Do More Than Kegels for Pelvic Floor Health

Kegel exercises have long been touted as the superhero of pelvic floor workouts, but there's much more to an optimally functioning pelvic floor than just one movement or working one group of muscles. The core muscles—your abdominals, lower back muscles and glutes—are also a crucial part of maintaining a strong and healthy pelvic floor.

No, Kegels aren't enough, and the idea behind constantly tightening and squeezing the muscles is flawed. Often women have overactive and too-tight pelvic floor muscles, and the real antidote may be to learn how to relax them.

Why we leak

To understand the anatomy and flawed thinking behind a blanket prescription of pelvic-floor-tightening exercises, Jennafer Vande Vegte, a certified pelvic rehab provider, uses the following analogy.

"Think about your bladder like a filled balloon inside of your lower abdomen, stem and opening pointing down," Vande Vegte explained. "For this analogy, the balloon is your bladder, and the stem and opening of the balloon are your urethrae. Some women can't generate enough muscle force around the balloon's stem to keep the opening closed. Other women might be putting way too much force on the balloon itself by breath-holding, using poor technique or clenching their abdominals."

If the "balloon" was recently filled with caffeine, alcohol or other irritants, it will likely want to empty itself while you're exercising, sneezing, jumping or doing other physical activities. Lifestyle factors and medical history can also influence how the pelvic floor functions.

"Sometimes, the support structures around the balloon and the stem have been stretched or damaged through childbirth, surgery, aging, hormone changes and chronic strain, such as with heavy lifting or constipation," Vande Vegte added. "This situation makes it harder for the muscles to do their job of support and closure, and leakage can occur."

Why we need to shift the focus

Kegels are meant to help tighten and strengthen the muscles that prevent urine leakage. However, women aren't always experiencing leakage due to weak pelvic floor muscles.

"Typically, women think they leak urine because they have a weak pelvic floor," explained Kirsten Kupras, a physical therapist specializing in pelvic health. "This could very well be the case. If the pelvic floor muscles are not strong enough to stabilize against increased load from exercise, this could result in leakage. However, more commonly, it is because the pelvic floor muscles are too tight. Specifically, they are hypertonic and have a higher resting tone than they should."

Kupras continued, "You can think of the pelvic floor as the foundation—it stabilizes from deeper and internally. However, the glutes, transverse abdominis and deep hip stabilizers also influence the strength of the pelvis. All of these muscles must work in synchroneity to create a balanced, stable foundation."

The deep abdominal muscles and pelvic floor have to work together, explained Vande Vegte: "Like they are on the same light switch, increasing function of the deep abdominal muscles feeds into healthy pelvic floor function, and vice versa."

If your deep core muscles (transverse abdominis), which help stabilize the pelvis and lumbar spine, are slow to engage or too weak, it can cause an overactive pelvic floor to compensate, which leads to too tight muscles (hypertonicity).

"We now know that hypertonic pelvic floor muscles can lead to leakage," Krupas said.

Your glutes are an essential part of your pelvic floor health as well. They provide stability for the pelvis, allowing the pelvic floor muscles to support the organs, including your bladder.

"If you have adequate glute strength, the pelvic floor muscles are allowed to do their job of supporting your organs, stabilizing your sacrum and pelvis, and stabilizing the head of the femurs in the hip joints," Krupas explained.

Strengthening and stabilizing the core and glute muscles will support the entire pelvic floor, encouraging balance in the musculature and helping to end urine leakage.

What to do for a healthy pelvic floor

Learning to relax or tighten your pelvic floor muscles properly takes time, as does building strength and stability in your core. Here are some exercises and activities that can help.

Relax your pelvic floor

Knowing how to release and relax the pelvic floor muscles is vital. The following practice is best down laying down with knees bent and your feet flat on the floor, but can be done in any position.

• With one hand on your chest and one below your rib cage, inhale for 3 counts.
• On the inhale, completely relax your pelvic floor muscles. This should feel the same as when you are passing urine, but should not involve pushing or straining the muscles. Sometimes visualization can aid with muscle relaxation.
• Exhale for 4 counts, bringing your pelvic floor muscles up and tight, the same motion as you would to stop urine midstream.
• Continue breathing and relaxing for 5 to 10 minutes.
• Practice this each day for as many sessions as you have time for.

Build functional strength

Functional strength and stability in connection with your breathing and pelvic floor muscles will increase awareness and control.

• Perform several repetitions of body-weight squats multiple times per day while focusing attention on your pelvic floor muscles. Remember to relax on the inhale and contract (tighten) on the exhale.
• Strengthen your glutes with body-weight or strength-training exercises, such as lunges, glute bridges, squats and deadlifts.
• Practice mobility and flexibility exercises for your legs and groin muscles, especially your adductors (think: inner thighs), which can overcompensate and tighten when your pelvic floor support is weak.

Practice during everyday activities

Practice your breathing, tightening and relaxing exercises during your everyday activities and workouts, such as whenever you pick up a heavy load, whether that be a barbell, your child or your grocery bags. Bring awareness to your pelvic floor muscles during all of your activities to prevent urine leakage and build a stable, functional support system.