Exercise and Leaks: Dispelling the myths

Do you leak urine with exercise? Many women limit their exercise due to leaking with running and jumping.  They think that they need to do more “kegels” to strengthen their muscles more. They hold their pelvic floor muscles tight, in hopes of decreasing the leakage. The truth is, this is usually not the case. The answer to not leaking with exercise is not more “kegels”. The majority of the time, the pelvic floor muscles have increased tone, or too much overuse: not weakness. The pelvic floor muscles might have trigger points or pain with palpation. They may have a delayed activation, or spasm with relaxation. Many women may not be able to elongate the pelvic floor muscles at all.

The pelvic floor muscles need to lengthen, this is an eccentric contraction. This eccentric loading creates more power for the concentric contractions, or shortening of the muscle. The concentric contraction in the pelvic floor muscles is important to close the urethral sphincter to stop the flow of urine and prevent leaks.

If you leak with running and jumping, your pelvic floor stay in a contracted position to prevent more leaking. While this may sound like a good strategy, by keeping the pelvic floor muscles tight, you actually have less power and a higher risk of leaking. In pelvic floor physical therapy, we see women who leak with exercise, they have increased tone and sometimes pain when we touch the muscles of the pelvic floor. They also demonstrate poor eccentric elongation of their pelvic floor muscles which decreases the power of the pelvic floor.

The other myth regarding leaking and exercise is that it is just the pelvic floor that needs attention. False. There are a myriad of issues that can contribute to leaking when you exercise. There is a symphony of muscle coordination that happens to allow you to run or jump. There can be mishaps anywhere that create a problem somewhere else. For example, your obliques may be too tight, preventing good rib excursion with breath, limiting diaphragm excursion, which keeps your pelvic floor in a guarded and tight state. That is just one of a million examples.

In pelvic floor physical therapy, we want to improve the coordination of the pelvic floor muscles so that they can have proper eccentric elongation prior to jumping or before the foot hits the ground. We will look at you from head to toe to determine where in the symphony someone is performing poorly. Therapy will focus on the timing of the contraction of the  pelvic floor, along with addressing any other musculoskeletal concerns. The goal is to allow your body’s orchestra to play beautifully.

If you are leaking with exercise, don’t assume you need to do “kegels”. Most likely you don’t need to.  Also, dont blame the pelvic floor, There can be many reasons for the symptoms of leaking. Some simple tips to try on your own are:

• Practice diaphragmatic breathing to work in relaxation and elongation of your pelvic floor.
• Work on lengthening your pelvic floor with a wide legged yoga stretch or happy baby pose.
  

Most importantly, please make an appointment with a pelvic floor PT. We will trouble shoot where your issue is, and evaluate your muscle coordination, develop an appropriate exercise program, and rule out any other issues that may be contributing to your leaking.

At Foundational Concepts, we offer a FREE 15 minute phone consult to answer questions for you and make sure you are in the right place to reach your goals.