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Why Do I Leak with Exercise?

I decided to re-visit a topic that we have talked about before, primarily because I seem to have had several people ask me recently, “Why do I leak when I work out?”  Followed by “It is normal after babies isn’t it?”  Let me begin by saying that leaking urine during exercise is common, roughly 1 in 3 women experience it.  However, it is not normal, it is a sign that there is a breakdown in the core system.  Just like knee or hip pain would indicate a weakness in the system, so does incontinence.  Yet we don’t always seek help for incontinence either because we are embarrassed or we assume it is just part of motherhood.  As a physical therapist I see women everyday who leak urine with exercise.  It is important to recognize this as a symptom of muscle imbalance and educate women to seek help so they can reach their exercise goals and prevent further problems from arising in the future.

It is very important to have an evaluation by a pelvic specialist in physical therapy to determine why the leaking is happening.  Leaking urine does not always mean you need to do more “Kegels”.  Often the issue may be muscles that are too tight, do not properly coordinate with the abdominal wall, and diaphragm muscles.  There may be hip muscle weakness that causes an imbalance in the system and when restored, the pelvic floor can function more optimally.  Even if your Gynecologist or urologist say you don’t need physical therapy, you need to seek help from one. Be your own advocate!  Many states allow direct access, meaning you can see a PT without a physician referral.  The other important part to evaluation by a pelvic PT is that they actually put their finger inside your vagina to assess what the muscles are doing.  If they only use biofeedback (surface electromyography) they are not getting a true picture of the muscle function.

Core stability is important in order to perform simple daily activities, but especially important in exercise.  This requires muscular strength, awareness and coordination with the deep abdominal muscles, respiratory muscles and the spinal stability muscles along with the pelvic floor.  It is important to work with a pelvic PT to determine what is wrong with your core system.  If weakness is the problem, we can train the muscles to generate a strong contraction with appropriate relaxation.  It is just as important to be able to relax as to contract.  The idea of just doing Kegels all day long is quite wrong and poor advice.  Constant tension is not the goal, in any muscle.  The relationship with the respiratory, spine and abdominal muscles is of utmost importance.  One great way to begin to retrain the system is with coordination of breathing:
Lay on your back, with knees bent and feet flat.  Inhale and allow the belly to rise, and relax the pelvic floor, feel heaviness in the pelvis.  As you exhale, open your mouth to allow a “haaaaa” sound and feel your deep abdominals and pelvic floor lift gently. Work on this daily, until the sense of contract vs. relax is easy to feel in the pelvic floor.  When you can feel this, move onto sitting, standing or with other activities like squats.  With squatting, inhale as you squat down, and exhale on the upward motion, contracting the pelvic floor and abdominal muscles.  When lifting baby, inhale and squat then exhale and contract while picking up baby.  This can be applied to all exercises and functional tasks. Best advice would be to stop the activity that is causing leaking for now, and focus on retraining this system to function properly, eventually working up to the activity that is the problem.  You have to take the time to build a solid foundation before you progress to higher level activities.

Share this with friends, family, sisters and mothers.  There is never one answer to “why do I leak with exercise”  every person is individual and needs an individual program specific to their body.  We know that 1 in 3 of you reading this is experiencing this symptom.  Take the time to have your body evaluated by a women’s health physical therapist to develop an appropriate, individualized exercise plan for your body.  This will allow you to reach your fitness goals, and keep a healthy, strong body that you can be proud of.

–Sarah Dominguez, PT, MSPT, CLT, WCS

This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you.  If you enjoyed this blog, check out our website at for more blog entries and to learn more about our specialty PT practice, Foundational Concepts.  Follow us on Twitter @SarahpelvicPT or @Jenn_pelvic_PT or @AmandaFisherPT and like us on Facebook/Foundational Concepts for updates.

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