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.