If you leak urine when you laugh, or struggle to get to the toilet due to urgency, there's a good chance someone has told you to “just do Kegels” a common name for pelvic floor exercises.

For some woman, strengthening the pelvic floor relieves urinary incontinence and can be an important tool in fighting urgency. For others they can be confusing, hard to master, or even disappointing, and they might even make things worse.

If you've tried pelvic floor exercises and thought “why is this not working for me?”, you are not alone and it is not your fault. This post explains why pelvic floor exercises don't work for everyone and how to know what your body actually needs and where help is available.

You Might be Doing them Wrong

You should not take this as a criticism as it can be quite difficult to find the correct muscles, which are basically invisible. The goal is to lift and close the pelvic floor muscles around the urethra, vagina, and anus. However, many women tend to push down, like when having a baby, instead of lifting up as intended. It is also common to tighten the buttocks muscles and inner thighs or to hold one’s breath instead of engaging the pelvic floor muscles. Instead of strengthening your pelvic floor, holding your breath increases the pressure downward ,which puts strain on the pelvic floor.

Another common problem is inconsistent practice. Pelvic muscle training is like any training; it requires regular practice and takes weeks to months of gradual progression to show clear improvements. There is a good chance that you have other distractions in your life that make it hard to get to your pelvic muscle exercises. Consequently, if you haven't noticed a difference in a couple of weeks, it's easy to give up, especially when no one explained that it may take longer than you recognized, or that your specific pelvic floor exercise regimen might need adjusting along the way.

There is more than one approach to pelvic floor exercises and the regimen that you are pursuing may not be right for your needs. Most women will need a regimen that includes both quick responses and longer holds as well as the ability to coordinate these functions. The pelvic floor doesn't work in isolation as it is part of a larger system that includes your diaphragm, deep abdominal muscles, back and hip muscles. This is why your pelvic floor exercise program needs to match your body. Effective pelvic floor exercises depend on developing strength and endurance but where are you at the start? Some women start with pelvic floor muscles that are weak or under active, while others have over active muscles, where learning to relax the muscle tone is important. These differences are why it is so important to have a professional in urinary incontinence to help you tailor the regimen to your needs.

It is also important to consider your urinary symptoms as well as other health issues. If you are not having luck currently, you may need a modification of the pelvic floor exercises you're doing or you may need biofeedback which refers to devices that help you find and contract your pelvic floor muscles. Without feedback it can be extremely hard to know if you're doing it correctly. Luckily there are many approaches to providing biofeedback that can help you find the pelvic floor muscles and do the exercises correctly.

It Might be the Wrong Treatment for You

There are many causes of urinary incontinence, and it is not uncommon for women to have more than one problem at the same time. Pelvic floor exercises are especially useful for stress urinary incontinence, where weakness in the pelvic floor muscles and/or support tissues compromise the bladder’s ability to hold in urine. Under these circumstances, small increases in the pressure in your abdomen can overcome the weakened bladder closure mechanism, causing leakage with coughing or laughing or lifting. While effective for stress urinary incontinence, pelvic floor exercises may be less effective if you have other causes of urinary incontinence. So, if they're not working for you, it may be time to see a urinary incontinence expert who can determine what causes you to leak.

Not everyone has a weak pelvic floor either. Your pelvic floor can be too weak where it's under active, but it can also be too tight or overactive, or it might be poorly coordinated so that it is not activating at the right time. If your pelvic floor is overactive standard pelvic muscle exercises could make it worse and even cause pain. Pelvic floor exercises are not always about strengthening the muscles but more often about improving their function through coordination, appropriate relaxation, and support. So, pelvic floor exercises may be a valuable treatment for you, but only if they are focused on your specific pelvic floor needs. Which again, highlights the importance of having the support of a clinician who can guide you in pelvic floor exercises.

What Should I Do If Pelvic Muscle Exercises Aren’t Working for Me?

Here are some practical steps that you can take. The first is to get a proper assessment of your urinary symptoms. A provider who has experience in urinary incontinence can learn a lot from just taking your history and listening to your description of your symptoms. They can also tell you whether pelvic floor exercises will be helpful for you and they can specify a regimen for your particular condition.

If you are diligent in your exercises and are still not seeing the results that you'd like, then an assessment of your pelvic floor muscles may be indicated. A pelvic exam can help to show whether your pelvic floor is weak, tight, or both and can check for coordination, endurance, and timing. This will help to tailor a program to your body and lifestyle.

There are also devices that will help provide biofeedback to improve your pelvic floor exercises, and these are available through providers who specialize in treating urinary incontinence. Most importantly your knowledgeable provider can tell you whether or not you need a different type of treatment to manage your symptoms. Remember you do not have to live with urinary incontinence. It is a treatable condition.

And, you can access this care directly from your home through a virtual visit at Dry Days Health.

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