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 because the muscle fibers don’t overlap enough. A person in this scenario may benefit from increased strength training. Conversely, if the muscle fibers overlap too much (ie the muscle is tight) this will also be weak, again because the muscle will not be able to generate force. Tight does not equal strong. Tight= tight=weak! This situation would require a release of the tension prior to focusing on strength. Now hopefully you see why more Kegels (ie tightening) will be ineffective! And as a pelvic PT, I see much more of the latter situation when it comes to the pelvic muscles.

  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. And repeat over and over throughout the day. One thousand bicep curls don’t help you much with a half marathon. So an isolated contraction isn’t actually what is required when you bend to lift your toddler or when you perform burpees at the gym. We need to focus on functional re-training our core system to optimize results. 

  3. Many factors can contribute to UI. It’s just a sign that something is off somewhere in the core system. Let’s also take into account standing and sitting posture (alignment matters!). How about if someone has diastasis recti? What about a prolapse? How about someone who constantly grips their tummy muscles or who truly has a weak transversus abdominus? This list goes on….

The best way to assess all the factors that contribute to UI specific to you would be to see a Pelvic Health PT. And if you are pregnant, you would absolutely would benefit from One Strong Mama, which incorporates an effective and functional way to retrain your core system and provides such an amazing support system and network!

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 or our YouTube Channel here