To Kegel or not to Kegel?

To Kegel or not to Kegel?

You may have read on social media that you should be doing kegel exercises to help strengthen your pelvic floor. BUT, what is the pelvic floor? And more importantly, what are kegel exercises and should you be doing them? The answer is…it depends.

The pelvic floor is a sling of muscles located at the bottom of your pelvis that span from your pubic bone to your tailbone. These muscles have many different functions, including:

  • Sphincter control – they control the opening and closing of the urethral and anal sphincters and thereby help start and stop the flow of urine, gas and poop.
  • Support – they help support the pelvic organs (such as your bladder, rectum, +/- uterus).
  • Sexual – they play a role in orgasms and can help increase pleasurable sensations.
  • Sump pump – they help circulate lymphatic and venous fluid back towards the heart.
  • Stability – the pelvic floor is one of the four main “core” muscles, which work together to help provide stability for our abdomen, low back, and pelvis.

The Kegel refers to a pelvic floor muscle contraction, which involves contracting (flexing) and relaxing the pelvic floor muscles. Often times, however, these are done incorrectly.

When someone does have a weak pelvic floor, they may run into issues such as stress incontinence, urge incontinence, frequency, prolapse, and/or low back pain. Strengthening can be an effective way to improve these symptoms. HOWEVER, if you have symptoms such as pain with intercourse, pain with urinating or emptying your bowels, incomplete emptying, urgency, and/or frequency, then strength focused pelvic floor exercises may NOT be appropriate to start. In both cases a person may be experiencing incontinence…however, the treatment approach would be different.

In the latter scenario (increased tension), treatment may first focus on reducing pain, tension, and tightness with a variety of exercises, education and manual therapy techniques. Once this is accomplished, it may then be suitable to start pelvic floor strengthening.

A pelvic floor physiotherapist can help you determine if you have a weak or tense pelvic floor, and they can create an INDIVIDUALIZED program to help you meet your goals.

During an initial assessment, your pelvic floor physiotherapist will go over your health history, symptoms, and goals. They will then complete an external exam (i.e. posture, low back, sacroiliac joint (SI joint), hips) and/or an internal vaginal and/or rectal exam. This will allow your physiotherapist to evaluate your pelvic floor strength, coordination, tone, areas of pain, and potential prolapse. Please note that an internal exam is only completed with the Client’s consent and it does NOT involve a speculum. While an internal exam can help provide lots of useful information about the pelvic floor, it is not necessary if you are uncomfortable with the procedure, or you are experiencing a lot of pain. You do not need a doctor’s referral to see a pelvic floor physiotherapist. If you are interested in optimizing your pelvic floor, you can book an initial pelvic floor physiotherapy appointment by calling the Lake Country Sun City location, or book now with our direct online booking.

Bladder Incontinence

This one’s for the ladies.

Ladies, have you notice the increase in the number of bladder leakage commercials on TV these days? Brands like Poise and Always have caught on that there are a large number of women who experience bladder leakage on a daily basis. These commercials are great in one aspect because they open up doors for women to have conversations. This is important because these issues may be embarrassing to discuss with friends and therefore are often sealed behind tight lips or talked about only in doctors’ offices. The downside to these commercials is that they make you feel like a pad is the best way your bladder leakage can be addressed. Many women who have bladder leakage do not seek information regarding the underlying cause, the type of bladder leakage they have or additions ways it can be addressed.

To fill in some of the gaps – there are essentially three types of bladder leakage. First there is stress incontinence (loss of bladder control). This type usually occurs because the pressure exerted on the pelvic floor is too forceful for weakened muscles during a cough, sneeze, laugh or any event that increases intra-abdominal pressure.

The second type of incontinence is called urge incontinence. This type of leakage is usually behaviour driven and occurs because of toileting cues and conditioning surrounding your learned habits. For example, you just pulled into your drive way – before you pulled up there was no urge to go to the bathroom. However, now that you are in the driveway you are frantically rummaging through your purse to grab your keys, you found them. Now, to make it to the front door you waddle the whole way there because all you can think about is emptying your bladder and by the time you get the lock open you may have already leaked before you made it to the toilet.

The final type of incontinence is called mixed and is a combination of stress and urge. In addition to using these products there are other ways to treat bladder leakage. One of the treatments for stress incontinence comes from gaining body awareness and control of your pelvic floor muscles and retraining them to turn on before a cough and sneeze. The treatment for urge incontinence involves behavioural retraining surrounding your current toileting habits.

Now that you are aware there are more options, perhaps it’s time for you to take control of your leakage and contact a physiotherapist who treats women’s health in an effort to reduce or eliminate leakage.

Sabina Lee is a registered physiotherapist at Sun City Physiotherapy’s Winfield/Lake Country clinic.

Exercise after Pregnancy

Exercise after Pregnancy

Physiotherapy » Category: "Womens Health"

Exercise after Pregnancy

There are a few things a woman should take into consideration when resuming exercise after pregnancy: Pelvic floor strength and her abdominal muscles. Restoration and strengthening of the Pelvic Floor muscles is very important and should begin in the early days and continue weeks after delivery. Whether her delivery was vaginal or C-section, special attention needs to be paid to the post-partum woman’s abdominal wall. A widening of the gap between the two bands of the Rectus Abdominus muscle, known as Diastasis Recti, may not resolve spontaneously after pregnancy.

Pregnancy and childbirth puts a woman’s body through one of her life’s most strenuous events. Laxity in the ligaments, an increase abdominal girth, an exaggerated forward tilt of the pelvis can alter the center of gravity, affecting dynamic stability of the spine and pelvis. Combined with the load of carrying a new baby and breastfeeding, these added stresses to the spine can lead to postural fatigue and discomfort. Physiotherapists are experts at analyzing posture and alignment and can prescribe postural exercises and advice on body mechanics.

Kegel exercises are an important part of pre-natal health. The Pelvic Floor muscles (PFM) lie at the base of the pelvis, and run from behind the pubic bone to the tailbone. Differentiate a PFM contraction from the buttock muscles. To avoid increasing intra-abdominal pressure, don’t hold your breath and push. Instead, think of pulling the two side walls of the vagina toward midline, and lift up inside. Hold this contraction for 10 seconds, without holding your breath.
Immediately after a vaginal delivery, many women find it hard to feel a contraction in their pelvic floor muscles. It works much easier if “muscle memory” exists from previous practice.
If you’re having difficulty with this, an internal examination by a women’s health physiotherapist can determine the extent of the problem. Other concerns, such as uncomfortable scarring after an episiotomy, can also be addressed.

We have 3 layers of abdominal muscles. 100% of women have some degree of Diastasis Recti, or abdominal separation in their third trimester of pregnancy. At 8 weeks post-partum, if the gap is marked (greater than 2 fingers width), if untreated it will likely still be a problem after a year. Diastasis Recti can aggravate low back problems and result in a midline “doming” of the abdomen under load. The underlying cause is an abnormal increase in intra-abdominal pressure during exertion, not the pregnancy itself.

If you suspect you have a Diastasis, try to avoid activities that strain on the abdominal wall. This would include sit-ups, especially over a large ball, heavy lifting, yoga postures that include back bends, Pilates “100’s”. This is until you have learned to contract the inner Transversus Abdominus (TrA) muscle to support the wall.

Two thirds of women with Diastasis Recti have some level of Pelvic floor dysfunction. The Pelvic Floor muscles and TrA work synergistically to support the pelvic organs, especially during exertion. Good tone in these muscles helps to prevent and treat prolapse and stress incontinence, which can show up in mid-life.

Women’s Health

Women’s Health

Physiotherapy » Category: "Womens Health"

Women’s Health


Pelvic Health problems don’t get a lot of press. If you have a bladder issue, for example a bit of leakage when you cough or sneeze; if you know where every bathroom is when you go out shopping, you have a problem. Chances are, you’ve never even spoken to your doctor about it.

Urinary incontinence, the involuntary loss of urine, is quite prevalent. It is estimated that 10-44% of women experience it to some degree. 50-70% of Urinary Incontinence is unreported. Stress incontinence can also affect men after a prostatectomy. Incontinence is NOT a normal part of the ageing process.

There are two main types of bladder incontinence:

Stress incontinence is like a leaky faucet. The bladder leaks with effort or exertion (like a cough or a sneeze). This may be due to weakened pelvic floor muscles, an ineffective sphincter muscle along the urethra, relaxed ligament/ fascial support of the pelvic organs, and/or hormonal changes. It is a common symptom during and after menopause.

Urge Incontinence is experienced with a strong urge to void, which is very hard to suppress. The bladder is like an overactive pump. Strong contractions of the smooth muscle in the bladder walls cause urine to leak out. Triggers can be the sound of water running, or putting the key in the door when we’ve been out for a long walk. Strong urge and increased frequency of urination can occur without leakage. This is sometimes known as Overactive Bladder syndrome.

What can be done about Stress incontinence? 

There are several types of treatment available. Conservative treatment involves pelvic floor muscle retraining, lifestyle changes, optimizing fluid intake. Biofeedback can be a useful tool in the training process. Sensors near the pelvic floor muscles measure the strength of a voluntary contraction and provide feedback. It can be a valuable learning tool.

Using the upper abdominal muscles excessively can add to the problem. There is a definite link between using the deepest layer of abdominals for proper support of the pelvic organs, and getting a stronger contraction of the pelvic floor muscles.

Specially trained physiotherapists can assess these bladder disorders, teach people with incontinence how to correctly perform specific exercises, advise how to retrain the bladder to improve continence control.

Medical interventions may be needed for more severe problems. During menopause, low

estrogen levels can contribute to the problem. Surgery is also an option for some women. Pelvic floor training is highly beneficial whether surgery is needed or not.

Many people don’t realize there is help out there for their issues, and spend large amounts of money on pads and incontinence products, or abstain from social events for fear of embarrassment. With a few months of regular adherence to an exercise routine and lifestyle changes, moderate degrees of incontinence can be cured. The first step is booking an appointment with a trained professional.