Pee during your workout?

by: Bri McCormick PT, DPT Pelvic Health Specialist

There is a fix for that!

I think every girl grows up hearing about this happening. Or thinks of what I endearingly call the ‘little old lady syndrome.’ You know, the vision you have of your grandmother or mother needing to go to use the restroom every 30 minutes. Or how you cannot take a road trip without stopping at every gas station. What about the vision you have of laughing so hard you pee your pants? Or ‘leak’ every time you sneeze?

I used to think that this was only something to worry about when you got older or after you had a few kids. Yes, this is true, you are more susceptible to having urinary incontinence (unintentional urine leakage) later in life and after you have delivered a baby; however, it is also very common in nulliparous women (or those who have NOT had children). I actually was shocked to hear how common it was in gyms, with athletes and younger women who have not had kids.

High-level sport appears to be a significant risk factor for incontinence in healthy young women (Vitton 2011)

Certain studies estimate that approximately 51% of women in the US over the age of 20 experience urinary incontinence on a regular basis. (Markland 2011).

Furthermore, it is estimated that 14% of women between the ages of 21-26 experience urinary incontinence (UI) during sport and exercise. This percentage continues to increase with age reaching 40% of those aged 48-53 years old. (Brown 2001).

Do you think these women avoid the activities they know will cause leaking? Of course they do! Or, they do what’s worse: buy pads so they can continue working out even with leaking. UI is underdiagnosed and undertreated, and only 30-45% of women with incontinence seek care (Huang 2006, Burgio 1994).

High impact activities may contribute to weak or under active pelvic floor muscular dysfunction and UI even in fit young women (Figuers 2008, Docktor 2007, Nygaard 1994)

I am happy to say there is a fix for these problems and much more with the help of properly trained physicians and physical therapists.

The vast majority of my clients tell me that they have never heard of ‘pelvic floor physical therapy.’ Or that they did not realize this was even a field of expertise.

In general, physical therapy is the assessment and treatment of musculoskeletal disorders or those diagnosis that affect the musculoskeletal system. Pelvic floor physical therapy is the treatment of any diagnosis or dysfunction that affects the musculoskeletal system of the pelvic floor.

What is your pelvic floor?

The pelvic floor is the “compound structure which closes the bony pelvic outlet” (Messelink 2005). So… what does that mean? It is the bones of the pelvis, pelvic floor muscles, fascia, ligaments, and tendons, peritoneum, as well as the viscera; AKA, anything that holds things ‘up and in’ the pelvis.

The muscles in the pelvic floor are considered part of your ‘deep core’ and has many functions you may not realize. One of which is keeping you continent (not peeing during your workouts!) The pelvic floor muscles are designed to contract ‘upwards and inwards’ when there is a need to support your trunk or with a rise of pressure within your abdomen.

When you have this increase in intraabdominal pressure, it can put stress directly on the bladder, pelvic floor, and other sensitive tissues. When does this intraabdominal pressure increase occur? Lots of times! Think about when you cough, sneeze, lift weights or even repetitively lift your kids. It occurs any time you use your core or abdominal muscles and significantly increases at any time you hold your breath.

Holding your breath in a specific way to create what is known as ‘Valsalva’, or increased pressure within the abdomen can be a useful tool in lifting weights at the gym or during your CrossFit routine. But this is only effective and safe when your body is able to manage that pressure built while holding your breath. If you have a weakened pelvic floor for whatever reason, this can cause a huge push against your bladder and other organs putting you at risk for leaking or even prolapse or a hernia.

If you experience leaking during working out, coughing, sneezing, you most likely are experiencing what is called stress incontinence. This is because the amount of intraabdominal pressure, or ‘stress,’ put on your bladder, pelvic floor, and surrounding structures is too much for your body to manage. It is at this point you leak urine.

Unlike what most of us ladies are told and although it is extremely common, urinary incontinence is not normal and can be fixed!


See a pelvic floor physical therapist!

It is important to consult your primary care physician or regular OBGYN to make sure there are no other underlying problems. However, if the only issue is pelvic floor muscular dysfunction, that can easily be assessed by your highly trained pelvic floor physical therapist.

Once your therapist assesses your pelvic floor muscle performance, you will be taught proper exercises and techniques to support this area of the body to get you back to doing whatever it is that you love! This is going beyond doing the typical ‘kegel’ regimen most of us hear about. Did you know that almost 20% of women perform these incorrectly? (Henderson 2013). Because of this, it is important to have proper assessment and treatment to fix this support problem. A good therapist will not only teach you how to control the muscles of your pelvic floor but integrate this new skill into your workout or daily routine to give you full function and most importantly stop any incontinence.

If you are experiencing incontinence during your workouts, your body is telling you that you do not have enough support to be doing what you are doing. Not only is this dangerous to your pelvic floor, but for the rest of your body including low back, pelvis, and hips. These symptoms and ultimately the strain on your body can continue to get worse if not corrected and can lead to significant problems in the future.

If you are noticing even small amounts of leaking during increased activity level, coughing, laughing, or sneezing, please seek out a medical professional who is trained specifically in this specialty so you can return to moving safer, smarter and stronger.


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