“This exercise always makes me need to pee,” or “If that’s what we are doing, I should use the washroom first.”
Perhaps you have felt this, or heard someone joke about a certain exercise that makes you “need to go,” or perhaps has you worrying about leaking (or actually leaking) while doing it. Urgency and incontinence in exercise is surprisingly common and although it is mostly associated with postpartum exercisers, it can affect all ages and genders. So what is it, why does it happen and what can you do about it?
Both SUI (stress urinary incontinence) and urgency (the need to go NOW) are an indicator of an unprepared or poorly functioning pelvic floor and deep core system. This can be caused by a variety of things including pregnancy and childbirth, surgery, car accidents, back injuries, poor alignment, aging/hormonal changes and even some high level sports like gymnastics. Crossfit made headlines a few years ago when many athletes joked about incontinence being a sign of working out to the max, implying that it was a goal or positive marker to exercise until the athlete peed themselves! Obviously that was very quickly debunked but many people continue to quietly live with Stress Incontinence, not knowing just how treatable and manageable they are.
Your pelvic floor is a hammock of muscles spanning the bottom of your pelvic bowl that are involved in bladder and bowel function, sexual function and provide stability and support to the pelvis and abdominal organs. An ideally functioning pelvic floor will be reactive and elastic, allowing it to contract or relax reflexively to the demands it is experiencing. However, just like any other muscle group it can become weak, tight, overworked or inhibited due to a variety of factors including poor alignments, weak glutes, excess pressure (pregnancy or high impact sport) and trauma (child birth or injury). When performing higher impact exercises like jumping or running, the pelvic floor must be able to absorb and respond to the extra force it experiences, when it is unable to do so, this is when we experience urgency and/or incontinence.
So what can you do if you are noticing these symptoms? First off, don’t ignore them! It is never too late to address pelvic health considerations and training up a healthy pelvic floor will help prevent spine and hip injuries as well as addressing pelvic symptoms. A visit to a pelvic floor physio can be extremely helpful in creating a personalized recovery program and is my first recommendation when people speak to me about pelvic health concerns. Many of us tend to rationalize waiting until things are “bad enough” to consider seeing a rehab professional but in almost all cases, and especially when it comes to pelvic health, this is a poor choice. There are many nuances that can cause and exacerbate pelvic floor dysfunction and addressing it quickly with the help of a qualified professional will save you discomfort and likely money in the long run.
That being said, there are some quick things to try RIGHT NOW that can help in the meantime:
- Reach out to your trainer: Talk to us, let us know (privately) what you are experiencing so we can offer you alternatives that keep you moving without causing symptoms. A lot of the time this just means dialling back on impact until you are better prepared. Just like a grumpy knee or a delicate lower back, there are lots of ways to work with instead of push through pelvic floor dysfunction or weakness
2. Learn to relax the pelvic floor: It may seem counterintuitive to relax a system that is allowing leaking to happen but remember, the pelvic floor needs to be reflexive in order to react appropriately. If it is constantly gripping (just like gripping hip flexors) then getting a full contraction when needed is not going to be possible. Imagine hovering at the bottom of a push up for a minute and then trying to push back up quickly, not going to happen right? It is the same with the pelvic floor when it is unable to relax. Your pelvic floor can hold tone for many reasons but an interesting one to note is that it is a muscle that is tied to our flight or fight response which means stress can deeply affect it. Learning to relax the pelvic floor means learning to truly unwind which is valuable all on its own. Meditation and breathwork can be incredibly valuable here. For a good intro exercise, check out this video which shows you how to relax, and then contract your pelvic floor
3. The kegel: Most commonly encountered during pregnancy and postpartum, the kegel is a voluntary contraction of the pelvic floor and can be a valuable tool for strengthening regardless of gender. Some cues to achieve this contraction include drawing your hip bones together in the front, lifting your genitals up and into your pelvis and stopping the stream of urine. To perform a kegel, take a nice wide relaxed inhale and then as you exhale think of drawing your hip bones together and drawing up your genitals. Be sure to relax completely between kegels. Check out the above video and give it a try, more is not always better with these so try a few (6-8) reps once a day or before a workout and see how it goes. Having trouble? This is a great thing to discuss with your trainer or physiotherapist.
4. Breathing matters: Your diaphragm which is a muscle heavily involved in respiration works in synchronicity with your pelvic floor so breathing is an essential part of optimal pelvic floor function. When performing high intensity exercises, just ensure that you are breathing vs holding your breath. For ab work or lower intensity exercise try to focus on creating a 3D breath pattern that expands your lowest ribs in all directions.
5. Change your position: For upright exercises like idle position, try a slight forward lean or shifting your weight back so your glutes are more involved in the exercises that affect you. A forward lean reduces the downward impact on your pelvic floor while strong glutes help your core contract with more force. Other adaptations can include supporting your head in supine ab work or working with a reduced range of motion. Changing our position will change the force and pressure our deep core is dealing with and even small changes can make exercises more functional for where you are at right now. Again, this can be a great thing to discuss with your trainer, coach or rehab professional.
To summarize, SUI and urgency are commonly encountered problems while exercising but are not to be ignored. It is never too late to improve pelvic floor and deep core function and a properly functioning system will support you better as you age. There is no need to feel shame about experiencing pelvic symptoms, just as there is no need to push through or ignore them. You can always reach out to us with any concerns or questions you may have.