Updated: Feb 20
You are not alone.
Bladder leaks during workouts are common, especially during high impact exercises like aerobics, running & some exercises in boot camp or CrossFit, especially those involving jumping, lifting, or skipping. This is known as Stress Urinary Incontinence (SUI) & although this is common, it is not normal, and you can do something about it. This ‘something’ almost certainly involves addressing any pelvic floor issues you might have!
So, what is the pelvic floor?
The pelvic floor is a bowl of muscles in the base of the pelvis.
It has several different functions:
• It is an important postural muscle for the spine and pelvis.
• It is the muscular support for the pelvic organs – the bladder, uterus & rectum
• It is essential for continence and forms the sphincters that help keep the bladder & anus closed. It also helps to support the bladder neck when intra-abdominal pressure is raised, preventing urine leaking.
• It has an essential role in sexual enjoyment & orgasm.
If you leak when you are exercising, the pelvic floor is not doing its continence function properly & it is likely struggling to support the bladder neck against the rise in intra-abdominal pressure when you jump or do other exercises.
What can I do about it?
Many people cope with this SUI by wearing black leggings or a pad for exercise, by emptying their bladder before, or restricting their fluid intake while they are exercising or even stopping doing certain exercises which make them leak. This might keep you dry and make your SUI symptoms better, but eventually, you will begin to leak again with much less challenging exercises. You need to address the root of the problem and not just the symptoms!
Strengthening the pelvic floor muscles is the first place to start. The exercises should be done regularly, three times a day is recommended, and it can take a little time to see results. Doing pelvic floor exercises is often seen as the solution and is an excellent start, but it is often only part of a more complex solution & this is because:
• The pelvic floor does not work in isolation – it works with the diaphragm and the deep abdominal & back muscles.
o These muscles all need to work together as a team.
o Quite often, it’s not as easy as ‘just tightening your pelvic floor’ as you need to consider your breath – are you breathing?
o What are the other muscles in the system doing? For example, are you over gripping with your abs.
o We need to consider all the muscles in the system, not just the pelvic floor!!
• The pelvic floor itself may be over tight & gripping – a tight pelvic floor that won’t relax is almost as bad as a weak one, and it certainly won’t be functioning correctly!!
• Also the pelvic floor might not be contracting at the right time during the correct part of the activity, affecting your continence.
• There might be other pelvis issues such as pelvic organ prolapse or fibroids, which would also impact continence. So it’s often not as simple as just doing pelvic floor exercises, but it’s an excellent start to put them in your daily routine.
How do I do My Pelvic floor Exercises?
For the basic pelvic floor contraction, it is useful to exercise sitting upright on a firm chair. As you get better at this, you can do it standing up and then incorporate it into your daily activities & exercises:
The pelvic floor exercises comprise two parts – slow contractions & fast contractions.
An App ‘NHS Squeezy’ is available on the app stores for around £2.99, which can be a useful companion to exercising.
Tips for addressing those leaks
• Start your pelvic floor exercises –
o Make sure you are doing them in a functional position. Start doing them sitting but progress to STANDING UP.
o Many people only exercise their pelvic floor when they’re sitting down – in the car/at traffic lights etc. which is NOT FUNCTIONAL!!
o You run standing up and do most of the exercises that cause you to leak standing up so you should strengthen your pelvic floor in that position!!
• Make sure you BREATHE!!!
o Sounds obvious, but you should not be holding your breath while doing the pelvic floor exercises (or while you are doing your exercise programme).
o Holding your breath is often a sign of a weak & dysfunctional pelvic floor.
• If you have any doubts as to whether you are contracting your pelvic floor correctly – get it checked by a womens health physiotherapist – research has shown that 40-60% of women do their pelvic floor exercises wrong and the only way to make sure you are doing them correctly is to have an internal examination – this isn’t as scary as it seems and most women I examine say it is an extremely useful & illuminating experience and can easily identify if you have any weakness, asymmetry or over activity/tightness in your pelvic floor muscles.
So start today:
• Remember, leaking urine is not normal, and you can do something about it!
• Download the NHS Squeezy App & get going on your pelvic floor exercises, making sure you do them regularly (3xs a day)
• If you are unsure about any of the exercises or how to progress them to be more specific to your needs:
o would like more advice on any other incontinence problems, such as managing urinary urgency or urinary frequency.
o or have any questions about prolapse,
o come and see us at Chichester Physiotherapy & Pilates for a full assessment.