12 Sep Female Fitness, Exercise Incontinence & The Kegel Myth
Do you sometimes leak urine when you lift heavy weights during your workout? If you have to do jumping jacks or jump rope, do you plan to pee prior to the workout because you know if you don’t, you’ll find yourself running to the bathroom practically mid jump (exercise incontinence)? Have you had experience with chronic groin or hamstring strains when sprinting is integrated into your work out?
All of these issues are common things I see with athletic female patients. Pelvic floor health and dysfunction has started to get a little more attention in the medical community, but it continues to be a topic that few people are properly educated on. In addition, many of the women suffering from pelvic floor dysfunction and exercise incontinence are either too embarrassed to talk about it, or have been made to believe that incontinence or pelvic pain are a normal part of life, especially after having children.
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When being bombarded in the media with ads for pads for urinary leakage and overactive bladder medications, it is very easy to assume you have to live with your symptoms forever, and sadly, we accept this as truth. This is extremely unfortunate because these issues can have a huge impact on your physical well being, as well as your emotional health and quality of life.
It is important to know that your pelvic floor is a big group of very important muscles. If you can restore function and retrain your leg after a hamstring strain to return to your former sprinting or squatting glory, it should be simple to draw the comparison that a dysfunctional pelvic floor can be rehabilitated as well without need for long term pad use or meds.
The ease at which our culture will push you toward a pad and tell you it is normal to pee when you laugh, sneeze or jump, is akin to putting a bucket under a leak in your roof. It does not fix the problem, and it additionally leaves your infrastructure open to further damage if left to persist.
Believe it or not, 1 in 3 women suffer from some kind of incontinence issue, including exercise incontinence, and while this is a problem in and of itself, it can lead to other chronic pain and injuries when you add on athletic activity. It’s time to find out what the pelvic floor is, what it is supposed to do for you, and if it is not doing it’s job, what are your options to fix it?
What is the pelvic floor and what does it do?
Here is a short and sweet answer: the pelvic floor is the bowl that supports your internal organs. It is comprised of many muscles that have localized functions such as: controlling a bowel movement, controlling urine flow, and sexual and reproductive functions. It also has purpose for these muscles to work together as whole system for overall postural support of the body. This means that even when you don’t know it is working, it stabilizes you in general daily movements. In a perfect world, it functions automatically without you thinking about it. In the event that you have some sort of disruption to this automatic function, such as childbirth or injury, these muscle groups may require some retraining to work 100% properly.
Why might incontinence happen during fitness?
At the end of the day, every part of your body is connected. Your groin muscles feed into your pelvic floor. Your glutes have connections to your pelvic floor. And your pelvic floor will be then connected to many other areas of your body including abdominals, so on and so forth. If something isn’t working properly, something else will compensate. This is what the body does in any situation. Your neurological system puts function over all else. When something is not working properly, the brain just delegates more work to other structures to make sure you can do what you need to do in life, ie, walk, bend, lift, etc. It is subconscious and we are often completely unaware that this phenomenon is occurring.
Example: Double Unders: Why do you leak?
What happens during a double under?
- The body overcomes the force of gravity and leaves the ground.
- Upon returning to the ground, the force of your body weight makes contact with the floor. Imagine all those organs in your torso coming down with that force and exerting pressure down onto the pelvic floor.
- As this occurs, your leg muscles are quickly moving, stressing the pelvic floor where they attach up around your groin area.
All of a sudden, such a simple exercise is making a lot of demand on a potentially dysfunctional tissue. So what happens? The pelvic floor could “give” and leakage may occur. The groin muscles may sense the potential for injury and spasm to protect from over-pulling other vulnerable tissue. You may have back or knee pain, because your brain chooses to send the stress to another area in the hopes to prevent further dysfunction in an already weakened area. When an area of the body doesn’t do it’s job, something else will always inevitable pick up the slack to preserve function and ensure that the jumping jacks get completed, if that is the demand.
Why does this matter to you?
The situation described above leads to overuse. Think of it like this: if your pelvic floor is weak, the groin chooses to compensate to make sure something is stabilizing you. Now the groin is doing 2 jobs – the job of the groin AND the job of the pelvic floor. Eventually, something is going to have to give.
What are kegels and are they good for you?
A kegels is a pelvic floor contraction. If you try to tighten your pelvic floor as if trying to stop the flow of urine, the end result should be a kegel. This is a hot topic as of late, spurring lots of debate as to whether they are the solution or a problem when considering pelvic floor rehab. My answer to the above question is that they need to be prescribed properly to be effective.
Many women who are open enough to discuss their exercise incontinence and pelvic floor problems with their doctors are told, “do kegels.” The question of “how many” returns a surprisingly large and inconsistent array of answers between medical professionals, so it becomes that much more confusing for the patient. It is important to understand that a pelvic floor contraction, can come about for a variety of reasons.
A reactive quick kegel will hold against the pressure of a sneeze or laugh to prevent leakage. This kegel comes almost like a reflex – in a healthy pelvic floor it happens without thought or planning and requires appropriate timing to be useful. If a quick kegel happens after you have already urinated a little, your pelvic floor didn’t quite hit the mark.
Kegels may also be used for endurance training, such as holding for 5 or 10 seconds. Unfortunately, if you pelvic floor is already tight, such as in a spasm, further tightening or practice of kegels is not helpful, but in fact can cause more harm. It is also important to note that if you are holding kegels for 10 seconds at a time when your issue is that you pee when you sneeze, you are not retraining the right system.
So how can you assess your pelvic floor to determine if there is an issue?
I should preface this by saying if you have symptoms of pain, significant exercise incontinence, or have been diagnosed with an issue such as prolapse, you should absolutely speak with your doctor and seek out a professional, such as a pelvic floor physical therapist. The following is not intended as medical advice for any specific problem, but to give those interested in understanding this issue a little deeper the opportunity to try a self-assessment.
First, you need to be able to feel whether or not you can isolate your pelvic floor muscles. This could be as simple as inserting a clean finger into your vagina and try to perform your kegel. A good cue is to try to squeeze your finger, and then try to lift it as if using the muscles to pull it further into your vagina. If do this and you feel a nice strong squeeze and lift, that is a solid start.
You may take it once step further to determine some endurance capabilities of the muscles. Try to hold that contraction for as long as you can, and see when the squeeze dies off. If you can only hold for 3 seconds before you lose tension, you may want to work on holding for 2-3 seconds for a few reps and begin working up to longer holds. As this gets easier, move on to 4 and 5 second holds, or more reps of consistent hold times.
If you try a quick contraction and relaxation, you can get some feedback on your ability to do those quick kegels described above. Note how strong you feel the squeeze is, and then try to see how many reps you get before the power of the squeeze starts to fade. If you can only do 3 and then feel like the muscles are completely wiped, that would be as if you did 3 squats and your legs became Jell-o. You would want to work on getting the endurance for 4, 5, and 6 kegels in a row, all with the same strong power.
This, in my opinion, is the easiest way to see whether or not you are truly able to contract your pelvic floor on some different levels. It by no means constitutes a complete assessment, but may give you some valuable information about yourself. If you thought your pelvic floor was weak but you can do the above contractions, there may be weakness in other areas, such as your hips or core. If you can’t isolate these muscles and have issues of exercise incontinence and urinary leakage, there may be good reason for you to seek out further assessment by a professional.
How to find a pelvic floor physical therapist?
If you are looking for specific treatment regarding pelvic floor dysfunction, there are a few things to be aware of. There is a specialty of physical therapy where practitioners can be certified as Women’s Health therapists or specifically with pelvic floor credentialing. That being said, not all practitioners who provide these treatments have these certifications. It is not required for practice, though it may mean your therapist has more experience and higher qualifications to treat pelvic floor disorders. Typically, if a clinic offers pelvic floor physical therapy, you will see it mentioned on their website. If not, it is as simple as calling a clinic you are interested in and asking if they provide pelvic floor physical therapy.
You may also consider a word of mouth referral; if you are already working with an orthopedic PT, chiropractor, or massage therapist, they may know someone in your area who treats exercise incontinence and disorders of the pelvic floor.
Before seeking out a pelvic floor PT specifically, you should speak with your doctor regarding your concerns. They will often want to rule out more serious conditions, such as pelvic infections or other conditions that may require more serious medical management.
The moral of this article is: if anything described above sounds like a problem you have experienced, first, know that you are not alone. Second, know that you are not sentenced to deal with the problem forever just because a doctor or friend told you, “yeah, that is just how it is.” Seek further information and answers, and don’t accept living with chronic medical issues like exercise incontinence when you have not yet exhausted all of your options.
Leah Gillespie is a doctor of physical therapy specializing in orthopedic conditions and disorders of the pelvic floor. Though she treats a wide array of conditions across age ranges, she has a passion for treating sports injuries and whole body muscle imbalances due to her history of working with CrossFitters, weight lifters, and marathoners to name a few. She enjoys incorporating athletic taping into treatment and is a Certified Rocktape provider.
She has been involved in injury prevention teams for the Boston Marathon as well as the Northeast regional level of the CrossFit Games. She has a passion for educating her patients regardless of the diagnosis to empower them to take a more active role in their health and wellness.