Train Your Hips for Lifelong Continence

Kegel exercises are not the best way to avoid adult diapers
By Eileen Kopsaftis
Eileen Kopsaftis
Eileen Kopsaftis
July 7, 2021 Updated: July 7, 2021

“Requiring disposable underwear as I age is my personal goal,” said no one ever!

For those over the age of 65 and still living at home, more than 50 percent of women and 25 percent of men report urinary incontinence—and this matter is much more serious than just buying disposable underwear. Urinary incontinence has a profound impact on the quality of life of older people, their subjective health status, and levels of depression.

Incontinence also intimately affects the need for care as family members can be challenged to provide proper skin hygiene. That can put them in a situation where they feel they need to put loved ones in facilities.

No one ever set a goal to go to a nursing home either! Just sayin’.

Is incontinence really a rite of passage as you age? Can you not go below ground without having experienced the embarrassment of leaking when you cough? Since we all want to avoid the need for disposable underwear, it is critical to gain an understanding of true pelvic floor function to address this problem effectively.

Kegel Is Just the Beginning of the Story

Many have heard of Kegel exercises. The main premise of performing Kegel exercises is to consciously squeeze your “bathroom” muscles with the intention of strengthening the sphincter muscles, so unwanted urine leakage doesn’t happen. We must be thankful to Dr. Arnold Kegel for bringing much-needed attention to this very private issue that impacts countless lives; yet, these exercises are just the beginning of the story.

Kegel exercises focus on strengthening the urethral sphincter muscles. The urethra is a tube (with an internal and external sphincter) whereby urine exits the body. The internal sphincter is involuntary, which means you have no control over its function. The external sphincter is voluntary, which means it provides conscious control over urine flow and that’s the goal with Kegel exercises; to improve this conscious control by strengthening the ability to contract this sphincter.

Your Pelvic Floor Is More Than a Sphincter

A healthy pelvic floor is designed to successfully support the organs positioned above it (bladder, prostate for men, uterus for women, and bowel). A healthy pelvic floor will support a full, heavy bladder without leaking, even when there is no bathroom in sight. The major player providing this support is the levator ani muscle group, which is made up of the puborectalis, pubococcygeus, and iliococcygeus. This muscle group is designed to provide a force forward and upward to support those organs. I won’t veer off into the topic of organ prolapse but know this issue is often created by the same impairment, weak pelvic floor muscles.

The main reason Kegel exercises fail to fully restore strength to the pelvic floor is because you can’t think about squeezing your levator ani muscle and improve its ability to support all those organs including a full, heavy bladder. It is designed to work subconsciously, without thinking about it.

The bottom line is you can consciously squeeze your external sphincter till the cows come home but if your levator ani muscle isn’t strong enough to support the weight of your bladder as it fills with urine, you will be buying disposable underwear.

How Your Hips Work to Strengthen Your Pelvic Floor

Being sedentary is directly related to increased prevalence of incontinence because sitting on our backsides for hours will weaken our hips and, ultimately, our pelvic floor. This is a main reason being wheelchair-bound leads to incontinence. Yes, a person can have incontinence because of nerve damage or trauma, a chronic degenerative or neurological disease, or a medication side effect; yet, weak pelvic floor muscles are a very common culprit.

If you look at the muscles in the pelvic floor, you will see the levator ani is connected to a hip muscle called the obturator internus. When it comes to human function, everything is connected to everything else. This hip muscle isn’t just responsible for rotating your leg and helping to stabilize your hip joint, but it also stimulates levator ani activity.

Guess what happens if your hips weaken due to injury, or being non-weightbearing from a knee or ankle issue, or from years of prolonged sitting? Your obturator internus stops stimulating your levator ani muscle, and strength in the pelvic floor decreases slowly and steadily. Then one day, without warning, you cough or sneeze or jump down a step and wham—you leak. Or one day, you feel the urge to go to the bathroom and shockingly leak on the way there.

The Best Exercise to Strengthen Your Pelvic Floor

The best exercise to stimulate and strengthen the levator ani muscles is to work the hip rotation muscles in weight bearing. That weight can be your own body. Weight bearing allows you to benefit from something called ground reaction force and gravity as you naturally restore strength in the levator ani muscles. When doing the right training for these muscles, improvements are often seen in just a few weeks. Since the pelvic floor is an important part of the pelvic core, sports performance is also enhanced with this type of focused training.

Of course, it is always a good idea to seek out an expert to be sure you don’t hurt yourself or aggravate an existing condition before embarking on a new exercise routine.

Restoring optimal strength to the pelvic floor muscles is necessary to resolve pelvic floor issues. This can’t be done with Kegel exercises because these exercises don’t account for the truths in human movement. These human movement truths, when followed, provide authentic function that:

  • Is natural. We don’t lay on a table (as many do with Kegel exercises) when we live real life. We walk, run, climb stairs, and get in and out of cars, etc.
  • Complies with gravity and ground reaction force. These forces are what work to stimulate healthy muscle function.
  • Leverages mass and momentum. Neglecting this will inhibit success.
  • Trains the body in three planes. We move forward and back, side to side, and turn right and left. Training in just one plane breeds failure.
  • Elicits a reaction. Muscle reaction to motion is more important than creating said motion.
  • Facilitates joint proprioceptors, which tell the brain how your body is moving. Moving more body parts enhances this, sitting or standing still inhibits this as your proprioceptors are concentrated in your joints.
  • Creates subconscious reactions. Muscles need to be able to react properly without the need for conscious thought.
  • Promotes transformation versus stagnation. Muscles must adapt specifically to opposed demand.
  • Enables mobility and stability. Muscles must provide both strength and control of motion.
  • Provides success, internal locus of control, and relevance. Achieving steady progress, gaining control of the issue, and knowing the work being done is relevant to the problem brings joy to life.

Kegel exercises omit these truths from the equation. The question to ask is why can’t the muscles in the pelvic floor activate as needed? What is inhibiting that function? It is imperative to ensure your whole body is functioning well in all three planes of motion so you will not have any unpleasant surprises as you age.

Hopefully, you now understand incontinence isn’t an age-related issue; it’s a mobility and functional strength issue. Medical interventions may address some of the symptoms, but they don’t restore proper strength to the pelvic floor. Thankfully, the right training can.

Eileen Kopsaftis is the founder of An eclectically trained physical therapist, nutrition educator, and bestselling author of the book, “Pain Culprits!,” her passion is to empower people with the knowledge and training to move without pain and age well into their 90s and beyond. 

Eileen Kopsaftis
Eileen Kopsaftis