Research shows that a strong pelvic floor is associated with better sexual function and reduced urinary incontinence—which in turn elevates physical, mental, and social wellbeing. Despite the benefits of healthy pelvic muscles, it isn’t the first area we think to exercise. In fact, it’s often an afterthought in general health and wellbeing, and becoming familiar with this area of your body can be a difficult challenge without the help of an expert. The good news? Dr. Krystyna Holland, PT, DPT, who specializes in inclusive pelvic floor therapy, offers three helpful exercises that can strengthen and tone your pelvic muscles.
Why pelvic floor exercises help incontinence
Incontinence—or lack of bladder control—is surprisingly common. Someone may lose control of their bladder and experience incontinence from a simple act like coughing, sneezing, or laughing. And while we often associate incontinence with a weak bladder, the lack of bladder control most often stems from weakness in muscles nearby. “It is almost always the pelvic floor muscles that sit below the bladder, around the urethra that play the biggest role,” Holland explains. Lack of strength in the pelvic floor can stem from a range of conditions and experiences, including childbirth, heavy lifting, chronic constipation, aging, weak connective tissues, and a history of surgery. Fortunately, studies have shown that exercising the pelvic floor muscles can improve symptoms of incontinence up to 70 percent, regardless of age. “Regular pelvic floor exercise ensures three things: that the pelvic floor is coordinated enough, strong enough, and big enough to support our organs and maintain continence,” Holland adds. It’s important to understand that strong pelvic floor muscles are important not only for harnessing bladder control, but also for reducing pelvic organ prolapse—an uncomfortable condition where the pelvic organs fall downward into the vagina.
Pelvic floor exercises for incontinence
Urinary incontinence can happen to anyone, but Holland reinforces that exercising these muscles regularly can promote greater bladder control while elevating comfort and confidence. “Ensuring that our muscles are coordinated and strong enough to do what we are asking of them sets us up for the most success in regards to maintaining continence.”
1. Pelvic floor muscle contractions
“Pelvic floor muscle contractions, commonly referred to as kegels, are like a bicep curl for the pelvic floor,” Holland explains. It’s true that kegels are the most common pelvic floor exercise, but that doesn’t mean they’re ineffective. “Being able to do isolated pelvic floor muscle contractions can be helpful to increase the size and coordination of the pelvic floor,” she adds. The potency of a kegel lies in being able to do them correctly. That means carrying them through a full range of motion, Holland adds. “Take a deep breath into the lower abdomen, letting the belly rise, and then gently contract the pelvic floor as you exhale. When I say to ‘contract the pelvic floor,’ what I mean is to gently squeeze and lift the muscles that would stop the flow of urine,” Holland adds. These instructions apply to all genders. “Pelvic floor muscle strength and coordination is important for people of any gender and with any genitals—everybody and every body, if you will.” Holland also points out that a full kegel includes staying aware of your body’s positioning though all parts of the breath. “It’s important not to miss the elongation and relaxation of the abdomen and pelvic floor during [your] inhale, as it is a common contributor to urinary incontinence, especially during exercise,” she adds.
2. Squats with glute activation
Like everything in our body, the pelvic floor muscles don’t work by themselves. Holland points out that the pelvic floor muscles work in conjunction with the glutes, back muscles, deep abdominal muscles, and inner thigh muscles (adductors). They also work in connection with the diaphragm, which is the muscle that helps us breathe. “Because of the relationship with these other muscles, it’s important to get all of the muscles working together. Squats, particularly squats that emphasize the glutes, can be an excellent pelvic floor strengthening exercise.” When working with patients, Holland usually recommends that people place something behind them when squatting down. This helps give them something to direct their glutes toward, which emphasizes glute activity over quad (thigh) activity. “Think of squeezing the glutes during the standing portion of the squat. For extra points, I’ll recommend that people inhale on the way down, and exhale on the way up to get the diaphragm involved and coordinated as well.” If you’re new to squats—or you need extra support when engaging with this exercise—a sit-to-stand motion can also work. Instead of squatting freely in the air, you’d begin sitting in a chair. Then, Holland tells patients to stand up, and “squeeze their glutes at the top and send their hips back to the seat behind them as they lower.”
3. Release your abs
Any exercise that strengthens the thighs, back, or abs can support pelvic floor strengthening and incontinence, but it’s also important to strike a balance between ab engagement and disengagement. “Something that is sneakily contributing to urinary incontinence, especially during exercise, is actually an overactivation of the abdominal and pelvic floor muscles,” Holland points out. Yes, you heard that right: despite the constant cues to tighten and engage our abs, it could be working against us. “Muscles are meant to be reactive, meaning that they change shape and position based on the task at hand,” Holland points out. “When we override their reactiveness by forcing them to get tight and stay tight, they will often tire out when we need them most, like landing after jumping.” While tightening the abs is helpful for a strong core, it shouldn’t become a constant state. Holland suggests trying to relax them more during workouts. “It can be most helpful to not tighten the abs on purpose, and sometimes let them actively bounce and jiggle during jumping.” No matter your age or experience, pelvic floor exercises can help prevent and mitigate incontinence and support a greater quality of life. Next up: 5 Lifestyle Habits That Could Be Harming Your Bladder Health
Sources:
Dr. Krystyna Holland, PT, DPT, Founder of Inclusive Care Physical TherapyInternational Urogynecology Journal: Strong Pelvic FloorClinical Interventions in Aging: Pelvic Floor and Quality of Life in WomenHarvard Health Publishing: What to Do About Pelvic Organ ProlapseMaturitas: Pelvic Floor Exercises for Urinary Incontinence
