Pelvic Health Physiotherapy: more than just “kegels”

Pelvic Health Physiotherapy: more than just “kegels”

Pelvic Health Physiotherapy: more than just “kegels”

Karlyn Driedger, MScPT, BScKin

Individuals who are experiencing urinary incontinence often hear that they should perform kegel exercises. They also often hear that incontinence is a normal part of pregnancy or aging. Although urinary incontinence is common, it is not normal, and conservative treatment is available. In addition, kegel exercises are not an appropriate exercise for everyone, are often performed incorrectly and should be recommended on an individual basis.


Urinary Incontinence:

The involuntary loss of urine, often with coughing, sneezing, laughing, running or jumping. Common, but not normal.

Kegel Exercises:

Voluntary contraction of the pelvic floor muscles with the goal of increasing pelvic floor muscle strength and reducing incontinence.


What’s the role of the pelvic floor?

The pelvic floor is a group of muscles that sits within the pelvis (in men and women!). One function of these muscles is to wrap around the opening of the urethra, contracting in response to increases in pressure (during a cough or sneeze, for example), in order to prevent urine from leaking. If urine is leaking, it can indicate insufficient pelvic floor muscle strength/endurance, or incorrect timing/coordination of the pelvic floor muscles. The resting tension of the pelvic floor muscles, whether tight or loose can also contribute to urinary incontinence. Individuals with urinary incontinence do not all have weak, loose pelvic floor muscles!


Think of it this way…
Two people walk into a gym looking for training advice. One woman has been running for years and wants to train for her first triathlon. The other just bought her first pair of running shoes and would like to be able to run 5km. These two women would not receive the same advice. Their baseline strength and endurance would be different, their running experience would be different, and their goals would be different.


Pelvic floor muscles need to be treated like muscles anywhere else in the body. Urinary incontinence is different for different people. Some individuals may go through multiple pads or liners in a day, whereas others may only need to wear a liner when exercising. Others may notice urine leakage varies depending on the time of day, what position they are in, or how full their bladder is.


Similarly, these individuals should not receive the same advice on how to strengthen their pelvic floor muscles. Their baseline strength and endurance would be different, their awareness of their pelvic floor muscles would be different, and their goals would be different.


Bottom Line: If you are experiencing urinary incontinence, the best approach is an individualized treatment plan by a registered physiotherapist who specializes in assessment of the pelvic floor and treatment of urinary incontinence.


Clinical research has established, with the highest level of evidence, that pelvic physiotherapy should be the first line of treatment (before surgical consultation) for urinary incontinence (Cochrane Collaboration, 2010). Many complaints of urinary incontinence can be significantly improved within 8-12 weeks of physiotherapy treatment.


Re-Build Yourself.

Karlyn is a Registered Physiotherapist at Foundation Physiotherapy with a special interest in pelvic health physiotherapy. She has completed numerous post-graduate courses in pelvic health physiotherapy. You can learn more about pelvic health here.