New Moms and Almost-Moms: Practice Pelvic Strengthening

Many women experience uncomfortable and inconvenient incontinence (involuntary urinary leakage) during and after pregnancy. A review of trials using pelvic floor-strengthening exercises (Kegels) found that pregnant women who do these exercises are less likely to experience incontinence, and Kegels can also help women who already have incontinence.

The price of motherhood

If you’re suffering from incontinence, you’re not alone. About one third of women have urinary incontinence and one tenth have fecal incontinence. It usually starts during or after childbirth, due to the weight of the developing baby on the pelvic structures, changes in hormones that control the tone of the urethra and surrounding tissues, or a combination of these (no one knows for sure).

Giving birth vaginally, as opposed to by Cesarean, can raise risk, but only in the short term. Urinary incontinence is also more common as we age, as a result of declining hormone levels that normally help keep the pelvic tissues toned. Fecal incontinence following childbirth is usually caused by damage to the tissues surrounding the anus during delivery.

Doctors and midwives have recommended pelvic floor–strengthening exercises to pregnant women since 1948, when Arnold Kegel first introduced them. The idea behind the exercises is to help strengthen the muscles that support the pelvic organs (bladder, bowel, and uterus) and to help the urethra close more efficiently.

If you’ve never tried to do a Kegel, you can practice while urinating. Every time you stop the flow of urine, you are contracting the muscles of the pelvic floor. It’s the same idea when you’re not on the toilet: alternately tighten and relax the same muscles that you used to stop and start the stream of urine.

Kegels keep you dry

A review published by the Cochrane Collaboration looked at 15 different studies to see just how effective Kegels are for preventing and treating incontinence related to pregnancy and childbirth. The review found that pregnant women who had never had incontinence were about 56% less likely to develop it when they practiced Kegel exercises than were women who didn’t do the exercises. Women who had urinary incontinence three months after delivery were 20% less likely to have it after a year if they kept up the Kegels.

“The greatest treatment effect was seen in the trial with the most intensive, supervised pelvic floor muscle training program,” the review’s authors commented. The exercises also worked for women with fecal incontinence; women who did Kegels were about one half as likely to have incontinence at the one year mark as were women who didn’t do them.

If you’re pregnant, now is the time to start

To do Kegels, start by holding the contraction for three seconds, and then relax for another three. Gradually work your way up to being able to contract for ten seconds, with a ten-second rest between contractions.

Eventually you should be able to do three sets of ten exercises per day. You’ll find that they get easier with practice, and you really can do them anywhere: at a traffic light, waiting in line at the bank, or while you fold laundry. Putting the effort in now can help avoid embarrassing wetness later; if you already have incontinence, it’s not too late to start your Kegels.

(Cochrane Database Syst Rev 2008;4:CD007471)

Kimberly Beauchamp, ND

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