Why kegel chairs won’t fix your leaking (and what will)
When it comes to pelvic floor physical therapy, many people are under the impression that they are just going to be taught how to do kegels. When I was pregnant with my first son, I remember seeing a folder on the wall in my OB’s office titled “kegels” with hand outs of how to do a kegel inside of the folder, but pelvic floor physical therapy was never mentioned to me. This perpetuates the idea that when it comes to the pelvic floor, it’s all about kegels.
I’m here to tell you that you don’t need to be doing a billion kegels.
A kegel is an isolated contraction of the pelvic floor muscles. Cues are often given such as “lift a blueberry into your vagina”, “stop urine and gas”, or “imagine sucking liquid up a straw with your pelvic floor muscles”. These cues can be helpful to know where your pelvic floor is and how to contract it. But let’s be honest about kegels as an exercise: they are boring and not functional. So although your pelvic floor PT may give you these cues to feel where your muscles are, you shouldn’t be doing isolated kegels at every stop light.
Your pelvic floor muscles respond to movement and force. When you jump, run, cough, or sneeze, your pelvic floor reacts to support your pelvic organs. But of course your pelvic floor isn’t the only thing involved with these activities. Let’s talk through a few common scenarios we see in our office.
Leaking with jumping and running
If you are jumping or running, your feet, ankles, knees, and hips all absorb forces along with your pelvic floor. If your feet and ankles or your hips aren’t strong and absorbing forces well, your pelvic floor will have to work quite a bit harder. So if your feet/ankles or hips are a large part of the problem - just doing kegels clearly won’t help. We need to address force absorption and any mobility limitations at the ankles and hips to improve pelvic floor function with these activities. There can of course be other things involved in leaking with jumping and running (such as breathing technique, posture, etc), which also need to be addressed (and kegels won’t fix!).
Leaking with coughing, sneezing, and laughing
Coughing, sneezing, and laughing all increase intra-abdominal pressure. That means there is a quick increase in pressure on the organs in your abdomen and down onto your pelvic floor. In a well coordinated and functioning pelvic floor, the muscles will react and cushion the organs. If the muscles are very guarded, it’s like pushing the organs into concrete. If the muscles are uncoordinated or feel “offline”, they won’t respond to support against the downward pressure. In both of these scenarios, the quick increase in intra-abdominal pressure can cause leaking of urine, stool, or gas as the pelvic floor is unable to respond to the pressure placed on the pelvic organs. The key here is to improve the coordination of the pelvic floor muscles by retraining the diaphragm and pelvic floor muscles to work together.
The kegel chair - what it is and why I am calling BS
The kegel chair is just that - a chair that you sit on that uses electromagnetic waves to make your pelvic floor muscles contract. The most common chair I see advertised is the Emsella. It is often advertised as this amazing fix to urinary incontinence.
In my opinion, the kegel chair is just another form of a BS “quick fix” that simply doesn’t work.
Here are 5 reasons why you should skip the kegel chair
The problem probably isn’t a “weak” pelvic floor. As seen in the examples above, often the pelvic floor muscles are the victim of problems elsewhere, or they simply need more range of motion or coordination. If you are a runner who is seriously lacking ankle and hip strength and mobility, doing a billion kegels won’t change a thing.
The pelvic floor muscles are reactive to breathing and movement. Sitting on a chair and having a machine contract your pelvic floor muscles over and over again does not teach them how to coordinate with your breath or movement.
Isolated contractions are not functional. You don’t need to walk around all day squeezing your pelvic floor muscles to prevent leaking. Really you don’t need to squeeze your pelvic floor muscles for much of anything - they should be responding to movement, so that’s how we need to train them.
Kegel chairs are expensive. You can work with a pelvic floor physical therapist for a fraction of the cost of what you would pay to sit on one of those chairs.
Kegel chairs may actually make your symptoms worse. If you hold a lot of tension in your pelvic floor, contracting your muscles over and over again may actually increase tension and make your leaking (and other pelvic floor symptoms) worse.
So what will fix your leaking?
It depends! It is important to work with a pelvic floor physical therapist who takes a holistic approach to treatment. That means they will take the time to hear your story, watch you move, discuss any lifestyle factors that may be impacting your symptoms, and work with you on your personal goals.
As mentioned in the examples above, we often need to work on breathing, coordination, and foot/ankle and hip mobility and strength. However, the best exercises and approach for you really depend on many personal factors.
Interested in working with me one-on-one? I am currently accepting new patients both virtually and in-person at my office in Collierville, TN and my new office in East Memphis, TN. You can contact me directly at alexis@absolutekineticspt.com or schedule here.
Blog post written by Dr. Alexis Hutchison, PT, DPT, OCS
Do you experience leaking with coughing, sneezing, running, jumping, or lifting? Check out our FREE PDF download “Yes, You Can Run, Jump, and Lift without Peeing Your Pants”.