak
the muscles are too tense
or the muscles are not well coordinated.
And keep in mind that these categories are not exclusive to each other so patients can definitely fall into two or even all three of them.)
Why an assessment of your pelvic floor matters when considering exercise
In my practice, I assess the pelvic floor muscles thoroughly during an exam to determine what specifically is happening in an individual’s pelvic floor.
However, if you haven’t had a detailed assessment, it can sometimes be a bit harder to determine which category you fall into and why exactly you’ve having symptoms. And if you aren’t sure why you’re having pelvic floor symptoms, then doing exercises to try to fix your symptoms can sometimes be a shot in the dark.
What I mean is that you wouldn’t necessarily need to do strengthening exercises if you’re not particularly weak, nor would you need to do stretching exercises if you’re not particularly tense. And if you do the wrong exercise for you, you could be worsening your symptoms!
So in that case (the case in which you are randomly choosing a pelvic floor exercise without knowing the why behind your symptoms), then yes, pelvic floor exercises can make incontinence worse.
Let me give you an example that I see all the time in my clinic from patients who are experiencing incontinence and pelvic floor dysfunction:
A woman in her early forties comes to my clinic to tell me that she’s leaking during her group fitness classes. She assumes her pelvic floor must be weak.
She’s tried to do kegel exercises (pelvic floor contractions) often because she’s heard that they can help strengthen the pelvic floor, but her symptoms seem to be getting worse, not better.
She ends up in my office, desperate to get some help so that she doesn’t have to resign herself to wearing pantyliners for the rest of her life, when she’s still so young to begin with and she'd love to get rid of her incontinence symptoms for good.
I do a full-body exam and realize that her pelvic floor muscles are actually quite tense. And because of this, they aren’t coordinating well (it’s difficult for muscles to coordinate well when they’re too tight!).
Because the muscles are coordinating well, they therefore aren’t reacting appropriately to support her bladder when she runs or jumps.
So to fix her incontinence, we actually need to work on releasing tension in her pelvic floor rather than on simply strengthening it.
And doing kegels in this situation has actually increased her pelvic floor tension, which feeds right into the problem.
We work together on getting her pelvic floor muscles to relax, while also working on any other factors that may have contributed to her symptoms (such as lower body or core weakness, bathroom and hydration habits, and more) and after a few months, she’s able to crush her workouts without worrying about leakage!
This story plays out every day in my clinic, which is why I wanted to write this blog.
If you take nothing else away from this post, please remember that blindly doing pelvic floor exercises when you haven’t had a pelvic floor assessment is not a good idea and can indeed worsen incontinence (or any other pelvic symptom).
This is actually why I’ve seen many people who use tools such as an at-home pelvic floor training device, or even the pelvic floor chair seen in many med spa clinics, not have good results.
Just as you wouldn’t arbitrarily take a medication before having labwork to ensure that you do actually have an infection, you shouldn’t do random pelvic floor exercises without first gaining an understanding of why you’re having pelvic floor symptoms to begin with.
If you are looking for help and want to know exactly what will help you solve your incontinence and know how to exercise "correctly", rather than perpetuate the issue, know that the gold standard is a pelvic floor assessment by a qualified pelvic floor therapist.
If you have questions about pelvic health therapy or are ready to book your assessment, please reach out here or schedule a discovery call here.
Urinary leakage doesn’t have to be something you just live with and I’d love to help you get to the root cause of your symptoms!
