Why Kegels Might Not Eliminate Urinary Incontinence

As a Pelvic Health PT, I’ve been at odds with the over-prescription of Kegels as a silver bullet ‘cure’ for all things wrong in the pelvis, specifically urinary incontinence (UI). This could be a much longer blog post, but I stuck to the top 3 reasons why I think Kegels are generally ineffective.

  1. Urinary incontinence may come from weak pelvic muscles, but not all weak muscles need strengthened.

Weakness in the pelvic muscles can be complicated. But simply put, all muscle fibers in our body need to overlap the perfect amount to generate an optimal force. So, if a muscle is too long (over lengthened) then it will be weak. Now, if the muscle fibers overlap too much (ie the muscle is tight) this will also be weak. Tight does not equal strong, tight= tight=weak! Now hopefully you see why more Kegels (ie tightening) will be ineffective! It is common to assume that when something is not working well, it needs more tone, however with the pelvic floor, that is simply not the case. 

We need to begin thinking less in terms of muscle tone and more in terms of function. Ideally, in pregnancy and beyond we train our pelvic floor and core to work optimally, to support us when needed, to not work so hard when not needed. The prenatal programs (like One Strong Mama) that emphasize ideal core and pelvic floor function as opposed to “kegel” 40 times a day are the ones I recommend.

And, if you’re a professional in the prenatal realm, the Body Ready Method gives you access to easy techniques used to assess a client’s pelvic floor and gives you the safest exercises clients can do on their own to strengthen their core with something other than kegels.

2. Kegels don’t replicate function.

Pelvic muscles never work in isolation, so why train them that way? We are taught to do them in the car while at a stop light, possibly in less than optimal alignment. One thousand bicep curls doesn’t help you with running a half marathon. So an isolated contraction isn’t actually what is required when you bend to lift your toddler or when you perform jumping jacks at the gym. I know many women who can kegel all day long, but still leak pee and have urinary incontinence. 

It again goes back to attempting to rid ourselves of the old paradigm: more muscle tone = better. It does not. That is not to say that there is not a time and place for a kegel. There is. But most people are doing them successively during the day under the assumption that it will and does increase pelvic floor function and reduce urinary incontinence. It does not.

3. Many factors contribute to IU.

It’s just a sign that something is off somewhere in our pressure system known as the core system. Excess pressure in our core and pelvic floor is one of the primary reasons behind UI and pelvic floor disorders and reducing that pressure must be the keystone of the treatment plan. There are multiple things that lead to excess pressure in our core such as standing and sitting posture (alignment matters!). How about if someone has diastasis recti or a prolapse? How about someone who constantly grips their tummy muscles or who truly has a weak transversus abdominus? This list goes on and the bottom line is that we cannot spot treat our pelvic floor and just do kegels hoping that they will resolve it all. We need to look at the bigger picture and often when we do, the urinary incontinence begins to be resolved. Even if not one kegel was ever done. 

Body Ready Method is an online training for prenatal professionals offering a tool kit that aims to broaden the scope of professionals who wish to work proactively with pregnant people. Using the tools, techniques, exercises and assessments in BRM you can help assess all the factors that contribute to UI specific to each body and treat each unique case with effective training.

All women’s bodies are unique. If you would like to talk about how the above relates to your specific condition, feel free to contact me on FB. If you’d like to read more, you can visit our blog here.

Author Bio: Jessica Dufault is a Pelvic Floor Physical Therapist in Madison, WI at Mindful Motion Physical Therapy.     

Stretching During Pregnancy

Stretching is by far one of the most common recommendations during pregnancy for both pain relief and general maintenance. All you need to do is search “pregnancy stretches” and you’ll get a lot of hits, videos, blogs and more! 

The popular line of thinking is: stretching makes us more flexible and more flexibility is ideal. If we stretch a lot and become more flexible, we will feel better and we will prevent injury. Additionally, flexibility is often touted as something that can create / foster space for baby to come down and out. While it can feel good to stretch, having more flexibility is not in fact “better”, does not create “more space” and it certainly will not prevent injury or pain during pregnancy.  

Let’s dive deeper into flexibility. In addition to the reasons above, another reason that pregnant people work on flexibility is because they think that it will help create more space for baby to come out. 

What is flexibility?

Flexibility is passive mobility. Basically, how far you can passively stretch a tissue. Like with dropping into a split pose, a pigeon position, any position where you “hang out” into a stretch.

With flexibility, no control is needed. It is simply how far / deep you can get into a particular stretch or pose. Flexibility does not teach the body to utilize the range of motion, it just uses what is already there or uses gravity or even an external force to get us into the shape. Therefore, it’s not usable to the nervous / muscular system as a means of getting stronger or making long term changes.

Take the extreme example of a split. I can drop down into one, but do I have strength at that end range? Can I control my body there? No. I can just drop down into one. So that range is pretty useless in terms of offering me strength. Yes, great for Instagram. Not great for much more. 

Stretching while pregnant

During pregnancy, a lot of people have an increased amount of passive mobility/flexibility due to relaxing and that relaxing is absolutely fanning the flame. When we increase our passive range of motion, but not our active range of motion – we can actually predispose injury and we won’t increase movement potential in a way that translates into birth or life, at all. 

I am not flexible, what should I do?

Instead of flexibility as the goal, consider mobility and increased range strength training. Mobility training is the ability to actively control ranges of motion. Increased range strength training is when we strengthen our muscles in multiple range of motion. The combination of mobility and increased strength training actually leads to increased ranges and people often feel both stronger and more mobile. 

For the prenatal client who perhaps already has a large passive range of motion (ROM), the goal may not be to increase ROM, but to increase the ability to control the range of motion that they already have. I am not saying, do not stretch. I am simply educating on the myths around flexibility and stretching. Many of us are taught that stretching makes us more flexible but in fact – mobility training plus increased range of motion strength training is what works best! 

Our “stretching” routine should be done in a way that creates stability and greater ranges of motion.  Otherwise not only is it useless, it can actually cause injury. This is especially the case when you take a pregnant person, already more flexible, and add in a bunch of stretching. 

If your pregnant client has pain, please don’t tell them to stretch it away. Most likely, they need to learn how to control their ranges of motion properly! Want to know more? Reach out to us, follow us on Facebook and Instagram, and check out our Body Ready Method course, where we teach birth and fitness pros how to work with the prenatal population. 

Baby Is In Breech Position, Now What?

Don’t panic if baby is breech.

The baby may not stay in breech position. It is common that a baby will be breech between 27 weeks and 34 weeks of pregnancy. Most of those little nuggets will find their own way head down. Some breech babies may need a little assist to find their way head down. Often, there are many choices and opportunities to help breech babies find their way head down, and plenty of time to do it.

Know your options if baby is breech.

  • Your client can choose to do nothing.  Many families choose to wait and see if baby turns back to head down on their own.  It is okay to take this route. However, if baby does not turn head down by 36 weeks an external cephalic version (ECV) should be suggested.  This is a relatively safe procedure where an OB/GYN or Midwife will use their hands to try and turn baby head down. ECV can be very comfortable to downright painful for your pregnant client.  There is a 50% chance it will be successful. If you are or know of a well experienced ECV doctor your client can see, the chance can increase up to 70%. Whatever the case may be with your client, make sure they are asking ECV doctors for their success rate.
  • Your client may also choose to do nothing, and opt for a cesarean section. This is the most common choice of families who find out their baby is breech.

There are many complementary therapies that have been shown to be helpful in creating room in the body for baby to find their own way head down before your client chooses a cesarean section.

  • Acupuncture has a long history of assisting baby’s to find their best position.  Several studies have shown that the combination of needling and moxibustion (the burning of mugwort herb) are effective methods of helping baby find their way into best position.
  • Hypnosis is another therapy many find helpful in encouraging baby to find their way head down. Studies show that this is particularly helpful right before attempting an ECV on breech baby.
  • Chiropractic care for helping breech babies is another accessible option in most areas. The chiropractor should be prenatally certified, and if they are doing the Webster technique, they should have the Webster certification. This ensures patients are working with a doctor who is experienced and skilled in working with pregnant people.
  • Use the Body Ready Method to assess and identify what areas of the pregnant person’s body are restricted and prescribe appropriate exercise based on those findings. Finding balance and space in the tissues can help baby go head down.
  • Soft tissue therapies can be helpful to reduce stress and help soft tissues (muscles, tendons, ligaments, fascia) become more responsive and functional.  These therapies can include, but are not limited to, massage therapy, myofascial release, Rolfing, Feldenkrais, Traeger, and many more.  These therapies can potentially create more space in the belly for baby to find their own way head down.
  • Dynamic Body Balancing™ taught by Dr. Carol Phillips is another method of bodywork that has been quite successful in helping babies find their way head down.  Carol has a listing of practitioners on her website.
  • Spinning Babies™ has a series of exercises that have been helpful for many families to help get their baby into best position.  Starting these exercises early, and doing them often garners the best outcomes according to data collected by Spinning Babies practitioners.  Here is a link to the Spinning Babies website.

Use your BRAINN:

Whenever presenting a method of helping to turn a breech baby, run through the BRAINN acronym with your client. It is a good method to be sure they choose what is correct for them and their family. What does BRAINN mean?

  • B – benefit – What are the benefits? This is an easy one.
  • R – risk – What are the risks?  Every method will have risks. There is always risk when you choose to do an intervention.  Some risks are minimal, and some are a bit scarier.  
  • A – alternative – What is the alternative?  There is always an alternative if the risk outweighs the benefit for your client. Make sure you are ready to offer one.
  • I – intuition – Make sure your client is listening to their intuition. They should do what feels right to them.
  • N – next – What happens next?  Typically with any intervention, there is a next step.  Sometimes it is homework, sometimes it is rest, sometimes it is medication.  Make sure your client knows what the procedure is for the practitioners they have chosen to work with.
  • N – nothing – What happens if we do nothing?  Often, clients have this choice.

Let your client know it is okay to only do as much as feels right.

It is easy for your pregnant clients to feel overwhelmed. Keep in mind they are going to work, going to appointments, caring for their family, and doing breech homework, it may feel ridiculously exhausting. Make sure they are only doing what feels right for them and their baby. Let them know it is more than okay to try a therapy and decide it is not for them. Everything is not for everyone. Appointments and homework need to fit into their lifestyle. It should not feel like a chore, but a choice.

Author Bio: Adrienne C. Caldwell is a bodyworker and educator. She specializes in helping create space in the human body for baby to find their best position for labor and birth.