Pelvic floor therapy for urinary incontinence is often misunderstood. Learn why Kegels don’t fix incontinence and how pelvic floor coordination actually plays a critical role!
If you’ve ever leaked while running, sneezing, or picking up your toddler, you may have been told the solution is simple…
“Just do your Kegels.”
The reality is far more nuanced for urinary incontinence.
Recently, an article circulating in major media suggested that pelvic floor physical therapy is essentially equivalent to doing Kegels and that medical interventions like injections or surgery may be more effective solutions for urinary incontinence.
Naturally, this raised a lot of questions from women in the Holistically Well community!
As a holistic orthopedic and pelvic health Doctor of Physical Therapy, I want to clear up the confusion and walk through what the research and clinical experience actually show about pelvic floor therapy for urinary incontinence.
EPISODE 50 | HOLISTICALLY WELL PODCAST — WHY KEGELS AREN’T ENOUGH: THE TRUTH ABOUT INCONTINENCE & PELVIC FLOOR HEALTH
Whether you learn best by listening, reading, or watching, there is something for you! You can catch the audio version on the Holistically Well Podcast—available on all your favorite platforms!
Holistically Well Podcast on Apple | Episode 50
Holistically Well Podcast on Spotify | Episode 50
Holistically Well Podcast on YouTube | Episode 50
KEY EPISODE TAKEAWAYS
💪 Pelvic Floor Therapy vs Kegels
💧 Why a Strong Pelvic Floor Can Still Leak
🧠 Pelvic Floor Coordination vs Strength
🏃♀️ Pelvic Floor Physical Therapy for Urinary Incontinence
🤱 Natural Treatment for Postpartum Bladder Leaks
The Most Common Misconception About Pelvic Floor Health
Many women assume leaking happens because their pelvic floor is “weak.”
But you can actually have a very strong pelvic floor and still leak.
Why?
Because pelvic floor function is about pressure management and coordination, not just strength.
A pelvic floor that is strong but poorly timed can still allow urine leakage during activities like:
- running
- jumping
- coughing
- sneezing
- lifting a child
Instead of asking “Is my pelvic floor strong enough?” we should be asking: “Is my pelvic floor reacting at the right time?”
Why Kegels Alone Often Don’t Fix Incontinence
Kegels are just one small tool in pelvic floor rehabilitation.
In fact, many patients I work with don’t need more contraction at all.
They need to learn how to:
- relax the pelvic floor
- coordinate breath with muscle activation
- manage pressure through the core and diaphragm
- respond dynamically to movement
A helpful analogy is comparing two surfaces catching a water balloon!
The Brick Wall vs The Hammock Analogy
Imagine throwing a water balloon at a brick wall.
The wall is strong, but rigid. The balloon bursts on impact!
Ok friend, now imagine tossing that same balloon into a hammock.
The hammock has strength, but also flexibility and responsiveness, allowing it to absorb the impact. Your pelvic floor should function more like the hammock.
If the pelvic floor is overly rigid or poorly timed, the bladder hits that rigid structure during movement and that’s when leaking occurs.
What Pelvic Floor Physical Therapy Actually Looks Like
Pelvic floor therapy is far more comprehensive than doing Kegels on the floor. 😅 A skilled pelvic floor physical therapist evaluates the entire system. By the entire system, we’re talking…
Breathing Mechanics
The pelvic floor works directly with the diaphragm.
Your therapist will assess how your pelvic floor moves as you breathe.
Core and Pressure Management
Your abdominal wall, pelvic floor, and diaphragm must coordinate to properly manage pressure inside the abdomen.
Poor pressure management often contributes to leakage.
Posture and Alignment
Postural changes can dramatically affect pelvic floor function.
For example, postpartum women often develop:
- anterior pelvic tilt
- rib flare
- altered breathing patterns
These adaptations can disrupt pressure regulation and lead to leakage.
Movement Patterns
Pelvic floor therapy should eventually include functional movements such as:
- squatting
- hopping
- lifting
- running mechanics
If you leak while running, your therapy should address running mechanics.
Should Women Skip Therapy and Go Straight to Surgery or Injections?
Procedures like Bulkamid injections or surgical interventions can absolutely have a place in treatment.
Here’s the thing… they do not address the movement and pressure strategies that often cause leakage in the first place.
In fact, research across medicine consistently shows that patients who complete physical therapy before surgery have better surgical outcomes.
This principle applies to knee replacements, hop replacements, and pelvic floor surgeries! Many women discover that after proper pelvic floor therapy, their symptoms improve enough to delay or avoid surgery altogether.
Is Urinary Leakage a Normal Part of Motherhood or Aging?
One of the most common things I hear women say is; “I just had kids… it’s normal to leak.” or “It’s just part of getting older.”
I’m here to say, urinary leakage is common, not normal.
Leakage typically reflects modifiable factors like:
- breathing mechanics
- muscle coordination
- strength distribution
- load tolerance
- bladder habits
Addressing these factors earlier leads to better long-term outcomes!
A Habit That Can Make Urgency Worse
One simple takeaway from today’s conversation is to stop the “just in case” pee.
Frequent preventive bathroom trips train the brain and bladder to expect urination at specific triggers like leaving the house or pulling into the driveway!
Over time this can contribute to urge incontinence, where the urge to urinate becomes difficult to control.
What most folks don’t know is that limiting these habits can help retrain bladder signaling!
What To Do Without Access to Pelvic Floor Therapy?
Access is improving as pelvic floor physical therapy becomes one of the fastest growing specialties in PT. Yet still, many women still face barriers such as location, childcare, scheduling changes, and limited providers.
This is why structured online pelvic floor rehabilitation programs can also be the most helpful starting point! Online, virtual physical therapy programs allow women to learn the foundational principles of pelvic floor coordination, breathing mechanics, and pressure management from the comfort of their home!
Physical therapy is not only for injury or pain. Many of our clients use preventative physical therapy to:
- Maintain pelvic floor health
- Optimize strength and mobility
- Support athletic performance
- Reduce risk of injury
- Prepare for pregnancy or return to exercise postpartum
- Optimize fertility ahead of conception
We offer “wellness” or “tune-up” visits for patients who want to stay proactive.
Your body is an investment. When you care for it consistently, you prevent breakdown before it begins!
