Firm up your pelvic floor muscles to fight ‘the urge’

Libby Trausch explains to a patient how the pelvic floor muscles work.
Dr. Libby Trausch explains to a patient how the pelvic floor muscles work.

The National Association for Continence estimates that 25 million American adults suffer from incontinence. Many seniors accept it as a part of growing old, but urinary incontinence is not normal and can be cured.

Urinary incontinence comes in two forms: stress and urge. Stress urinary incontinence is partially caused by uncoordinated pelvic floor muscles that cannot control leakage when you cough, laugh, sneeze, exercise or lift a heavy object. Urge urinary incontinence is associated with a sudden, strong urge to pee. The bladder contracts uncontrollably, sometimes for no reason at all. To improve both types, you must learn to control your pelvic floor muscles.

“When you have a strong urge, your bladder is contracting. If you don’t have the pelvic floor muscle control when the bladder squeezes, you leak,” says Libby Trausch, D.P.T., a physical therapist who specializes in pelvic health at Des Moines University Clinic. “Strong muscles will stop the urine from leaking out.”

The pelvic floor muscles sit beneath the bladder and other organs, supporting them like a bowl or hammock. They work together with the diaphragm and abdominal muscles to keep pressure down in the abdomen, assist with posture and support the pelvic organs. When we feel the need to urinate, we tighten these muscles to hold back the pee until we can get to the bathroom. Like your other muscles, the pelvic floor muscles can be toned through exercise.

These exercises, known as Kegels, build stronger and thicker pelvic floor muscles to help control the bladder. A proper Kegel is done by squeezing and lifting up inside the body – as if you’re stopping the flow of urine or holding back gas – and relaxing fully. You are less likely to leak if you can do 10 kegels, squeezing for 10 seconds and relaxing for 10 more. Most people’s muscles are too weak to hold for that long, so Trausch recommends holding for three seconds instead. You should do 10 Kegels twice a day, slowly working up to a 10-second hold.

A quick contraction can stop a sudden urge. Learn to squeeze your pelvic floor muscles before you sneeze, cough, laugh or strain. Hold the contraction if you feel relaxing the muscles will cause leakage. “You have to be able to do a quick contraction, but you also need to be able to do long holds, and that’s for 10 seconds. They’re endurance muscles,” Trausch says.

“Persistence is key. Sometimes the muscles are very weak and it can take months to notice a difference in how well you can do a Kegel,” she adds. “Understanding how and when to control your pelvic floor muscles is more important than doing a lot of Kegels.”

Some people have tight pelvic floor muscles and too many Kegels can increase the problem. If you have pain or discomfort associated with bladder function or intercourse, difficulty passing stools or strong or frequent urinary urgency, you should work on relaxing your pelvic floor muscles instead.

“If you have pain or discomfort, Kegels are a no-no. To relax your pelvic floor muscles, try imagining the muscles of the pelvis dropping, becoming very heavy or sliding off the bones,” advises Trausch.

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