Why Does Exercise Cause Leaking?

crossfit exercise leaking stress urinary incontinence women's health women's physical therapy Jun 15, 2023

Ladies, does this sound familiar? You’re on the weight lifting platform attempting a new deadlift PR when, midlift, you pee a little. Or you’ve stopped doing double unders because they kept making you leak and you don’t want to go through that embarrassment again. Or your kids want to jump on the trampoline with you, but you turn them down, again, because you know every time you jump on that thing it makes you pee. You’re not alone.

41% of female athletes experience leaking, also known as urinary stress incontinence. It’s even more common among powerlifters and weightlifters with studies showing 50% of these athletes experience urinary stress incontinence. BUT it doesn’t have to be this way. There are things you can do right now to start decreasing your embarrassment and start getting back to those big lifts. 

First let's touch on what urinary stress incontinence is and what causes you to leak. Urinary stress incontinence is a leakage of urine during moments of physical activity that increases abdominal pressure, such as coughing, sneezing, laughing, or exercise. 

Let me introduce you to your abdominal cavity. At the top you have your diaphragm, at the bottom you have your pelvic floor muscles, in the back is your spine, in the front are your abdominal muscles, and in the middle are your lungs.

Together these things create and manage your intra-abdominal pressure. This pressure is super important. It is what helps to stiffen your spine when you brace during a heavy lift and is a big part of what helps you clear your throat when you cough. It also has a huge role in helping women deliver babies. 

Complications occur when this pressure increases to a level that your muscles aren’t strong enough to manage. 

The pelvic floor is comprised of a group of muscles, a couple of which are super important in controlling the flow of urine through your urethra. 

When the pressure inside your abdominal cavity increases it pushes on your bladder. Typically, your pelvic floor muscles contract to ensure that the increased pressure does not cause any leaking. But, say you’ve had a baby, things like childbirth can really weaken your pelvic floor muscles. When your muscles are weak they aren’t able to counteract high levels of pressure. It’s all a game of balancing pressure. If you increase the abdominal pressure above what your muscles can handle you’re going to leak. Stress Urinary Incontinence (SUI)

 There are 2 ways to manage this.

  1. Decrease the pressure to a level your muscles can handle.
  2. Increase the strength of your pelvic floor and abdominal muscles so that you are able to handle the increased pressure without leaking. 


How to Decrease the Pressure

Let’s talk about a couple things you can do to help decrease the pressure. As we went over, your lungs sit right in the middle of your abdominal cavity and help create the pressure inside. 

    1. Learning when to breathe with weightlifting and making sure you are breathing while performing activities like jumping can really help with decreasing your abdominal pressure. Performing a valsalva while lifting can increase your pressure by 2-3x what is experienced with free breathing. Breathing out during the hardest part of your lift is a good way to bring that pressure down and decrease your likelihood of leaking. 
    2. Using a weight lifting belt increases your abdominal pressure by 10%. Sometimes just removing this is enough relief to keep that squat dry. 



How to Increase Strength

The other thing that can help is strength. The pelvic floor is made up of muscles, which can be strengthened just like any other muscle. If your pelvic floor muscles are strong they will be able to function against increased pressure levels better. 

The same basic principles of strengthening apply to your pelvic floor. They need to be placed under progressively harder tasks in order to build strength. This doesn’t just mean kegels. Although this can be a good place to start, kegels alone won’t typically develop the strength needed for double unders or heavy lifts. You need to find what your threshold is. 


When do you start leaking? What is the weight, what is the rep, what is the activity that brings on your leaking? Once you know your threshold you need to work right below it.  

If you start leaking with deadlifts on the first rep at 90% of your max, see how many you can do at 80% and train there. While at that percent be mindful of your pelvic floor. Think about performing a kegel like contraction right before you start to stand up during your deadlift. 

Another key area to strengthen are your abdominals. All of them. Not just the rectus, make sure you are getting those deeper layers involved. One of those deep muscles, the transverse abdominus, causes your pelvic floor to contract along with it. Studies have shown that strengthening this muscle helps strengthen your pelvic floor also. 


Try incorporating core strengthening exercises in the standing or hanging position to increase the functionality and incorporation of the deeper levels of abdominal muscles. Core strength is very important and plays a vital role during weightlifting. Performing a proper abdominal brace is a big part of lifting correctly and also plays a major role in managing your pressure. Your brace should not feel the same as trying to poop. All of the pressure should not be directed downward. As you can imagine that just makes your pelvic floor have to work against a lot more. 

Like any change having to do with your body, it’s going to take time. Bodies change slowly and require consistency. If you are struggling with this. Know you aren’t alone and you don’t have to continue to struggle.

If this is you, reach out today to speak with one of our Women's Health Specialists!

If you have questions about how to properly brace during a lift, what a pelvic floor contraction should feel like, or are curious about other pressure management techniques. Give us a call. I’d love to go over your questions with you and get you back out there…. Only a little dryer. 

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