Is pelvic health physiotherapy just teaching people how to do “kegels”?
Pelvic floor physiotherapy is not “just” teaching people how to do “kegels” (pelvic floor muscle contractions). Pelvic floor muscle contractions are sometimes a portion of the exercise program, but they are not prescribed to everyone!
I tried kegels and they didn’t work, what now?
Research shows that most people actually do not complete “kegels” (pelvic floor muscle contractions) correctly. Simple verbal or written instruction does not constitute adequate training for a Kegel exercise program (Bump et al 1991) . In its 2008 clinical guidelines on the conservative management of urinary incontinence, the Society of Obstetricians and Gynecologists of Canada recommends that “proper performance of Kegel exercises should be confirmed by digital vaginal examination or biofeedback”.
Weakness is also not always the issue either, this may be the reason “Kegels” didn’t work (if they were being done correctly).
How do I know if I should have a pelvic floor physiotherapy assessment?
Ask yourself the following questions:
1. Do I experience urinary or faecal incontinence (any loss of urine or stool without control). Does this happen when laughing too hard, jumping, running, etc. (stress urinary incontinence)?
2. Do you have bladder or bowel urgency? AKA when you “have to go” are you rushing to the bathroom? Do you void “just a little” even though you had a very strong urge?
3. Do you have urinary frequency? Are you urinating/voiding more than 5-8x per day?
4. Do you experience pelvic pain (bladder pain, pain with intercourse/penetration, tailbone pain, etc.)?
5. Do you have unrelenting low back pain, buttocks pain, pain with sitting, abdominal pain, or groin pain?
6. Have you been pregnant and/or given birth (vaginal or C-section)?
7. Do you get up in the middle of the night to void?
8. Have you had gynaecological, urinary or prostate surgery?
9. Do you have difficulty emptying your bladder?
10. Do you have constipation? Do you strain to have a bowel movement?
Do you have any of the pelvic health conditions listed under “Women’s Health” or “Men’s Health”?
If you answered “yes” to any of the questions above, you should book a pelvic health physiotherapy assessment!
Is it normal to have a little urinary leakage after having children or as I get older?
No, it is not normal to have any urinary leakage after having children or as you get older! If you’ve had 0 kids or 12 kids, it’s still not normal (though it is very common). It is also not normal to start “leaking” as you get older.
Should I have surgery to stop my incontinence or to “fix” my prolapse?
Conservative management therapy such as pelvic floor muscle training should be offered as a first line therapy to all women with pelvic organ prolapse (POP). Level 1 Grade A Evidence (Abrams 2013, More et al ICI 2013, Hagen, 2014).
British Guidelines – as presented at the ICS Conference 2010 in Toronto: pelvic floor muscle training should be the first line of defense against stress urinary incontinence. This should be completed before surgical intervention is considered
Sometimes surgery is necessary for some people, but only as a last resort.
Should I stop and start the flow of urine to test my pelvic floor strength?
No, you increase your risk of a UTI doing this and you likely won’t empty your bladder.
Can/should I practice my “kegels” on the toilet?
I advise against this, you want to be completely relaxed when you’re on the toilet and build that relationship between your brain and body.
Amanda the Physiotherapist 