Why “Kegel’s” May Not Be Enough

Do you know where every bathroom is at every place that you go, and in between? Do you find yourself running to the bathroom when you hear or touch running water or put your key in the front door? Perhaps your bladder is ruling (or ruining) your life…

As a pelvic floor physical therapist, I often hear on the first day of meeting a new client that she has “been doing Kegel’s without them helping” her symptoms. There can be several reasons for the exercise to not be working. This can vary from improper performance of this exercise to other lifestyle and behavioral habits that continue to cause bladder control problems. Often, extremes in behaviors can cause urinary problems: not enough water vs too much, emptying your bladder too frequently vs not enough. Here you will find some different ways to help to regain control of your bladder – and your life.

First, let’s go over some important factors that can cause urinary leakage, aside from weakness of the “Kegel” or pelvic floor muscles:

  • Water Intake: Too much or not enough can cause issues.
    • Too much water means you’ll be weakening your bladder controlling muscles by overusing them. The bladder also becomes accustomed to frequent emptying and will not want to be stretched nor held for too long. The bladder is like a two year old, if its schedule is altered it can throw a tantrum.
    • Not enough water means the contents of your bladder become concentrated and begin to irritate the lining of your bladder. This causes the bladder to want to empty and thus makes it more difficult to avoid leakage.
    • There is much debate in the health and wellness community regarding how much water is appropriate. The urogynecologists with whom I work closely generally recommend 5-7 (8oz) glasses of water per day. This can vary by personal needs and activities. For some this is too much, while for lactating moms this may not be enough. 
  • High intake of bladder irritants.
    • The Top 3 Offenders: Artificial Sweeteners, Alcohol & Caffeine: The more of each of these items that we put into our bodies, the more irritated the bladder becomes and the more likely it is to leak.
  • “Just in case” urinating
    • Frequently emptying the bladder more often than every 2 hours during the day can cause urge incontinence as the bladder can become accustomed to emptying too frequently, thus not wanting to stretch or fill fully.
  • Waiting too long to urinate
    • Teachers and health care providers often hold their bladders too long. Frequently holding your bladder during the day for more than 4 hours overstretches the bladder and can make it more reactive and more likely to empty with little to no notice.
  • Bearing down to empty the bladder
    • This weakens the bladder control muscles by stretching them out while they are contracting, weakening them and also bulging the bladder downwards.
  • Back and Leg pain, loss of mobility or strength
    • These can affect the ability of the pelvic floor to function both directly and indirectly. The pelvis does not exist alone.
    • Overly tense muscles and trigger points can also affect bladder control. A visit with a pelvic floor physical therapist may be helpful.
  • Hormonal changes & childbirth can affect pelvic floor muscle function and support.
  • Hovering and not sitting
    • When we hover over the toilet, our bladders are not able to empty as well which increases the concentration of the urine in the bladder, thus increasing the irritation of the bladder lining, thus the likelihood of leakage.
  • Constipation
    • Pushing during bowel movements is a common side effect of constipation.
    • The extra weight of a full colon on the pelvic floor muscles places additional strain on them and can affect their ability to control the bladder.
  • Sleep Apnea
    • Untreated sleep apnea places pressure on the pelvic floor muscles, overstretches and weakens them. Many with sleep apnea have difficulty with waking frequently at night due to the extra pressure placed on the bladder
  • Stress can also affect bladder control as the bladder is set up to empty in fight or flight situations. 

Strategies to improve bladder control include: 

  • Performing quick 2 second pelvic floor muscle contractions 5-7 times at the onset of urgency. Preferably when sitting for maximal support.
  • Diaphragmatic breathing can also help to calm down the central nervous system and improve the brain’s bladder control mechanism. This technique is described here, where it can be utilized for pain control as well. 

Improper strengthening of the pelvic floor muscles can be another cause of loss of bladder control. Please see the post How to Perform Kegel’s for Men and Women for details on how to perform these bladder controlling exercises properly.

So now you can see how bladder control goes beyond performing Kegel’s.

Image google 

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