Do you leak when you laugh, cough, sneeze, lift or exercise?

If your answer was yes, you are not alone.

Over 5 million Australians experience problems with controlling their bladder and bowel. Urinary incontinence affects up to 13% of men and 37% of women. (Australian Institute of Health and Welfare, 2006).

Now the great news is that there is more talk about incontinence as the topic is becoming less taboo. Incontinence is less seen as merely just a part of being a woman, a mother or aging. It is a step forward that many people know that it is important to do your kegels. So what are kegels? Kegels are pelvic floor muscle strengthening exercises done to treat urinary incontinence and improve sexual function.

Yes, there is research which confirms that pelvic floor muscle training is beneficial for improving urinary incontinence if done CORRECTLY. Like any other type of muscle training, the technique and the approach is vital to ensure the best results. Would you expect to strengthen your bicep if you were to do 1- 5 light bicep curls randomly every few weeks, a few quick, a few slow, whilst your attention is on something else? The answer is no, like anything done well in life there must be an intention and simply doing your kegels here and there will not benefit you.

Here are 3 keys to kegels:

1. KNOWLEDGE of your body
2. AWARENESS of your pelvic floor muscles
3. SPECIFICITY of your kegel program

KNOWLEDGE of your body

Though the pelvic floor is out of sight, it should not be out of mind. To achieve mind muscle connection, we firstly must have knowledge of our own body to understand the pelvic floor and the function. Picture the pelvic floor as a trampoline which consists of muscles and connective tissue which form the base of the pelvis. There are different muscles of the pelvic floor which attach from the front of the pelvis (pubic bone) to the back (coccyx). The muscles also attach to the sides of the pelvis to each sit bone (ischial spine). There are 3 holes in the pelvic floor of a woman which allow passage from front to back of the urthera which connects to the bladder, the vagina with connects to the uterus and the rectum which connects to the bowel. 

Top view of the female pelvic diaphragm and deep pelvic floor muscles

The functions of the pelvic floor:

1. Constricts urethra & anal canal to control bladder and bowel movement
2. Constricts vagina to increase the sexual sensation of the vagina (pain during sex, may be a sign of hypertonic pelvic floor muscles. In this case, kegels may not be appropriate. Instead, Pelvic floor relaxation techniques will be beneficial and seeking professional advice is recommended)
3. Supports the internal organs: bladder, uterus, bowel
4. Part of the deep stabilising system for the trunk along with the deep abdominal muscles, deep back muscles and the diaphragm

Side view of the female pelvic floor and surrounding anatomy

AWARENESS of your pelvic floor muscles

Now that you have a brief understanding of the pelvic floor anatomy and function, the next important step is to be able to engage and relax your pelvic floor muscles.

Remember:

• Pelvic floor contraction causes a lift and tightening of the pelvic floor muscles
• Pelvic floor relaxation causes lowering and lengthening

There are many different cues, imagery and methods when doing a kegel so remember that everyone is different and it is important to find what works best for you. Here are just some examples:

1. Cue: The feeling of stopping urine mid-stream and stop from passing wind. (not advised to actually stop your flow whilst peeing as it disrupts your patterning of urinating)
2. Imagery: Imagine drawing up a pea via your vagina towards your pubic bone then gently dropping it back down into a bucket of water and seeing the ripples from around the centre as you relax and lengthen your pelvic floor down towards your sit bones
3. Method: 90/90 breathing, lying on the back with legs up at against the wall at 90degrees whilst engaging with your pelvic floor (see video)

SPECIFICITY of your kegel program

The pelvic floor muscles are like any other muscle in the body. To build tone and strength you need the correct amount of load and it needs to be specific to the functional activities that you require. Strengthening can take up to 3-5months of consistently progressed exercise.

Do you find it difficult to endure long travelling or find yourself struggling to hold on till you find a toilet?

• Train your pelvic floor endurance (long holds) Target 10seconds but start with what you can comfortably hold, only increase by 1 sec as able. Aim for 8-12 repetitions of 3 sets, minimum x3/week.

Do you leak with sudden increases of intra-abdominal pressure e.g. coughing, sneezing, lifting?

• Train your pelvic floor strength and power. Contractions must be at 80-100% effort. Aim for 5-10 repetitions of 3 sets, minimum x3/week.

Knowledge, awareness and specificity are the keys to kegels. You aren’t alone and there is help out there. Remember, these are just general guidelines to inform and educate and does not replace professional advice. Every woman's body is different and not everyone will benefit from pelvic floor exercises as there are many other factors which can cause incontinence. To ensure pelvic floor training is appropriate for you to consult a qualified pelvic floor physiotherapist.

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