Do you think it’s normal to pee your pants during exercise? You are not the only one. Barb shared her story with me during her first pelvic floor physical therapy visit. She didn’t understand why she had never heard of pelvic floor physical therapy before. She was surprised that help was even available after tolerating years of peeing her pants during exercise.
Barb always made sure she wore her black leggings when going to her Zumba class. She knew at some point during the class, especially when the jumping started, that she would pee herself. For added protection from being embarrassed, she would arrive a little early to make sure she could get a spot in the back of the class.
When she told her doctor about the leakage, he would dismiss it as “part of motherhood” from having 3 kids. It even seemed to be a running joke with her friends that admitted to peeing a little when they sneezed or laughed.
It didn’t seem like a big deal at first, but the leakage was becoming worse over time. Not just with Zumba class, but when carrying groceries inside the house, or even just standing up sometimes. When she saw the diaper commercials on TV, she couldn’t help but wonder if that was going to be her future…
This is actually based on a true story. I work with women all the time who are struggling with leakage issues. Unfortunately many of them think they just have to live with it.
But this is simply not true!
Leakage is more common among women than you think. It is estimated that 1 in 3 women experience leakage. It hits all ages, from teenagers, young athletes, new moms, older moms and grandmas.
We will talk about leakage with exercise in this blog. If you experience leakage with that “gotta go gotta go” feeling also knows as urge incontinence, check out my blog with helpful advice here..3 Ways to Train Your Bladder Like a Boss
What Causes Leakage With Exercise?
In some cases having weak pelvic floor muscles, otherwise known as the “kegel” muscles, can contribute to leakage. This can happen after having babies, or as we get older there is a loss of muscle tone along with hormonal changes that can affect our pelvic floor strength.
Sometimes having pelvic floor muscles that are “too tight” or clenched from either habit, stress, or perhaps from current or past pain, can also contribute. This includes those who have a habit of sucking in their stomachs. If we are squeezing our stomachs in, the pelvic floor muscles are staying contracted as well.
Other times it can be related to our posture, especially while under load such as during weight lifting. It can also be from techniques we have developed when exercising, such as with holding our breath.
Let’s talk about our breathing as the first tip to help prevent peeing during exercise.
Do not hold your breath. Now I realize that if you are doing workouts such as CrossFit and you are lifting heavy, that strategies involving holding your breath can be used to complete the lift. However for the person that does not lift that heavy, simply learning to exhale while completing the resistance part of the exercise will help minimize the pressure along the bladder that contributes to leakage.
When you hold your breath you build up what’s called “intra-abdominal pressure.” Go ahead and hold your breath, what do you feel? Do you free pressure down vaginally, or like you may have a bowel movement? When you do this while under load as with lifting weights, this places pressure along the pelvic floor muscles. This can cause a strain along those muscles, and in turn they are not able to do their job to lift and support the bladder to prevent leakage.
Avoid Butt Tucking. An example of this is when doing a squat.
Many have been taught as you come up from a squat to tuck your butt underneath. This could potentially cause leakage as this motion can cause downward pressure onto the bladder. Coming up into more of a neutral position from the squat position may be best in relieving pressure, thus minimizing or eliminating leakage.
photo courtesy www.JessieMundell.com
When performing standing exercises with resistance, try and keep your “ribs stacked over your pelvis”, meaning more neutral position with your spine (as with picture on the left) versus butt tucked under (picture on the right). This could include standing exercises such as triceps, overhead presses, or even while sitting using machines at the gym.
Incorporate the Pelvic Floor Muscles During Exercise
Before we put all this together, let’s look at how to do a pelvic floor contraction.
Doing a correct pelvic floor muscle contraction will help you to be able to support the bladder during exercises. Sometimes women think they know how to how to do a pelvic floor muscle contraction, also known as a “kegel,” when in fact they do not. They may engage their butt muscles or inner thighs instead.
Here are some cues that might help you correctly “find” the pelvic floor muscles:
- Imagine there is a marble outside the vaginal opening. As you contract the pelvic floor muscles you imagine bringing this marble up inside the vagina, then to relax the muscles you want to let the marble “release” back outside the vagina.
- Imagine lifting a tampon inside the vagina.
- Visualize the motions of a jellyfish. Contract the pelvic floor muscles as when a jellyfish moves upward, relax the muscles as how the jellyfish moves downward.
- Imagine there is a straw inside the vagina, and you are using that straw to drink.
Techiniques to Stop Leakage During Exercise
When doing a squat-first inhale, keeping the abdomen and pelvic floor muscles relaxed. Lower into your squat keeping your knees over your toes and weight along the middle part of your feet. By shifting your weight along the middle part of your feet versus the heels, you will get a better engagement of the pelvic floor muscles.
As you stand up, exhale while contracting the pelvic floor muscles, keeping the muscles engaged while standing back up.
When working out doing squats with added weight you can use the same technique:
As you hold weight as with a kettlebell in front or a bar resting on your shoulders, inhale on the way down, exhale with a pelvic floor contraction on the way up.
If you are doing standing overhead presses with a bar or free weights, exhale and engage the pelvic floor as you complete the overhead lift.
If doing lunges with free weights by your side, inhale on the way down, then exhale on the way up as you engage the pelvic floor muscles.
A great source for athletes including the Cross Fit Community is https://thepregnantandpostpartumathlete.com
Additional Tips During Resistance Training
Exhaling during the resistive part of the motion you are doing prevents you from holding your breath, which could potentially place pressure downward vaginally that could cause leakage.
Make sure you are relaxing in between reps of exercises. Some women think if they contract the pelvic floor muscles the entire time during exercise they can stop leakage. The muscles have to let go and relax so they can contract and do their job. Keeping the muscles clenched the entire time can actually cause leakage.
Slow down if needed to relax in between reps.
No butt tuck at the end of the squat, come up into a neutral position.
With activities such as running you do not want to be doing pelvic floor muscle contractions during the run. The body will know what to do automatically as long as there is some underlying pelvic floor strength. For more info check out my blog for Runners that leak here
Want more advice on stopping leakage with exercise? (including jumping jacks) then download my free e-book found on my website titled How to Exercise Without Peeing Your Pants
Then of course to get individualized solutions to stop leaking during exercise…
See a Pelvic Floor Physical Therapist
A pelvic floor physical therapist can check to make sure you are contracting the pelvic floor muscles the correct way. We can also watch you exercise to see what needs to be “tweaked” a bit to help minimize or eliminate leakage.
You may be thinking it’s no big deal if I leak a little here and there. But if you do nothing about it now, chances are it will worsen over time, and will become more frequent.
Remember Barb’s story? She had success with pelvic floor Physical Therapy and ditched wearing only black leggings to Zumba.
Now Barb doesn’t worry anymore about peeing her pants during exercise.
If you want to find out more how physical therapy can help, please give me a call for a free phone consultation. I would love to help you!
Owner Indy Women Physical Therapy