Leaking while exercising? You are not alone. More than 40% of elite female athletes leak with their sports. Imagine how high that number is in the regular population; Women who are exercising, going for a jog, taking classes, weight training, etc. Many women limit their exercising because they leak urine. This is what we call stress urinary incontinence.
When women talk to someone about their leaking, they are often told to do more Kegels (pelvic floor contractions). But what if I told you that it is not the pelvic floor’s fault?? And more Kegels WILL NOT solve the issue!! We will look at this in more depth and focus on running, because the research is primarily in running. However, the information carries across all forms of exercise.
When the pelvic floor contracts, the muscles should lift the perineum and the bladder and put pressure on the urethra, effectively closing it to prevent leaking. Elongating the pelvic floor (thing go to the bathroom) does the opposite. The lift is a concentric contraction like a bicep curl. The elongation is an eccentric contraction. We need to have eccentric contractions to have a reactive, stronger concentric contractions. This is true with the training of all muscles.
When we are running, we want to have an eccentric contraction prior to heel strike so that we can have a quicker, stronger pelvic floor concentric contraction to absorb the forces as our foot hits the ground. As researchers have looked at runners who have good bladder control versus those that leak, there have been interesting insights.
- Women who leak with running have higher levels of pelvic floor muscle activity compared to those that do not. Their pelvic floor is working hard throughout the exercise trying to prevent a leak. But the pelvic floor cannot work in isolation. It needs the help from its synergists in the abdominal wall and gluteal (buttocks) muscles to be effective. Women who leak tend to rely only on the pelvic floor and not have the muscle coordination with the deep core muscles.
- Women who leak have the same pelvic floor contraction strength, no matter the exercise. In women who do not leak, the pelvic floor contraction strength will change or modulate dependent on the exercise. Think about the muscle force you need to lift a feather vs a fifty-pound box. In women who leak, their pelvic floor is always trying to lift the fifty-pound box.
- Women who leak have less upward lift of their pelvic floor with a concentric contraction. So even though their pelvic floors are working at max capacity throughout their exercise, the muscles are not as efficient and do not give the upward lift that helps to close the urethra off from leaking.
- Women who leak contract their abdominal wall before their pelvic floor. Women who do not leak contract their pelvic floor and then the abdominal wall. This is all about the timing. The pelvic floor muscles should contract prior to the abdominal muscles to help close off the urethra prior to the force from the ground while running. If I squeeze the middle of the toothpaste tube but do not put the cap on, I am going to have issues.
If you are leaking with your exercise, you are not alone. But that does not mean that there is nothing you can do about it. Working with a pelvic floor physical therapist can help improve the coordination of the pelvic floor with the abdominal wall and hip muscles. While working with a pelvic floor physical therapist, we will also help train all the muscles to work together as a team to help prevent leaking. So, when you hear to just do more Kegels, know that Kegels are not enough. We need to look at the big picture and help your pelvic floor work with the whole core.
Your pelvic floor therapist should look at you running patterns, you overall strength and coordination to determine a root cause of the issue. We offer a free, 15 minute consultation to answer any questions you may have and ensure you are in the right place to reach your wellness goals. Click here to set up your free consultation!