3 Strategies to Strengthen Your Pelvic Floor
After an afternoon of pumpkin picking at a farm in their hometown of Raleigh, North Carolina, Kerrie’s kids, ages 4 and 6, had one activity in mind: riding a giant tunnel slide with their mom. “I sat on my piece of burlap and enjoyed the trip down,” Kerrie recalls. But the sudden stop at the end was too much for her to handle. With urine soaking the front of her pants, Kerrie dashed to the restroom, where she stood under the hand dryer, then resorted to the old wrap-your-coat-around your-waist-trick. “The wet spot was still noticeable to me, but I hope not to anyone else,” she says.
Kerrie’s story is far from rare. About half of women in the U.S. experience incontinence, and both pregnancy and childbirth can bring it on and worsen it. Hormonal fluctuations during pregnancy and breastfeeding weaken the pelvic-floor muscles (the ones that support and control the bladder), and giving birth can stretch or tear them. At two months postpartum, 30 to 40 percent of women who delivered vaginally also leak, says Kimberly Ferrante, M.D., assistant professor of obstetrics and gynecology and urology at NYU Langone Health, in New York City.
The problem will usually resolve within six months, but for some moms it persists when they laugh, cough, jump, or sneeze. Sex can spur leaks, and frequent “just in case” trips to the bathroom can also train the body to release urine at the slightest provocation. But with know-how and diligence, incontinence is preventable and treatable. The following strategies can help you get back to dry.
Consult a Professional
Pretty much any mom who’s pushed out a baby could benefit from an assessment by a pelvic-floor therapist, who can determine whether your Kegels are effective, chart your progress, and tailor a workout routine to your particular problems, says Stein. This kind of care is standard in France and other European nations, but here in the U.S., it’s typically only recommended to women who complain of pelvic pain, incontinence, or sexual dysfunction to their doctor. (Your gynecologist may also notice pelvic-floor weakness during an internal exam, says Benjamin Brucker, M.D., assistant professor of urology and ob-gyn at NYU Langone Health.) Getting the services covered by your insurance usually requires a prescription, just like any other form of PT. To find a physical therapist in your area, check the website of the American Physical Therapy Association.
Too nervous to get started? Don’t be! Here’s what to expect at your first appointment:
- You’ll forget what TMI means. The PT will want to know all about your incontinence: When, where, how much, how long it’s been going on. Any awkwardness you feel will quickly fade as you realize that this person has heard and seen it all before, and just wants to help.
- There’ll be an exam. In a private treatment room, your therapist will ask you to strip below the belt and relax on an exam table with a sheet draped over your lap. Patients are often surprised to find that the pelvic-floor assessment is a lot like an internal exam, minus the stirrups and speculum. “We’re assessing muscle function, which includes strength, coordination, amount and quality of movement, and pliability,” says Amy H. Pannullo, a pelvic-health therapist at Duke Health in Raleigh, North Carolina. “We also look at things like core strength, pelvic alignment, posture, and much more.”
- You’ll get graded on your pelvic-floor strength. To do this, your PT will ask you to perform a Kegel while she has one finger inside your vaginal canal and another on your lower abdomen. This test also helps her assist you in correcting your Kegel form and guides her in choosing the exercises you’ll do at home. (If you struggle to isolate the right muscles, she may use electrodes and a biofeedback machine or a real-time ultrasound to help you.) In some women who have incontinence, the problem isn’t related to muscle weakness and Kegels could potentially worsen the condition. “That’s why seeing a physical therapist is so important,” says Pannullo.
- She’ll assign homework. Your PT will craft an exercise program that includes pelvic-floor and core exercises as well as stretches. Before you leave, you’ll book follow-up appointments to monitor your progress.
Master Your Kegel Moves
There’s a good chance you first learned how to do Kegels at a slumber party while huddled over directions from Cosmo or Glamour, so it makes sense that you may need a refresher on proper form. “Most women squeeze their glutes, inner thigh muscles, or abs, which doesn’t help,” says Amy Stein, a pelvic-floor physical therapist and founder of Beyond Basics Physical Therapy, in New York City. To perform Kegels correctly, first locate the right muscles. While on the toilet, stop the flow of urine. Note how this feels; these are the muscles to clench and unclench during Kegels. (Once you’ve got it, there’s no need to do this test again, says Stein. Repeatedly stopping while urinating can send a confusing signal to the brain that may eventually make you unable to fully empty your bladder.) When you’re ready to do a Kegel, locate the muscles, clench them, hold the contraction for three to ten seconds, then fully relax for the same amount of time. The exercise is easiest to do correctly when you’re lying down on a flat surface (like a yoga mat), so try to do it this way most of the time in the beginning. Aim for ten repetitions three times a day.
Once you’ve mastered a basic Kegel—meaning you can do it throughout the day without thinking too hard—try these advanced moves:
- Timed tightening. Strategically doing Kegels just before a trigger activity (like coughing) can train your muscles to activate on their own and prevent accidents, says Stein.
- Standing squeezes. Practicing Kegels in an upright position (as opposed to lying down) challenges your muscles to work against gravity. Stand with your feet hip-width apart. Do five slow Kegels as you breathe deeply; hold each for ten seconds, then rest for ten seconds. Then do five fast Kegels: Hold for two seconds, rest for two seconds. Work up to ten reps of both types of standing Kegels.
- Active Kegels. Tighten your abs and do a Kegel as you march in place for ten seconds. Rest for five seconds. Do this ten times, lifting knees higher and marching faster, and keeping abs and pelvic-floor muscles tight. You can also try Kegels while doing small jumps or any kind of exercise, from pilates to yoga to CrossFit. Just be sure to relax between each set.
- RELATED: Strengthen Your Pelvic Floor Workout
Discreet Little Helpers
It can take up to six months for a woman with straightforward incontinence to notice significant improvements through Kegels and pelvic-floor therapy. (About 50 percent of women are satisfied after three months.) These products will help you stay dry in the meantime.
- Pads and liners. The ones designed for incontinence (like those made by Poise) are longer than maxi pads and better at masking odor.
- Absorbant underwear. Icon undies (from the same company that makes THINX period panties) are more Calvin Klein than Depends. The lining of these sleek underpants can hold up to 6 to 10 teaspoons of liquid. They’re also heat-sealed along the legs to control seeping and engineered to neutralize odor and combat bacteria. $24 to $36 per pair.
- Pessary. Your gynecologist can fit you for this ring-shaped device (usually made from plastic or silicone) that you manually insert under your urethra to provide extra support all day. Poise makes an over-the-counter disposable version—called Impressa—that may help too. “It’s relatively new and there isn’t much data on it yet,” says Dr. Ferrante. “I tell patients there’s no harm in trying them to see if they work for you.”
The Surgical Option
having kids and still regularly leak through pads after trying Kegel exercises or physical therapy, you may want to ask your doctor whether or not he would recommend midurethral sling surgery. In this 20-minute outpatient procedure, a urologist or a urogynecologist inserts a thin polypropylene sling under the urethra, creating a permanent supportive backstop that helps stop the unwanted flow of urine—putting an end to leaks. Patients tend to be very satisfied with the results, with reported success rates ranging from 86 to 99 percent.
The midurethral sling is considered safe by the FDA and has been backed by more than 2,000 scientific articles. But like any surgery, this one comes with a long list of possible risks, including organ perforation. Before you decide to go under the knife, be sure to discuss with your doctor any potential downsides that could particularly affect your health.