Sometimes I laugh so hard tears run down my leg.
-Just about every mama who has given birth
Okay, folks, I have only admitted to wetting my pants one time publicly, and I say without shame that it was a glorious experience. However, I’m not exactly hoping to make a habit of it, you know?
And yet, after becoming a mother I suddenly developed a fear of trampolines, Super Bowl commercials, and sneezing. If Ryan Gosling memes had been around back then I’d have been a goner – seriously, have you seen these?
Anyway, back to the subject-at-hand, which I’m sure is #1 on your list of conversation topics for dinner soirees, backyard BBQ’s, and baby showers – INCONTINENCE! After Katie was born I sought the help of a specialist to help me rehabilitate my pelvic floor. Like 99.99% of the experts out there, she recommended kegels.
Chances are you have tried them, too – but what if the kegel instructions you find online, and in most medical offices, childbirth classes and magazines can actually MAKE MATTERS WORSE? Did you almost fall out of your chair just now? Stay put and I’ll explain.
Incontinence Hotline: Can You Hold, Please?
Most of us think of childbirth as the cause of incontinence, but according to some experts it really just accelerates a process that most people in our culture experience. The primary cause goes back to modern factors, so over time women who have not given birth – and even men – find that they cannot “hold it” anymore.
What modern factors, you ask? Apparently, the main culprits are the way we use the toilet, the shoes we wear, the way we sit and how we exercise. Here’s why:
The pelvic floor is made up of the muscles, ligaments and tissue which attach to our pubic bone and sacrum. Basically, it’s what holds up our organs so they don’t fall out. According to Katy Bowman of Aligned and Well, we want the pelvic floor to be like a trampoline – taut yet supple. To get this taut characteristic, it’s important that the pelvic floor be kept firmly in place on both sides.
Unfortunately, these days many of us have weak gluteal muscles due to lack of use. Instead of squatting to pee, we sit on toilets that flush. We sit on big, overstuffed chairs that cause us to tuck our sacrum under rather than push it out. We don’t do as much walking as we used to. Collectively, all of these things contribute to weak gluteal muscles.
When the bum is weak it doesn’t hold up it’s end of the trampoline well, and we end up with something that looks like this:
The trampoline has turned into a hammock! In this state, the pelvic floor cannot properly support your organs and maintain the functions it was designed to.
According to biomechanist Katy Bowman, Kegel exercises can tighten the area temporarily, but without strong glutes they’ll actually just pull the sacrum closer to the pubic bone and cause more dysfunction over time.
“A kegel attempts to strengthen the PF [pelvic floor], but it really only continues to pull the sacrum inward promoting even more weakness, and more PF gripping. The muscles that balance out the anterior pull on the sacrum are the glutes. A lack of glutes (having no butt) is what makes this group so much more susceptible to PFD. Zero lumbar curvature (missing the little curve at the small of the back) is the most telling sign that the PF is beginning to weaken. Deep, regular squats (pictured in hunter-gathering mama) create the posterior pull on the sacrum. Peeing like this in the shower is a great daily practice, as is relaxing the PF muscles to make sure that you’re not squeezing the bathroom muscle closers too tight. Just close them enough…An easier way to say this is: Weak glutes + too many Kegels = PFD.”
There it is, y’all! Squatting to pee in the shower is GOOD for you because it allows you to engage your pelvic floor in the way it is optimally designed for. Of course, you CAN just do squats, but for best results you’ll need to make sure that you practice relaxing your pelvic floor muscles, stopping just shy of urinating. Or you can just pee in the shower.
Are Kegels Always Bad?
So here’s the deal: It seems that kegels – if done by themselves – can make matters worse by making the muscle shorter/tighter and pulling the sacrum in. If you have strong glutes this is probably not an issue, but there are other things to keep in mind. Most kegel advice is bogus, says Alyce Adams, RN – aka The Kegel Queen. According to Alyce, here are some top kegel “don’ts.”
Don’t do hundreds per day
“Here’s why we don’t do 200 kegels a day. Kegels work by increasing your control of the pelvic floor muscles, and by building mass and tone in the pelvic floor. How would you build mass and tone in any other muscle in your body? As anyone who does weight training knows, you’d do a small number of strong, sustained reps. Not 200 “quick flicks,” or 200 anything! Your pelvic floor is no different. We have decades of research to tell us what types of kegel programs work. Why aren’t more people using it?” The Kegel Queen, R.N.
Don’t do little squeezes
“Just like any other strength training, Kegels should consist of several strong and sustained reps.” says The Kegel Queen. You need a strong squeeze and a full release. According to Katy Bowman, not fully releasing is like doing arm curls and then leaving your arm curled up. You’ve contracted your muscle but you can’t properly use it. (source)
Don’t do them while driving
It’s hard to focus on doing a STRONG squeeze and full release while handing snacks to the kids in the back seat, flipping on your turn signal and trying to remember if you’re supposed to take the first or second left.
“1. To do a strong and sustained contraction requires focus. Could you dead lift your max weight while driving? Impossible, of course, but even if you could do this move in a car, you wouldn’t because it requires too much concentration.
2. Having a routine is what makes any exercise program succeed. Saying you can do Kegels anytime doesn’t mean you will.
3. A proper Kegel includes fully relaxing; letting the muscles go completely soft, and letting your mind go with it. Not something you want to do behind the wheel.” – The Kegel Queen
Don’t move the wrong muscles
“Kegel Queen says that the pelvic floor and only the pelvic floor–not your butt, your abs, your hip flexors–should contract during a Kegel.” (source)
Don’t make the wrong movement
“A Kegel, says the Queen, is a contraction that lifts the pelvic floor up and forward” (source)
Don’t make kegels complicated
“Devices that require you to take off your pants will eventually collect dust in the back of your underwear drawer, says The Queen.” (source)
Theoretically, kegels wouldn’t be necessary if we’d grown up squatting more often and not tucking our sacrum’s while we sit. However, in some cases they may be appropriate. If I were going to go this route, I’d consult an expert or check out The Kegel’s Queen’s materials to make sure I’m engaging the right muscles. Personally, though, I’m going with squats!
Other Ways To ♥ Your Pelvic Floor
Ditch the high heels – here’s why
Don’t tuck your sacrum under when you sit – try this instead!
Squat – This post is specifically written for mamas preparing for childbirth, but it applies to everyone
Bottom Line (No Pun Intended!)
If you want to jump on trampolines, snort with laughter over Ryan Gosling memes and, um, sneeze, make sure that your glutes are strong enough to hold up their end of the pelvic floor. For more info check out “Down There For Women” by Katy Bowman.
Will you change your approach to kegels after reading this? Why or why not?
Read My Comment Policy
There is a foot stool being manufactured in the United States that can help with your colon health and help get you into the squatting position while you use the toilet……. go to http://www.squattypotty.com !!!!!! Includes a 60-day money back guarantee!
Wouldn’t a regular stool work just as well??
Kate @ Modern Alternative Mama
No. I’ve used both. The Squatty Potty puts your feet way off to the sides, giving you a true “squat,” while an ordinary stool keeps your feet in front of you. It’s not the same position or feeling at all. And it does help.
Amusingly, one of my young children climbs up and squats, perched over the toilet. We didn’t teach that, the kid just does it.
My 2 year old has been trying to squat on the toilet, too. I kept telling her to sit down but now I’m thinking I should just let her squat!
I was watching her at a recent camp out and she kept squatting to look at bugs, etc. All I could think of was this article! hehe.
Thanks for the info on the Squatty Potty. I was thinking, “$25 for a STOOL?” But if there is an actual difference then I can see why it costs that much.
I was just going to post this same thing! I still like the idea of peeing in the shower, though. 😉
VERY interesting and informative. Thanks much! I’m going to check out the DVD.
Thank you so much for doing this! I’ve been researching a bit of this myself and frustrated with the conflicting views or lack of information. Or high prices on information. At least this is a safe step I can do myself!
THANK YOU!!! My husband is a physical therapist who has helped heaps of women struggling with incontinence, post c-section issues, etc. in the last few years. If it is serious, get help from someone. If not, the advice to ditch the heels has helped over a dozen women that he has personally worked with right away…which is shocking. Stop wearing the heels! 😉
Wow, another great reason to stop wearing heels! They cause the calf muscles to shorten, and the achilles tendon to thicken.
Isn’t Katy awesome? After 6 pregnancies/births/babies, I don’t “sneeze pee”.
You should also encourage readers to check out FIT2BE.US
She has done major research on this and encourages strengthening the abdominal muscles…with all the proper terminology 😉
Lesley, I tried your suggested link and received no result.
Love that you included Katy Bowman. I also recently came across MutuSystem, worth checking out for the base program focusing on the pelvic floor, tummy etc. using squats and other good stuff.
This is a reply to the e-mail sent out about the giveaway and the buyers club. Both links to the buyers club do not work… Just wanted you to know 😉
I’m kinda relieved about the Kegel thing. I hate them but always felt guilty for doing a million a day like my midwife told me to.
Another benefit of peeing in the shower? It’s better for the environment. My husband lived in Brazil for a while and they had a water saving campaign where they encouraged people to pee in the shower. Here is one of the commercials basically saying that everyone does it – men, women, musicians, athletes, aliens, monsters…. Ha, ha. It’s a funny commercial.
Soo this is TMI probably (but then again, this whole post is one big TMI!), but this makes me glad that I loathe public restrooms and toilets, I REFUSE to touch the toilet seat and ALWAYS squat above. Looks like this is a good habit after all (;
Ha ha! I do the same thing! We’ll have to practice at home now, too… 😉
Squatting over the toilet isn’t the same as squatting over a hole in the ground. Squatting over a toilet doesn’t let you relax enough to release all the urine and that can cause other problems. Squatting over a hole in the ground bends your knees and ‘opens’ everything up.
After my first baby..long long LONG difficult home birth posterior baby. I think I was up and moving to much to soon. I had pee pee issues and my hips were off for some time despite all the chiro work. With baby two I walked up till the moment she was born. Labor was quick. Midwife insisted I did not leave the bed for 10 days and then just to sit at the table to eat. Wow…major difference. No pee pee issues, no hip issues. In fact I was back in my pre peggo pants in 6 weeks. I am super happy all my shower pee pees are ok and my primal squatting in the garden is doing something good!
YAYYYY, I LOVE that you know about Katy’s work! What a funny and informative lady. (Just as you are. :-D)
I have begun doing kettle-bells, which I was trained in by a CrossFit instructor a few years ago. The emphasis with this kind of exercise is core strength. During the standard swings I can feel my (very week post childbirth) pelvic floor hard at work. I am working ALL the muscles that need help, including my abs, with these simple exercises. In just a week (doing 5-10 minute daily workouts) I’ve already noticed a marked difference in the strength of my pelvic floor and my badder control. I highly recommend this!
Yay! I no longer feel guilty about not doing kegels. I hate doing kegels! I don’t mind squatting at all. Thanks for this post. 🙂
Oh man, as a women’s health physical therapist I can’t tell you how awful and unsupported this article is. The explanation of the anatomy is just plain wrong, incontinence in post-natal women is NOT just a sped up process of aging and the pelvic floor is a complex area with a lot of dysfunction; kegels (performed properly) are a commonly prescribed exercise, but the gluteals can not do what the pelvic floor is intended to do and they do not pull the pubis and sacrum closer to one another…how could ‘weak’ pelvic floor muscles overcome the skeletal strength of the pelvis? This article is a disservice to incontinent women. And by peeing in the shower does she mean squat while standing anyway??? This is a terrible no that will eventually lead to dysfunctional voiding and pelvic floor hypertonicity. I would love the author of this article to please respond my e-mail and then we can have a phone call before she misleads more mommies. Thank you!
Susannah, this post cites the opinion of Katy Bowman, a well-respected biomechanic scientist.(http://www.alignedandwell.com/katysays/about-2/). I find her explanation of how the gluteals play a role in the function of the pelvic floor to be very logical, and know many women who have benefitted from her recommendations. I suppose we must agree to disagree on this.
Perhaps you should be more specific about the squatting posture. I believe you intend for a squat all the way down, with your butt close to the floor? I like to do about 50 squats every other day to keep my core activated, which may help for incontinence as well.
Anything I’ve read about squatting to help strengthen the pelvic floor says to do a deep squat in the shower when you pee. Deep squats outside of the shower (as a regular exercise program) can be helpful too.
Tracy @Pelvic Guru
Thanks for good info regarding pelvic floor muscles. However, I am concerned about the advice to “pee in the shower”. We must consider the entire urinary system and how it is connected to the brain/spinal cord/urinary reflexes – not just the ability of the pelvic floor to contract and relax. I am a pelvic floor specialist with 14 years experience and I work with women and men dealing with these types of issues every day. Please share this so that women are empowered with full information to make informative decisions about their complete health.
One thing that is not mentioned in this article is that there is a big issue with women and Overactive Bladder. This is a sudden and often urgent need to “pee” and can be associated with leakage due to the overpowering contraction of the detrusor (bladder muscle) against the possibly weakened pelvic floor.
So, why is peeing in the shower an issue? There’s a response that happens in the brain that affects the neurology, urinary reflexes and sensitivity of the bladder. So, if you pee in the shower every time, when you see water or hear water, you are susceptible to INCREASING that response to “gotta go, gotta go, gotta go right now”! I tell my patients to make sure they don’t go in the shower, if they have overactive bladder and/or pelvic floor muscle weakness.
I totally understand that this article is aimed at discussing pelvic floor contractions and biomechanics, but we have to make sure we address the complete pelvic health/urinary/bowel system vs. just mechanics.
On that note- Never do Kegels while urinating. This is a popular thing written in magazines and still shared by healthcare professionals. Though, it can give an idea of how well you can stop the flow of urine, it will also disrupt the normal reflexes you need (and cause pelvic floor muscle issues and possibly retention issues) to go when your bladder contracts and your pelvic floor should relax.
I hope this helps! Here’s a link about other things you should know about the toilet and pelvic floor: http://pelvicguru.com/2012/11/05/toilet-talk-things-you-should-know-but-probably-dont/
That’s an interesting thought, Tracy. Perhaps if a woman steps in, washes her hair, squats to urinate and then continues on with shaving, etc. it becomes a more conscious thing rather than something that is hardwired neurologically. After all, we visit the restroom many times a day in between tasks 🙂
This article reminds me of my trip to China where a majority of their toilets are flush with the floor. If you need to do your business, you would have to do a deep squat over the opening. It’s difficult for me to explain this so try searching “eastern toilet” or “toilets in China” in Google. It feels awkward using these toilets at first but once you get the hang of it, it should feel more comfortable.
So glad to see you connected with Alyce! : ) She’s got so much to learn from!
Thank you for posting this!! I used to work as a receptionist in a Pelvic Health and Incontinence Clinic, and this was a subject a lot of women struggle with, especially after having babies. There are specialists that can work with you if these suggestions don’t help. Look up Physical Therapists that are specifically trained in Pelvic Health. They really are wonderful, and the results I saw in our patients were nothing short of miraculous! 🙂
Very interesting & informative! Mahalo nui loa!
Um…here’s the funny thing…i was JUST talking about this with some co-workers…who are all mothers, and who ALL confessed to having this problem! Then we proceeded to discuss how we do them while we drive! Of course!…not the right thing to do. I REALLY appreciate this!! I don’t want to fear trampolines, or always have to cross my legs when I sneeze…:)
Would this be the reason my butt got flatter after I had my baby? I had a c-section would it affect me the same way?
I’m not sure, Anne! Possibly?
India has the same toilets as China. It is porcelain flush to he floor and you need to do a deep squat. It is different then just squatting over a toilet with the stool mentioned.
As easy as it is to put every one together, people are so different, postural issues are very individual.
While some people may have no glute connection, other people may be squeezing them like their life depended on it! I teach Pilates and see many different muscle patterns. I believe it’s worth seeking help for a person’s individual needs. But generally a very good article, being able to squat is helpful, and the letting go of a muscle slowly also very good advice!
I am close to 60 and squatting hurts my knees. Any suggestions?
I don’t know what the best approach would be, but perhaps Katy Bowman would have some suggestions!
Yroko M. @ Mommy's Fit Life
Kegels are totally over-rated so I’m glad to know that they’re not necessary and that peeing in the shower is actually a good thing!
Oh. My. Bob. I can’t believe it! Well I CAN believe it, which is why I plan to change a LOT of things. practically everything I do! wow!!!!!!!!!!! thanks so much.
Thanks for this post!! Hate to say it, but I needed it! Valuable information.
I am so glad you posted this! I used to work at a Pelvic Health Clinic, and a LOT of women had a problem with incontinence after childbirth and beyond. If you are not having results by yourself, I would highly encourage you to go see a pelvic floor physical therapist in your area. They have biofeedback machines to help you make sure you are doing pelvic floor strengthening correctly and can give you great exercises that enhance all of your muscles that relate. We had great success there for that issue as well as any pelvic pain issues. It’s a great resource to have for a lifetime!
I know this is so late, and I didn’t read much of the comments so I don’t know if this was brought up but… Children squat to use the bathroom when they are in diapers. So it is must be natural movement in order to evacuate because nobody taught them to do this. In fact, we have to teach them not to do this.
I am in the midst of conducting research on pelvic floor strength as it relates to childbirth, incontinence, etc. I’m not super familiar with Katy Bowman, though I did read her article about this, and I must say that I have to disagree with her. First off, the thought of your sacrum getting pulled inwards by a strong pelvic floor is a little hard to fathom as the sacroiliac joint is a fairly fixed joint with minimal movement due to strong ligament support. The sacrum you have in your diagram is out of context because it is seemingly floating with no contralateral forces, when it actually it’s connected with two ilium. Secondly, the reason I’m doing research in the first place is because I have many questions about this myself. I have access to practically any journal article published through my university and I have yet to see a single valid trial that demonstrates Katy Bowman’s argument. In fact the amount of literature that supports pelvic floor exercises to decrease urinary incontinence is overwhelming- to the point that it is hard to synthesize all the evidence coherently into the literature review I’m working on. Thirdly, Katy Bowman referenced “research” that supports her idea, but I was not able to find her references. I’m in the practice of evidence-based medicine, so I would gladly read the literature that she is referring to with an open mind, but I simply cannot find it. If you are able to locate the references, please email them to me.
I read this post originally when posted, then while perusing Katy Bowman’s website was lead back to it- I would be so curious to know if/how you are incorporating her info on natural movement into the Potamus household, I.e. ditching couches, no positive heeled shoes, etc. It’s a little overwhelming for me, plus hubby isn’t totally on board. Curious what your takeaway is and how you apply it 🙂
Hi, I’ m Silvia from Florence Italy, sorry for my english, I’ m a fan of your site and I read you with affections.I was looking for a natural remedis for my boyfriend’ s mama’ s uterin prolapse. Her doctor want make a surgery but I think it’s not good. I think that exercises are one of the anwser to this problem, what do you think about this? And you think that acid alpha lipoic may be good for nerve recondition? I hope you can understanding with my bad english too.Thank you, bye.