You’re not alone if you’re a woman in your 40’s or older and have issues with leaking. 

But I’m here with a glimmer of hope for you!

Being a physical therapist and a good friend to many 40+ yr old women (and also a mother who gave birth to a large child), I get approached with this question quite often.  Actually, sadly, it’s never really in question form.  I’d love it if they’d ask me, “What can I do about my leaking?”  Instead it’s more of a defeatist statement like, “It’s so frustrating that I leak a little pee when I cough or jump or if it’s been too long since I’ve had a chance to use the bathroom”.  

All of these women tell me they’ve tried doing Kegels and they haven’t helped.  All of these women tell me the doctor told them they could have a surgery or else just live with it. 

UUUUUUGGHHHHHH!!!!

Okay, first of all, before you agree to any surgery, YOU SHOULD ASK FOR A REFERRAL TO A PHYSICAL THERAPIST, and actually go, and work hard on the exercises she gives you FAITHFULLY.   Another “first of all” is don’t ever settle for the “just live with it”.  I hear that WAY too often and always there is at least SOMETHING you can do to make some degree of progress!  And another “first of all”, Don’t Feel Embarrassed!  Statistics say 1 in 4 women are suffering with urinary incontinence, and that statistic includes women over just 18yrs old! You are not alone, and the sooner you do something about it, the easier your results will come. 

And here you are today!  Yes! Give yourself a pat on the back and be proud that you took this step and that you’re still reading.  And don’t quit until you get the results you want. Stick with it. Be persistent. You might see results in a couple weeks, or it might take you months. It’s worth it. Even if you’ve tried before and it didn’t work – try again! I know you don’t want surgery- so give it a try! There’s a good chance you haven’t tried these variations with your Kegel efforts, and I really think they are effective.  There’s also a chance you haven’t quite been doing them correctly because it really is hard to find the correct muscles to squeeze.  Keep on reading – and let’s get it right!

Kegel’s definition according to Oxnard Languages:  exercises performed by a woman to strengthen the pelvic floor muscles, involving repetitions of both sustained and rapid voluntary contractions of the muscles and used especially to treat urinary incontinence and improve sexual function.  Dr Arnold Kegel developed these exercises in the 50’s. 

Thank you, Dr. Kegel!  (btw- Men can also benefit from these types of exercises!)

Step 1 – Practice Isolating The Correct Muscles. 

Okay, we’re going to practice with a muscle you can actually SEE contracting.  Roll up your sleeve high enough that you can see your bicep. Bend your elbow to about 90 degrees, and rest your forearm on the table or the armrest of a chair.  Flex your bicep to get a good Popeye the Sailor Man bump.  Yeah!  Do it again.  Rest.  Do it again. Rest.  Do it again but this time hold it for a count of 5, 4, 3, 2, 1.  Great.  Now – this time do it without moving your wrist or making a fist…..  Use your eyes and look at your whole arm.  The ONLY thing that should be moving is your bicep.  See if you can really isolate just the bicep.  When you can do that with good control, now you’re ready to move on to the pelvic floor muscles.  This bicep exercise has nothing to do with helping you stop leaking, lol, except that it teaches you how to isolate and control a muscle and the effort it takes to do it correctly.  When exercising the pelvic floor muscles it’ll be important that you isolate them and not just suck in your stomach or squeeze your butt cheeks.

Step 2 –  Find The Pelvic Floor Muscles

I like to think of the pelvic floor muscles as something like a hammock that slings under you like thong underwear does.  But it’s more complicated than that because the muscles also provide upward support within you, like you’ve got a funnel standing upright on top of the hammock. Hmmm, well, let’s move on. 

When the pelvic floor muscles are contracted, they keep you from farting (or worse!), they tighten your vagina for a better sexual experience, and they can stop the stream of urine. Inside they hold up your bladder, bowels, and uterus, and support your spine.  Now let’s work on finding the muscles.  Go ahead and take a seat in a firm chair sitting with good posture and away from the back rest.  

Think about holding in a fart and squeeze those muscles inward and upward.  Push that fart all the way up to your belly button.  And I also need you to imagine you’re wearing a thong, because the area that the thong touches down there – that is the only area that should be contracting.  No butt cheek squeezing.  (If you want to see the difference, purposefully squeeze your butt cheeks and since you are sitting on a firm chair, you’ll feel yourself -like- get a little taller.  Those are not the pelvic floor muscles that we’re looking for, and they should stay relaxed throughout these exercises!).   

Now focus on the muscles (still in the area covered by the thong) that are more to the front of your body. The muscles that support your vagina and the hole you pee out of. 

Tighten that whole area, still trying to push that fart up to your belly button, push your pee all the way back up to your bladder (up to the belly button) and feel the whole length of your vagina contract.  That inward and upward effort is really important.  It’s not just about squeezing the holes shut, it’s about lifting them up through and around the funnel.   It could be very hard to do this and you might be uncertain if you’re doing it right.  Visualize that funnel inside you and that your muscles are surrounding it cylindrically and you need to squeeze from the bottom up like a tube of toothpaste.  (yeah, I crack myself up with these analogies too – but I find it’s often these crazy layman’s terms that gets people to understand it once and for all. lol). 

Ultimately you want to be able to forcefully squeeze that toothpaste up and hold it at the top for 10 seconds (or longer! How long of an orgasm do you want to be able to have??!) and do it 3 times, at least 2 times/day.  (Practice it during your morning and evening commute? While you’re brushing your teeth?  Make a plan right now as to when you think you can incorporate it into your day.  And now set an alarm on your phone to remind yourself!)  When you’re just getting started you might only be able to squeeze the holes shut for a brief couple of seconds.  But- work on it.  Hold them longer and tighter and involve more of the muscle each time.  They are muscles just like any muscle in your body and it takes time and practice to get them stronger.  Luckily the isometric variations are subtle enough to do any time anywhere.  

Step 3 – Variations and Inclusion 

The pelvic floor muscles have a very important partner nearby.  The transverse abdominis muscle.  A quick anatomy description of your abs:  the 6 pack muscle runs up and down your belly from sternum to below the belt. There are oblique muscles that run diagonally along your sides.  And there is a deep belt shaped muscle that wraps around your whole torso between your ribs and hips, and THAT is the one I’m talking about – the transverse abdominis. (When PT’s are talking about your lower abs – they’re mostly talking about the lower section of this muscle since it is the deepest one that has the most influence over the stability of your spine, and working together with your pelvic floor muscles to support your pelvic organs.)  

I’ve got some great exercises that include dynamic movements and isometrics of this important team, and I think it’s easiest if I demonstrate them in a video. And that, my friends, is coming soon!  Reach out to me through my CONTACT ME page and let me know that you want to be the first to know about it when the video is ready! 

Step 4 – Functional Integrations

Great! Now you’re contracting the correct muscles.  Now you’re regularly practicing them.  And Now you’re ready for some functional integrations that will really make a difference.   It’s all about the functional carry over into your daily activities.  Same is true for when I’m working on someone to strengthen their quad muscle after a knee injury or surgery.  If they’re just doing leg lifts, sure, their leg will get stronger.  But how is that going to translate into being able to go up and down stairs any easier?  It wont.  They need to strengthen their quad in a variety of ways that mimics their activities.  And how is doing perfect isometrics of your pelvic floor muscles going to help you keep from leaking when you jump or sneeze?  Actually – to some degree it will! But here are the variations that will really make a difference! 

Sit with good posture on that firm chair.  Squeeze your toothpaste in and up and hold it.  Now do a fake sneeze.  Gradually challenge yourself with bigger and bigger fake sneezes.  

Now stand up, squeeze those pelvic floor muscles in and up and hold them. And now do a fake sneeze standing.  Try it also laying down. 

To really test yourself if you’ve gotten better, when you have to use the bathroom, get on the toilet seat, don’t start peeing yet, tighten your new favorite strong muscles, and with that full bladder give a big fake sneeze then (and listen for the silence of no dribbles in the bowl!) 

Repeat the above steps for fake coughing. 

How about for walking, lifting, and jumping?  Same concept.  

Let’s start with walking. All those posture muscles should be consciously engaged.  Tighten pelvic floor muscles in and up and walk across your room.  Rest.  Repeat.  For now it’s a conscious over exaggeration of contracting your pelvic floor.  As those muscles get stronger and regain some of their natural muscle memory, they will contract to the correct intensity depending on your activity and the fullness of your bladder. 

Lifting.  Remember what you learned when we did contractions with squatting in the video.  Now put it to the test by actually lifting something.  Start light and with the item on a table.  Then use that light weight but with the item lower down on a chair.  Then put that light weight item on the floor.  Gradually increase the weight you’re trying to lift.  This is also great practice to protect your spine and avoid back injuries.  (If you have any issues with your spine- I’m here to help you with that as well!). 

Jumping?  Oh boy – the ultimate test of involuntary urination control.  (In my mind I’ve inserted a gif of a water balloon splashing).  I’d suggest you start with an empty bladder.  But eventually you should be able to jump, jump, jump despite how much urine you’ve got in there.  Contract your favorite muscles, do 5 bounces keeping your legs straight, rest, repeat. (You should also stretch your calf muscles if you’re going to be doing a lot of these! Yup, I’m a head-to-toe physical therapist here to help!).  If you’ve got one of those mini trampolines it would be great to do some bouncing or jogging in place on that.  These bounces are especially helpful if you’re an athlete or if your son happens to think you’re cool enough to join him and his buddies at Skyzone Trampoline Park. 

Step 5 – Keep It Up!  

And then keep keeping it up!  And if it isn’t making a difference despite your best efforts, get a referral to a women’s health physical therapist.  They are fully equipped and trained to help you.  They have biofeedback devices that are inserted to tell if you’re contracting the correct muscles. They have many other tricks and experiences that could help you improve control of your pelvic floor in a conservative manner and avoid surgery.  And, they’re professionals and do it all in a way that takes the awkwardness out of the situation. Suck it up, make the call, there is hope! 

Step 6 – Help Others

Please share your experience with me and your success stories so that I can include them as encouragement to all the women I’m trying to reach with this program.  A National Poll in 2018 revealed that 46% of women over 50 had urinary incontinence , 1 in 3 had daily episodes, and only 1 in 3 had ever mentioned it to their doctor.  Please share with me your testimony, and share this article with your friends and family. Let’s change the world together!