If you leak urine while jumping, lifting, throwing, or running, then you are experiencing pelvic floor dysfunction. Urinary incontinence is a common and fixable condition, but it requires that you take action just as you would with any other injury. It is important to recognize that bladder leakage during physical activity is common, but not normal.
Recently, leaking urine has become somewhat of a badge of honor in certain fitness circles. The party line for some high intensity fitness programs has become “if you aren’t peeing, then you aren’t lifting enough”. The long term effects of exercising in a manner that forces urine leakage can have serious and long lasting side-effects.
Urine leakage during physical activity is a product of imbalance of forces within the thorax. Specifically, forces in the body above the bladder exceed the strength of the pelvic floor muscles. This may be due to weakness of the pelvic floor muscles, which can happen as a result of heavy impact on the body. This is commonly seen in gymnasts, runners, or athletes who jump repetitively such as track and field athletes or basketball players.
Leakage can also be caused by holding your breath during exertion, as is commonly seen in weight lifters or during high force activity such as swinging a bat in softball or racquet in tennis. The reason is the thorax is like a high pressure canister. The lid to this canister is the diaphragm and the pelvic floor is the base. If you hold your breath during exertion such as lifting, the pressure remains in the thorax and is thrust downward onto the pelvic floor. This pressure is relieved by exhaling during the exertion move, and the pressure is released upward and out of the thorax.
Image via RHP Physiotherapy
In order to strengthen the pelvic floor muscles, it is necessary to contract them properly, and train them to be strong enough to withstand the forces that your activity demands from your body. There are many ways to do a Kegel, however if you are leaking urine, it is important to strengthen the muscles specifically around the urethra.
This is done by imagining that the urethra is a telescope, and you want to pull that telescope up and into your body. Do not contract the gluteal muscles (your butt, i.e. the muscles that you sit on). You should feel the contraction similar to the action of shutting off the flow of urine. Practice isolating these muscles while lying down, sitting, and standing. Begin by holding the contraction for 5 seconds, for 10 repetitions, 3 times per day.
Progress these by adding resistive training and performing kegel exercises with weights. The keys to gaining pelvic floor strength are consistency and using progressive resistance. Without consistently training your pelvic floor muscles, you will lose the strength and control you've gained. Without using progressively heavier weights, it is difficult to make significant improvements without doing 80-100 kegels per day, which is often the prescribed regimen. The problem with doing that many kegels each day is that it takes a great deal of time and energy, and you have to be dedicated to do it!
The very nature of having the weight inside the vagina cues the pelvic floor muscles to activate and contract to keep the weight from falling out. This not only improves strength but awareness of the muscles themselves. You can train the pelvic floor muscles for improved endurance, which is needed for most sports, as the muscles can fatigue with physical activity and result in leakage. Endurance training is done by placing the weight into the vagina, getting dressed, and performing easy, light chores such as showering, dishes, or preparing an easy meal.
Strength training for heavy exertion such as lifting, or power moves can be trained by placing the weights and performing various exercises. This can be done by doing the following with the weight in the vagina:
When we jump or shift weight, we often do so off the ball of the foot. This exercises begins to train the body to contract the pelvic floor when body weight is shifted onto the ball of the foot.
Stand up tall and bring one leg out to the side. Repeat 10x, perform 3 sets, then switch.
Perform a 45 degree squat, 3 sets of 10 repetitions.
Perform a kegel while gently pulling the cord away from your body, forcing your muscles to hold the weight inside in an eccentric contraction. Though this does not seem like much of an exercise, the nature of elongating the muscles while they contract is very challenging for them. 1 set of 10 repetitions is sufficient.
Add in extra body movement including exercises like yoga, pilates, a brisk walk, elliptical machine, or anything that encourages your legs and deep core muscles to activate for approximately 15 minutes with the weight placed.
Above all, remember that the same training that is used on other muscles can be expected of the pelvic floor muscles. You won’t be cured of urinary leakage overnight, but after a few weeks you will notice results.