Last week, I shared some thoughts, or what others might consider a rant ;), on my Facebook page regarding urinary incontinence during exercise.  I’m sure that most of my friends on Facebook saw the post, read the first few lines, rolled their eyes, and thought “there she goes again getting up on her soap box”.  And it’s a shame because although incontinence isn’t a very sexy or interesting topic of discussion, it’s one nonetheless that all of us ladies (especially those of us that are pregnant or have had babies) need to be aware of because it can and does happen to the best of us!

Just recently, I met with a postpartum mama because she was looking for help regarding how to get back into exercise after the birth of her baby.  At one point in our discussion, I was sharing with her that some exercises, if done too soon after childbirth, can have too much impact on the pelvic floor unless you have restored the function of the core and pelvic floor.  This Mama has been doing some pretty intense exercise activity without any core and pelvic floor restoration work, and I saw the light bulb go off in her head.  She asked me: “Is that why I leak when I exercise?”  

Later on that day, I came across a Facebook post that had tagged one of my friends (a mother herself); it was an advertisement for “pee-proof underwear” to protect athletes against leaking while working out.  A few other women (also women who have birthed children) chimed in on the post and made some comments like “I need these for pretty much every exercise/workout” or “Now, I have no excuse to avoid certain exercises”.

I get…I really do!  Most women have no idea that this type of issue can be resolved because no one ever talks with them about it. They may feel too embarrassed to even bring it up with their healthcare providers, or they simply chalk it up to just being “par for the course” with having babies because that’s what’s been impressed upon them by other women! 

I share these types of posts because I care about the health and well-being of my fellow ladies.  I want you to be informed, and to know that you don’t have to suffer in silence with this condition, that there is a way to fix it, and NO it’s not just one of those things that comes with being pregnant and having children. 

So, if you leak — even just a tiny bit — when you cough, sneeze, laugh,  jump, run, do a box jump, skip rope, do double- unders, or lift weights, know that there is hope, and you don’t just have to consider it as a “fact of life”.  Besides, wouldn’t you rather fix the problem, so that you can truly enjoy your workouts again…hell…enjoy living again, and not have to worry about leaking yourself with every little move you make?

You should understand though that fixing urinary incontinence is not a one-size-fits-all approach because what is causing it for one woman may not be the exact reason why another woman is experiencing it. 

What exactly is Stress Urinary Incontinence (aka SUI)?

Stress incontinence is the leaking of urine (even in small amounts) during activities that increase pressure inside the abdomen and push down on the bladder.  SUI is the most common form of incontinence in women under the age of 60.  It affects approximately 15 million U.S. adult women, and about 1 in 3 women experience SUI at some time in their life. Furthermore, women will wait an average of 6.5 years before seeking any kind of professional help for their incontinence problems.

What Causes Stress Urinary Incontinence?

As I touched on this a bit earlier, pregnancy and childbirth are some of the more common factors that can contribute to SUI.  Pregnancy and childbirth can stretch and weaken the pelvic floor muscles that support the urethra and help to keep it closed and prevent urine from leaking out.  There are also other that factors that can weaken the pelvic floor muscles/ and or increase pressure inside the abdomen such as the loss of pelvic muscle tone associated with menopause and aging, a hypertonic (overactive) pelvic floor that cannot fully relax (also very common in highly active women), hysterectomy, nerve and muscle damage from birthing or surgical trauma, obesity, chronic coughing due to smoking, lung disease, and other respiratory complications, anatomical predisposition, and repeated heavy lifting or high impact sports.  Yes…even elite athletes are predisposed to stress urinary incontinence…as we are all periodically reminded by the viral CrossFit video poking fun at women who leak during exercise.

There’s More to the Story

Hopefully by now, you are beginning to understand that it’s not OK to leak urine when working out (or coughing, sneezing, or simply moving about daily life).  Another thing for you to keep in mind is that the leaking in and of itself is a sign that there is something bigger going on with your body.  Your core and pelvic floor system is breaking down, and the pelvic floor just happens to be the place where the symptoms behind the problem manifest the most.  While we want to stop the leaking of urine, we also want to find out what’s going on in your body that’s causing the leaking and address and correct that as well. 

Women’s Physical Therapist, Julie Wiebe, PT, helps to explain what’s really going on behind the leaking:

“Incontinence is just one way of identifying a pelvic floor insufficiency. It is a signal that an imbalance in the deep core exists. The deep core is a closed-pressure system, and insufficiency in any component will impact the capacity of the whole.”

 Well…I Don’t Leak, So I’m Good…Right?

Not so fast!  To quote Julie Wiebe again: “A female athlete may not be incontinent, but do they have any hip pain? Or low-back pain? How about osteitis pubis? Pain, joint instability and incontinence are all just signals that the system as a whole needs attention.”

So to add to Julie’s point, you may want to reconsider how you have been treating that nagging pain in shoulders, upper back, in and around your knees, hips, and lower back both during and after your workouts.  It could very well be related to weak and/or uncoordinated core, pelvic floor, and hip muscles.  That’s why it’s best to seek an integrated approach to resolving your pain and identifying the root of the cause of the issue for you.

Also, some other signs that you may be suffering from core and pelvic floor instability:

  • Avoidance of certain exercises like double-unders, box jumps, heavy squats, deadlifts, running, etc. Remember we talked about that earlier? 
  • Limiting the amount of water you consume before or after a workout in order to keep the bladder empty. Probably not the best thing to do considering the risk of dehydration (especially during pregnancy), and the fact that dehydration/very concentrated urine can irritate the bladder and cause urgency even more.
  • You have to run to the bathroom immediately before you do any type of high impact exercise like running, box jumps, or double-unders.

Things That You Can Do To Help Your Situation

Seek Help

You will want to find a physical therapist in your area that specializes in women’s health, understands the pelvic floor, and is trained in performing internal exams.  If you need help locating someone in your area, please feel free to use the following link to locate a practitioner in your area:

http://www.womenshealthapta.org/pt-locator/

Get Your Alignment Right

I know I talk about this A LOT!  However, it’s because this is the sound foundation from which we build a solid, stable, and properly functioning core and pelvic floor.  Now, I realize that you aren’t going to be able to be in perfect alignment all the time, but know that the more you can keep yourself in good alignment the more well managed intra-abdominal pressure will be.  So again, let’s review what good alignment looks like:

  • Sitting or standing tall with your shoulders SLIGHTLY drawn back.
  • Rib cage stacked over your hips. No flaring of the rib cage like a solider or pulling the rib cage in so that you begin to round through the upper back.
  • Natural curve in your lumbar spine.
  • Tailbone untucked, not clenching your glutes.
  • Feet about hips’ distance apart.

Master Core Breathing

First and foremost, please know that the answer to pelvic floor issues and SUI is not always to do “more Kegels”, despite what you may hear from the news, your friends, popular health and fitness publications, heck…sometimes even your own doctor.  While they do have their place in regards to your pelvic floor health, it’s more “complicated” than that.  Instead of just learning how to contract the pelvic floor in isolation, you need to learn instead how to coordinate proper breathing mechanics in conjunction with both the activation and contraction of the core and pelvic floor muscles.

One way to do this is to get into a deep squat.  Let yourself inhale and completely let your pelvic floor relax and expand at the bottom of your squat.  Then as you prepare to stand up, exhale and lift the pelvic floor up and you ascend out of the squat. 

You will always want to inhale and relax through the pelvic floor on the easiest portion of every exercise, and then exhale and contract/draw up the pelvic floor on the hardest  portion of every exercise or right before impact. 

Train “Unsupported” & With Perfect Technique

Yes, I understand the reasons why athletes wear wraps, belts, braces, and other types of supports in the gym, and I believe there is a time and a place for them.  However, I prefer to see my clients relying on these types of things as little as possible.  Here’s why:  a weight belt or wrap is designed to be worn around your belly and back as a means to support and protect the lower back.  The way in which you are usually taught to use a weight belt is to fill your belly with air so that it pushes out against the belt.  That way you essentially create a “pressurized” container with your abdomen to support the lower back.  However, when you do this you create a HUGE amount of intra-abdominal pressure which does in fact help to stabilize the spine and pelvis, but most often at the expense of your pelvic floor. 

I mentioned that your core becomes a “pressurized” container in this scenario.  Keep in mind that all pressurized containers have a release valve in order to balance out the pressure inside, and your core is no different in this scenario.  In order to control that pressure, it has to be released somehow and this is usually through the weakest point in your body.  The belt isn’t the weakest point because of the material it’s made of.  Your abdominals and lower back are bracing hard and being supported by the belt so the pressure isn’t going to escape from these areas.  The diaphragm is a very strong muscle as it controls our breathing, so the pressure won’t escape from there either.  So the last option is for the pressure to escape via the pelvic floor because these muscles are the smallest of the group and have the least amount of surrounding support. Therefore, the pelvic floor bears the brunt of this huge amount of pressure and can begin to stretch and weaken as a result.

Another reason why I prefer my clients to train most often without any external support is to help them learn how to train and improve their weakest link.  Think about it…if you’re always wearing some type of support system, you’re never really giving yourself the chance to improve and work through any of your own physical limiting factors.  For instance, if you find that your back starts to round under any sort of heavy squat or deadlift, then you need to step back and drop that weight down to an amount where you are able to maintain a nice neutral spine position…regardless of how strong your lower body may be. 

So for the purpose of this article, if your pelvic floor happens to be your weakest link, then you need to step back, do a little investigation work, and pull the throttle back on the workout intensity.  On a side note…a lot of these high impact exercises are ones that you should hold off on during pregnancy and for some time post-pregnancy!  If your workout calls for a large repetition number of squats, deadlifts, box jumps, double-unders, burpees, etc., then ask yourself how many of these can you do BEFORE you begin to leak?  Instead of going all out with your effort, intensity, and repetitions, break the work up into small and manageable chunks or sets with lots of rest in between.  For example, instead of attempting to do 35 double-unders all at once, and you know that you will begin to leak usually around the 10th one, opt instead to do a set of 7 double-unders for 5 total sets with lots of rest in between each set.

 Train Those Glutes

Many women tend to stand with a posterior pelvic tilt (tailbone tucked under and glutes clenched)…especially postpartum women. A posterior pelvic tilt causes the sacrum/tailbone to move forward which causes a “slack” in the pelvic floor muscles.  Building a set of strong glutes will help to counterbalance that slack by pulling the tailbone back into optimal position again.

 Don’t Neglect Your Stretching & Mobility Work

When your pelvic floor is weak, sometimes your body will try and compensate for this weakness by using the glutes and inner thigh muscles to help keep the bladder closed.  How many times have you caught yourself crossing your legs when you have to pee really badly and are waiting in line to use the restroom?  This constant gripping and tensing of these muscles can cause them to be chronically tight which can lead to more problems.  Be sure you stretch and do mobility work for your glutes, hamstrings, inner thighs, and calves.

Be Patient With The Process

Most of all…it’s going to take some time to learn how to reconnect this system again.  Have faith and be patient with your body. 

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