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Kegels not cutting it? They aren't the only option for treating incontinence

Many women struggle with urinary incontinence. It’s uncomfortable and embarrassing. And worse, it’s linked with other health problems. Women can become dehydrated when they limit fluids to avoid leakage. They can also become socially isolated and depressed.

“Women stay home due to fear of not being able to find a bathroom close by, or fear having an accident in public,” says Salpi Salibian, director of program development for Hoag Hospital’s Pelvic Health Program in California.

It’s not a problem you should ignore. “Urinary incontinence tends to get worse over time, not better. Waiting to see if it passes will just lead to more years of discomfort and leakage,” says Heather Jeffcoat, a physical therapist and owner of Femina Physical Therapy in Los Angeles.

Fortunately, urinary incontinence (UI) is treatable.

A study published in the Annals of Internal Medicine in April found that behavioral therapies beat medication for treatment.

“I want more people to know that there is help for UI that isn’t surgery, drugs or diapers,” says Sarah J. Haag, a specialist in women’s health physical therapy and author of Understanding and Treating Incontinence.

Here’s what you can do

First, talk to your doctor about your symptoms—he or she can help diagnose the type of incontinence you have and develop an effective treatment plan.

Your doctor might recommend these DIY options:


Women have been told for years to do Kegel exercises, multiple times a day. And they can be helpful for a lot of women. But they aren’t always done properly.

“Almost half of women do Kegels incorrectly, or in a way that is actually making their problems worse,” Jeffcoat says. Many women tend to squeeze their gluteal muscles, which makes it difficult to be aware of the pelvic floor muscles.

Engage your lower abdomen instead, says Chitra Mittal, a women’s health expert at Liberty Physical Therapy in Jersey City, NJ.

Physical therapist Katy Rush owns a specialized physical therapy clinic, The Perfect Pelvis, in Missouri. Here’s her recommendation for a proper Kegel technique: Imagine you are picking up a blueberry with your vagina. It should feel like you are drawing your muscles up and in.

But Kegels aren’t always the solution. “Doing Kegels for muscles that are already too tight will only make the problem worse. If you often have pain, specifically lower abdominal pain, low back pain, or pain with intercourse, it is likely that the pelvic floor muscles are too tight,” Rush says.

For muscles that are too tight, you’ll need to focus on relaxation before strengthening.

Maintain a healthy weight

Need another reason to lose weight? Extra body weight can put pressure on the bladder and the pelvic organs. “A healthy pelvic floor should be able to contract, relax, and lengthen in a coordinated manner,” Mittal says.

Keep a bladder journal

Tracking your fluids and trips to the bathroom can help you identify triggers. Carbonated, caffeinated, and alcoholic beverages are known bladder irritants, says Salibian. If you wake up more than once a night to urinate, let your doctor know.

How physical therapy can help

Your doctor might suggest that you see a physical therapist who specializes in incontinence or pelvic floor problems.

“Studies have shown that working with a physical therapist who specializes in pelvic physical therapy and biofeedback delivers the best results. A pelvic physical therapist has specialty training in the pelvic muscles and everything that is connected to them,” Salibian says.

Your physical therapist might try:


This technique measures the electrical activity in a muscle—a contracted muscle will have a higher number. Biofeedback can show you if you are tightening and relaxing your muscles properly.

“Pelvic floor muscle biofeedback can be a great tool to help train women to isolate these hard-to-find muscles by giving them real-time feedback,” Jeffcoat says.

Electrical stimulation

Transcutaneous electrical nerve stimulation (TENS) uses electrodes to send pulses of electricity that stimulate muscle contractions and strengthen your bladder muscles.

Your physical therapist may also guide you in relaxation and strengthening exercises.

And if you’re not getting results on your own or with physical therapy, your doctor might recommend hormone replacement therapy, vaginal tablets, Botox injections, or surgical options.

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