A flock of Kegels

It’s ladies’ night out. Purse? Check. House keys? Check. Absorbent undergarment? Check.

A leaky bladder should be the last thing on your mind when you’re going out for a good giggle with the girls. But for many women, it’s one of the funky things that can happen after a seven-pound human or two passes through them. During pregnancy, or after birth or menopause, the muscles of the pelvic floor can weaken, resulting in stress incontinence (leakage of urine when coughing, sneezing or laughing) or a frequent urge to urinate.

However, a simple exercise, invented about 60 years ago by American gynaecologist Arnold Kegel, can make a dramatic difference. Designed to strengthen the muscles of the pelvic floor (which bridges the bottom of the pelvis and holds the pelvic organs in place), Kegels can help you put the squeeze on sudden leaks. And, if you’ve got a strong pelvic floor, you’re less prone to vaginal prolapse, which is what happens when the vaginal wall has been pushed forward by one or more of the pelvic organs (bladder, uterus, top of vagina or rectal tissue).

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Even if you already have a degree of prolapse, you can keep it from getting worse — and in some instances decrease it — by doing Kegels. “I think women are trained to feel that this is part of [what’s considered] normal, that it’s OK to have a few drops,” says Jennifer Skelly, director of the continence program at St. Joseph’s Healthcare Hamilton in Ontario. “They don’t pursue it because they don’t know the long-term ramifications.” Over time and especially after more babies, a weakened pelvic floor will worsen, which could lead to increasingly severe problems such as a cystocele (fallen bladder). “It may take a few years to happen, but if women did their Kegels after each child, they would likely prevent it,” says Skelly.

The key is to do Kegels properly and frequently enough. Fran Stewart, a nurse continence advisor (NCA) in Toronto, sees a lot of patients with weakened pelvic floor muscles. Like the many other trained NCAs across Canada, she promotes Kegels as an ideal non-invasive solution to maintaining pelvic floor health. “Often,” says Stewart, “patients can avoid having surgery done, if they learn to do them well.”

The perfect Kegel

Doing Kegel exercises incorrectly is a wholly wasted effort. To do a proper pelvic squeeze, imagine yourself in an important meeting experiencing the after-effects of too many burritos at lunch. The action of holding in an upsurge of gas is precisely how to perform a Kegel. (Your mother may have suggested that stopping urine flow is a good way to practise. Not so, say the experts — it can actually serve to override the brain’s normal control over the bladder sphincter.)

Just how many pelvic squeezes are necessary to tone those muscles? Overdoing them can cause your pelvic muscles to spasm to the point where you have trouble urinating. An ideal daily tally is 60 to 80, performed in sets of 10 to 20 throughout the day. Hold each squeeze for four seconds, then relax for four seconds. And “like with any exercise, remember to keep breathing,” says Stewart.

It can take a few months to notice an improvement. “The key message is that Kegels do work if they’re done properly, but they take time,” says Skelly.

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There are several ways to make sure you’re exercising your pelvic muscles correctly. You can insert a finger into your vagina while you squeeze. It should feel like an elevator, says Stewart: “You’ll feel [your] going up, and you’ll hold it, and you’ll feel it going down.”

Some continence specialists offer biofeedback programs that isolate individual muscles and let you know when you’re flexing them flawlessly. You could also work with a continence specialist to learn to do Kegels correctly. In fact, Skelly led a study of pregnant women experiencing symptoms of incontinence. Half were given one-on-one training sessions in how to do Kegel exercises; the rest received a standard handout. The women who’d received personal training reported greater improvement of bladder control after delivery. If you want to learn from an expert, contact the Canadian Continence Foundation (1-800-265-9575) for a specialist in your community.

Any time, any place

Kegels are one exercise where lack of time is no excuse. You can squeeze while writing a report, making dinner or watching a movie, while sitting, standing, lying down or walking. You can even practise with your partner during sex (who should be willing to help when told it’s for health reasons!).

While Kegels can be a woman’s best-kept secret, Stewart does have one word of caution: “Don’t wrinkle your forehead while you’re doing ’em!”