​Donald K. Liebell, DC, BCAO

477 Viking Drive Suite 170

Virginia Beach VA 23452 
8:30AM - 6:30PM M,W,F 

(By Appointment Tu, Sat) 


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The Right Exercises for Your Pelvic Floor...

To Reduce Stress Urinary Incontinence, and Help Various Health Problems

   By Dr. Donald Liebell

​​What is urinary stress incontinence? It is minor leakage upon coughing, laughing, or any motion that stresses or puts too pressure on the bladder.  It is actually quite common. 20%-30% of young women, 30%-40% of middle-aged women, and up to 50% of older women have it to some degree.

While urinary drip can increase with age, it is not aging itself that is the cause.  Bladder control problems can result from muscle weakness, spinal injuries, neurological disorders, infection, side effects of medications, constipation, diabetes, and stroke.  Certain foods and drinks may over-stimulate one’s bladder, which may increase volume of urine. This is known as a diuretic effect.  Alcohol, caffeine, some decaffeinated teas, coffee, carbonated drinks, and citrus fruits may contribute.

A Weakened Foundation

Pregnancy and hysterectomy are very common causes of weakening of the supporting pelvic floor muscles.  The pelvic floor muscles function like a hammock that supports a woman’s bladder, uterus, vagina, and rectum.  That is why stress urinary incontinence can occur at a young age.  Anything, including surgery that involves a woman's reproductive system (including hormones) can be a factor. 

Buckling Under the Pressure

If you are overweight, your belly itself may be pressing down on your bladder.  This can certainly contribute to your urinary leakage woes.  Being overweight can also cause excessive stretching and weakening of the pelvic floor muscles.  The same thing often happens during pregnancy.

But… there’s realistic hope for improvement:

A study published in the Journal of Urology found that every five-unit increase in body mass index (BMI) increases your risk of urinary incontinence by 20 to 70%. BMI is a measure of body fat based on height and weight.

Another study published in the Journal of Urology found that women who successfully lost weight decreased their weekly stress incontinence accidents by 65% after one year.

That’s the good news.  

The bad news is the part about having to lose weight!  Losing weight can be extremely challenging.  There are numerous obstacles and factors including thyroid problems, injuries, illness that impairs ability to exercise and/or its effectiveness. 

This is why strengthening the pelvic floor muscles is a must for improving bladder control and strength.

How does one strengthen the pelvic floor muscles? 

Are Kegel exercises the key?

The answer is both yes and no.  Research does indeed reveal that up to 70% of women with urinary stress incontinence, who regularly exercised their pelvic floor experienced improvement.

The intention of Kegel exercises is to strengthen the pelvic floor by strengthening the Pubococcygeus (PC) muscle.  The PC muscle is part of the levator ani muscle group.  These muscles are supportive structures involved in urinary control.  The levator ani group includes the pubococcygeus, as well as the puborectalis, and iliococcygeus muscles.

The levator ani muscles commonly lose strength and function from childbirth, particularly with three or more children.  Women are instructed to get a feel for the muscles used to stop urination, and perform alternating squeezing and relaxing (not while urinating).

Conventional wisdom has revolved around Kegel exercises for the PC muscle.  However, doing only Kegel exercises can make things WORSE!! 

Kegel exercises actually pull the sacrum (base of the spine) inward.  This can result in further weakness of the pelvic floor!


If they’re NOT the right exercise, why then, are they promoted as the cure-all? 

I do not know for certain.  However I do know that conventional wisdom is quite often wrong!

I suspect one of the reasons is that Kegel exercises are a fairly quick and easy thing to explain and recommend.  They are much easier for patients to perform than the truly best exercise for the pelvic floor…


Weak glutes are what makes the pelvic floor more susceptible to stress incontinence. 

In other words... Weaker Glutes + Too many Kegels = Pelvic Floor Dysfunction

If we had to pick one exercise that would be as close to a “cure-all” for many problems…

Squats are it!

   Squats promote a cellular-building environment (anabolic).  This supports muscle building for your entire body.  Squats are perhaps the best functional exercise.  Functional exercises are the ones that make you stronger for real life activities.

   Squats also help you burn more calories… even when you’re sitting still!  Squats build muscle… and for every pound of additional muscle you gain, your body will burn an additional 50-70 calories per day (even while you’re sitting still). 

   Squats are very helpful for injury prevention because they strengthen muscles, ligaments, and other connective tissues. 

   Squats can even help protect you against weight gain, heart disease, and diabetes because they support regulation of blood sugar and metabolism of fats.  Squats can even help reduce cellulite!

   Squats improve detoxification and drainage of waste products from your organs and glands, and can even support bowel regularity.

   If we investigate many cultures where squatting is the norm, we see low rates of knee injuries and back pain.  Our ancestors used to perform many daily functions such as harvesting, gathering, hunting, cooking, eating, etc. in a full squat position.

   The bottom line (yes, pun intended) is that if you want a strong and highly-functional pelvic floor, and all of the health benefits it promotes…you must squat!  Proper technique is essential, so make sure to speak to a qualified health or fitness professional (Yes, I can teach you). 

   Most people have no clue of how to squat correctly. 

   I believe this could be the main reason women are instructed to do Kegel exercises only for urinary stress incontinence.  If you are doing lots of squats, Kegel exercises will be supportive.  I have to wonder how many doctors can or will show their patients correct squatting form (I certainly do for my patients, daily).

   A Whole Lot of Nerve

   A complex interaction exists between the nervous system, the bladder muscles, the urinary tube (urethra), the spinal cord (and its branching nerves), and the brain.  Therefore, any energetic disturbance to these systems may result in stress incontinence and other disorders.

If you would like an excellent chance at reducing or eliminating your urinary stress incontinence problem, I can provide the proven effective electro-acupuncture (1x/week, 30 minutes, 12 weeks), and so much more! Just give the Liebell Clinic a call at (757) 631-9799 on Mondays, Wednesdays, and Fridays.  

​Dr. Donald Liebell

Research Study References

Randomized trial of transcutaneous tibial nerve 

stimulation to treat urge urinary

 incontinence  in older  women

Schreiner, Lucas; dos Santos, Thaís Guimarães; Knorst, Mara Regina.

International Urogynecology Journal, 09/2010, Volume 21, Issue 9

Sustained effectiveness of percutaneous tibial nerve stimulation for overactive bladder syndrome: 2-year follow-up 

of positive responders

Yoong, WA, Shah, P; Dadswell, R; Green, L. 

International Urogynecology Journal

24.5  (May 2013)

Percutaneous Tibial Nerve Stimulation

and Overactive Bladder

Sajadi, Kamran P; Goldman, Howard B,

Current Urology Reports,

09/2010, Volume 11, Issue 5

Posterior tibial nerve stimulation as neuromodulative treatment of lower

urinary tract dysfunction.

66(3):914-918. Van Balken MR, Vandoninck V, Gisolf KW, Vergunst H, Kiemeney LA, Debruyne FM, Bemelmans BL: 

The Journal of Urology


Sustained Therapeutic Effects of Percutaneous Tibial Nerve Stimulation:

24-month Results of the STEP Study

Kenneth M. Peters, Donna J. Carrico, Scott A. MacDiarmid, Leslie S. Wooldridge, Ansar U. Khan, Craig E. McCoy, Nicholas Franco, and Jason B. Bennett

Neurourology and Urodynamics
32:24–29 (2013) 

Cost of Neuromodulation Therapies for Overactive Bladder: Percutaneous Tibial Nerve Stimulation Versus Sacral Nerve Stimulation.

M. Martinson, S. MacDiarmid, E. Black. Journal of Urology

(Volume 189, Issue 1, January 2013,

Pages 210-216)

Cost-effectiveness of percutaneous tibial nerve stimulation versus extended release tolterodine for overactive bladder

 H. W. Chen, R. S. Bercik, E. F. Werner

And S. F. Thung

 Journal of Urology

 2012; 187: 178-184.

Financial Impact of Percutaneous Tibial Nerve Stimulation (PTNS) Treatment [10G]

Harmouche Jihad; Kurdoglu, Zehra MD; Kilic, Gokhan MD.

Obstetrics & Gynecology

May 2017

The efficacy of acupuncture in reversing unstable bladder in pig-tailed monkeys


Stoller ML, Copeland S, Millard AR et al[Abstract 2]

Journal of Urology 

(Suppl. 137), 104A (1987).

Effect of electroacupuncture on urinary leakage among women with stress urinary incontinence: a randomized clinical trial.

Liu Z, Liu Y, Xu H, et al. 

Journal of the American Medical Association (JAMA) 2017; 357: 2493- 501.  

The Efficacy and Safety of Electroacupuncture for Women with Pure Stress Urinary Incontinence:

Study Protocol for a Multicenter Randomized Controlled Trial

Liu, Zhishun, et al.

Trials, vol. 14, no. 1, 2013, pp. 315-315.

Electroacupuncture Improves Bladder and Bowel Function in Patients with Traumatic Spinal Cord Injury: Results from a Prospective Observational Study

Liu, Zhishun, et al.

Evidence-Based Complementary and Alternative Medicine, vol. 2013, 2013, p1-9

Electroacupuncture is Beneficial in Women with Stress Incontinence

Rosenberg, Karen. 

American Journal of Nursing

vol. 117, no. 10, 2017, pp. 61-62.

Effects of electroacupuncture on overactive bladder refractory to anticholinergics: A single-blind randomised controlled trial.

Zhang, J., Cheng, W., & Cai, M

Acupuncture in Medicine

(2015), 33(5), 368.

Multiple Sclerosis Patients with Bladder Dysfunction have Decreased Symptoms After Electro-Acupuncture

Soe, S. H. T., et al. 

Multiple Sclerosis

vol. 15, no. 11, 2009, pp. 1376-1377.

Acupuncture for Overactive Bladder

in Female Adult:

A Randomized Controlled Trial

Yuan, Zhengyong, et al. 

World Journal of Urology

vol. 33, no. 9, 2015, pp. 1303-1308.

Cost of Neuromodulation Therapies

for Overactive Bladder: Percutaneous

Tibial Nerve Stimulation Versus

Sacral Nerve Stimulation

M. Martinson, S. MacDiarmid, E. Black. 

Journal of Urology

Volume 189, Issue 1, Jan 2013, P210-216

Cost-effectiveness of percutaneous tibial nerve stimulation versus extended release tolterodine for overactive bladder

H. W. Chen, R. S. Bercik, E.

F. Werner and S. F. Thung;

Journal of Urology

2012; 187: 178-184.

Conservative chiropractic management

of urinary incontinence using applied kinesiology: a retrospective

case-series report

Scott, C., Rosner A., ​

Journal of Chiropractic Medicine 
(2012) 11,49-57 

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