LIVING WITH INCONTINENCE
Incontinence exerciseRead more
The Kegel or pelvic floor muscles sit like a hammock in the base of your pelvis and support the bladder, bowel, vagina and uterus. It’s the muscle you clench to ‘hold on’ when you don’t want to pass urine, faeces or wind.
Not surprisingly, the additional weight of pregnancy can strain the muscle and cause weakness. When this happens, your ability to ‘hold on’ can be compromised, causing incontinence. You can read more about how pregnancy and childbirth impact continence here
Kegel exercises are safe to perform throughout pregnancy and will keep your muscle strong. Integrating them into your daily routine should correct any existing leakage issues or prevent them from starting.
The name ‘Kegel’ is derived from an American gynaecologist, Arnold Kegel. He knew the pelvic floor muscle was important for continence and witnessed the lack of urinary control suffered by many pregnant women. Putting the two together, he described a series of exercises that were first published in 1948. His idea was to perform a simple series of pelvic floor contractions several times across the day to build strength and improve continence. And it works!
Kegel exercises were the first documented, non-surgical solution for female urinary incontinence. The doctor’s name became so closely linked with this aspect of gynaecology that the pelvic floor is often still referred to as the Kegel muscle.
These days, we know Kegel exercises benefit all people; men and women, those who’ve been pregnant and given birth and those who haven’t. A stronger pelvic floor improves bladder and bowel continence, as well as sexual function in both genders.
Some pregnant women experiencing bladder leakage believe the damage is done so there’s no point trying to fix it – but that’s just not true! You can read more about that and other Common Myths about You Pelvic Floor here and general Pelvic Floor Health for Women here
As you can see in the illustration below, during pregnancy, the pelvic floor supports not only your pelvic organs but also your growing baby. The extra weight coupled with an increase of the hormone ‘relaxin’ (which loosens ligaments in preparation for birth) can stretch and strain the muscle. The symptoms of this are urinary incontinence (especially when sneezing, laughing or coughing) and an uncomfortable feeling of ‘heaviness’ in the pelvic area.
If you’re not sure you have found it, try stopping your urine stream when you’re next on the toilet – that’s the same muscles. You should have a sensation of the muscle being drawn into the middle (from the front and back) and being lifted up into your pelvis.
(Once you’ve located the muscle, don’t stop and start your urine flow as an exercise. Although it’s a good way to identify the muscle, it’s not a good bladder habit.)
To get a clear picture of what’s happening, this video from the Continence Foundation of Australia give a three-dimensional view of the pelvic floor and explain the sensation you should experience when clenching.
The good news is that as your body shape changes with pregnancy, you can continue to do Kegel exercises, as they can be performed sitting, standing or lying down.
If it’s comfortable, start by sitting on a chair that allows both feet to be planted firmly on the floor. A firm seat with a back is ideal, like a kitchen chair. Pay attention to your posture which should be upright, with the shoulders relaxed back and the head in a neutral position (that is, neither looking up nor down). Imagine a thread running up your spine and through the top of your head that being gently pulled upwards. Arms can be by your side, or you can rest your hands on your thighs.
Standing means you also need to lift the weight of your baby, so is more suited to the first two trimesters. Stand with your feet should-width apart and relax your shoulders. Rock your pelvis forwards and backwards, then settle it into a neutral position, neither tipping forwards or backwards. Some people find it useful to imagine it’s a bowl of water that you’re trying not to spill.
Lying down will take the pressure of your baby and gravity off the Kegel muscle so is ideal for late pregnancy. See below for some floor and lying positions.
Once you’re in your chosen position, take a couple of slow, relaxing, deep breaths.
Now, breathing normally, clench your pelvic floor muscles and hold for a count of two to three seconds – more if you can manage it – then release.
Try not to hold your breath or engage your buttock, thigh and abdominal muscles. Focus on using just your pelvic floor. Engaging the other muscles distributes the load and reduces the effectiveness of the exercise.
If you don’t have a sensation of ‘letting go’ at the end of your count, it means that the clench slipped away before you got there. Experiment until you find a comfortable threshold, usually somewhere between two and ten seconds.
This ‘clench, hold and release’ action forms the basis of all pelvic floor exercise routines.
Clench and hold your pelvic floor for the count you identified as comfortable – somewhere between two and ten seconds. Then relax for ten seconds before repeating the same exercise. You’re aiming to do a set of ten.
If the muscle feels fatigued, stop and try again later, but you should be targeting six sets across the day.
Once you’re comfortable doing these, you might like to add some quick, intense clenches. For these, squeeze your pelvic floor as hard as you can, then let go straight away. Without resting in between, repeat this exercise up to ten times.
For the first two trimesters, you should be able to perform Kegel exercises in an upright position, either sitting on a chair or standing. This is ideal in the early stages, as you’re drawing your muscles up against gravity and the weight of your baby. Think of it as resistance training!
However, at some point during the third trimester, the weight of an upright position may be too challenging, so move a floor position. All fours will take much of the gravity and weight of your baby off the Kegel muscle, making the exercises more comfortable. If this position starts to feel awkward, lower yourself onto to your forearms which will take even more pressure off.
For most women, mastering the basics of pelvic exercises isn’t tricky – but remembering to do them is!
Use regular daily events to trigger your memory, such as:
There are several apps that will remind you, including some specifically for pregnancy. Google ‘pelvic floor reminder app’ and have a look around for one that you like.
A vaginal delivery can damage and stretch your pelvic floor, but if it’s in good shape to begin with, recovery should occur within a few weeks. If you’ve had a caesarean section, your pelvic floor still needs exercise to recover from pregnancy.
Check with your doctor, especially if you’ve had an episiotomy and stitches, but in most cases, you should be able to recommence Kegel exercises within a few days.
It may be that you can’t sense anything when you’re clenching, but persistence will pay off. Just remember to take a break if the muscle is feeling fatigued.
To incorporate Kegels into your new routine, some new mums find doing them every time they’re feeding or changing a nappy a useful trigger.
Incontinence during pregnancy is very common and typically caused by a weak pelvic floor muscle that is under additional pressure with a growing baby. This type of leakage is called stress incontinence
The good news is that once the muscles have regained strength through Kegel exercises, the leaking should stop,
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Asaleo Care makes no warranties or representations regarding the completeness or accuracy of the information. This information should be used only as a guide and should not be relied upon as a substitute for professional, medical or other health professional advice.