Updated: Jul 15
A little "oops" when I cough or sneeze is normal, right? I mean, it's the price to pay for having kids, isn't it? I'm getting older so rushing to the bathroom is just something I have to put up with, don't you think? It's not a big deal...
~NO, it's not "normal". It's common, but it's not normal.
~NO, it isn't the price you have to pay for having kids, though it can commonly occur after having kids.
~NO, you don't just have to just deal with it as you get older.
~YES, it is a big deal!
Did you know that almost half of all women have a problem with bladder leakage at some time in their life? That's a lot of women! And if you're reading this, chances are high that this is a problem for you too. But while problems such as leaking with a cough or sneeze, peeing "just in case" and rushing to the bathroom constantly may be extremely common, this is never considered "normal".
And while wearing pads, sitting out on activities you enjoy, limiting drinking to limit bathroom trips, and skipping places you love to go are ways to deal with with these annoying symptoms, it's not ideal. Taking simple measures now to help improve your bladder control can help you change your own future.
The problem with ignoring bladder problems
While you may be willing to put up with a little dripping here and there right now, leakage and urgency can often snowball and get out of hand as we get older and that little "oops" can grow into an "oh no!" There may come a time when crossing your legs during a sneeze or rushing to get to the bathroom might not cut it anymore.
The good news is that you have the power to change this trajectory! A great first step to improving bladder control is to ensure you have strong and well-coordinated pelvic floor muscles. Just like any other muscle in our body, these muscles can get stronger with targeted strengthening exercises, and the most well-known of these exercises is called the Kegel. While Kegels alone may not solve all your bladder woes, they are a great place to start.
What are Kegels?
A Kegel is just another word for a pelvic floor muscle contraction. This exercise is famous for a reason—it is the bread-and-butter exercise for strengthening your pelvic floor muscles, and has the research behind it to prove it. Kegels play an important role in building strong, coordinated pelvic floor muscles to help close off the urethra during a cough or sneeze and help support your bladder better to help you get to the bathroom in time.
But being famous doesn't mean they are easy. In fact, research by Kandadai et al shows up to a quarter of women do Kegels wrong! But don't fret: if you can slow down the flow of your urine while on the toilet, then you can do a Kegel. And bonus: you get to learn them while lying down...
How to do a Kegel correctly:
Because a Kegel involves squeezing muscles that are hidden away in the pelvis, it can be quite an intimidating exercise to try. But just remember that a Kegel is nothing more than simply tightening a muscle, just like you might tighten your bicep to strengthen your arm.
STEP ONE: Find your pelvic floor muscles
Locate your pelvic floor muscles by sitting on the toilet and trying to slow down or stop your urine flow. The muscles that you use to do this are your pelvic floor muscles. (Don't worry if you can't stop the flow; you are doing this just to "find" the right muscles.)
STEP TWO: Do a Kegel
Lie in a comfortable position on your back, with your knees bent. Squeeze your pelvic floor muscles UP and IN, as if you are stopping the flow of urine, as you practiced in the previous step. Now relax.
Congratulations—you've just done a Kegel!
Now that you know how to squeeze the right muscles, let's work on strengthening them. Here are two important ways to do Kegels:
Quick flicks: quickly squeeze your pelvic floor muscles (Kegel) and hold for 2 seconds, then fully RELAX for 2 seconds. Repeat this 10-15 times, 2 times per day.
Long holds: squeeze your pelvic floor muscles (Kegel) and hold for 10 seconds (or as long up to 10 as you can manage), relax for 10 seconds, and repeat for 10 repetitions, 2 times per day.
Because our pelvic floor muscles are made up of two different types of fibers (fast- and slow-twitch), it is important to do both these types of Kegels daily for maximum benefit.
Remember to breathe throughout—no breath-holding!
When you do a Kegel, you should feel an upward lift at your perineum; if you feel downward pressure, then stop and try again. If you are struggling with doing a Kegel correctly, it may help to try in a different position, such as lying on one side, or sitting on a firm surface.
Keep your buttocks and inner thigh muscles quiet as you do a Kegel.
Kegels must be done correctly and consistently to be effective. While you may start to see some improvement in your bladder symptoms after only 2 weeks, it may take up to 6 weeks or longer to see maximum benefit. So stick with it!
If you've done Kegels in the past and they didn't work, don't fret—they may still work for you! You may not have done them correctly or for long enough in the past, so consider giving them another try or getting some professional guidance.
You're never too old to try Kegels. Whether you've had problems for 10 months or 10+ years, you can work on strengthening your pelvic floor muscles.
Signs that your pelvic floor muscle strength is improving
Be on the lookout for signs that you're getting stronger, such as:
Leaking less often with a cough or sneeze, or not leaking until that 3rd sneeze
You're able to hold a Kegel for longer than when you started, or you can do more of them before you fatigue
You have less urgency on the way to the bathroom and can "hold it" better
You're going to the bathroom less often during the day and/or night
Should everyone do Kegels?
While Kegels can be a powerful way to strengthen the muscles which support the bladder and most people would benefit from doing them, Kegels aren't for everyone. Here are some tips to help you determine if this is an exercise for you:
You might benefit from doing Kegels if you:
Leak a few drops of urine while sneezing, laughing, coughing and/or exercising
Have difficulty controlling the urge to urinate and/or have to rush to get to the bathroom in time
Feel mild vaginal heaviness while on your feet, especially toward the end of the day
Are recovering your pelvic floor strength after having a baby
Want to work on preventive pelvic floor muscle strengthening to stay strong for the future
You might NOT benefit from doing Kegels if you:
Have signs of tense and shortened pelvic floor muscles, such as with pelvic pain, pain with intercourse, pain with sitting, bladder pain and/or vaginal pain.
Have difficulty doing Kegels correctly
If you have any of these symptoms currently, be sure to consult with me or another pelvic health practitioner BEFORE doing Kegels to see if they are right for you.
Signs that you may be doing Kegels incorrectly
With at least 1 in 4 women doing Kegels incorrectly, it makes sense to doublecheck that you aren't one of them. Here are some common signs you may be need help with your Kegels:
Your symptoms seem to be getting worse rather than better
You experience pain in your neck, back, and/or abdomen after doing Kegels
You experience new symptoms such as pelvic pain, pain with intercourse, pain with sitting, bladder pain and/or vaginal pain.
If you experience any of these signs or symptoms, be sure to stop doing Kegels and consult with me or another health practitioner.
The magic of Kegels
It's important to remember that bladder symptoms such as leakage, frequency and urgency almost always have solutions, and Kegels are often a big part of those solutions. In fact, Kegels can seem almost magical because they have the power to help such a wide variety of bladder and pelvic floor complaints.
But remember, Kegels alone may not solve all your bladder woes—there are many other exercises and strategies that can help you regain control. If after giving them a try for at least 2 weeks you do not see any improvement, consider reaching out to a healthcare practitioner for help.
Or join us for our next Six Weeks to Strong 💪 virtual pelvic Fitness Challenge! You'll learn everything you need to know to build a powerful pelvic floor, and get the motivation you need to complete the 6 weeks.
And as always, if you have any questions or need any guidance, I am just a quick email away.
Let strong pelvic floor muscles help you
face your future with confidence! 💪
About the Author: Angela is the owner of My Pelvic Therapy, PLLC and a licensed physical therapist. Prior to starting her telehealth private practice, she worked as a senior physical therapist for 17 years at Advocate Lutheran General Hospital in Park Ridge, IL, specializing in helping adults of all ages overcome their pelvic floor challenges. She received her physical therapy degree from Duke University, biology degree from University of Illinois, and is a lifelong learner of all things PT. Click here to schedule an appointment with Angela, or you can contact her at firstname.lastname@example.org. You can also find Angela on LinkedIn and Facebook.