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Photo by Luis Quintero on Unsplash
Photo by Luis Quintero on Unsplash

Many people start like to start the new year off with exercise regimens and plans to lose weight.

Unfortunately, often times women who start exercise programs to lose weight also lose their ability to control of their bladders and experience urine leakage during physical activity, otherwise known as stress urinary incontinence (SUI).

So what makes certain exercises more leak-prone? Which exercises put less stress on your pelvic floor? Read on to find out.

Why would exercise make you leak?

One leading hypothesis for what causes stress urinary incontinence is that sudden increases in abdominal pressure can put stress on the pelvic floor muscles, reducing the muscles’ “elastic recoil” which a muscle’s ability to rebound after a sudden stretch, which can cause weakness and reduced performance. As we’ve talked before in our blog series about pelvic organ prolapse, when the pressure in the tummy is stronger than the supporting muscles, tissues and tendons, things tend to travel south. If you are doing high-intensity activities like sprinting, jumping, lifting, and crossfit, you may be increasing your abdominal pressure without enough pelvic floor support to help your organs from shifting.

High Impact Exercises and Increased Prevalence of SUI

In general, higher impact sports, such as basketball, volleyball, and tennis have a higher prevalence of urinary incontinence vs. lower impact sports such as swimming and pilates (de Mattos Lourenco, et al., 2018). A recent article by Yang et al. (2019) found that SUI prevalence is higher in women who participate in CrossFit vs. aerobics. Certain sudden movements, including jumping and sprinting, tend to cause more leakage than slower, steadily paced movements.

The following is a list of exercises found to have higher prevalence of SUI in study participants from both the Mattos Lourenco and Yang studies:

High Impact Exercises That Cause More Leakage:

  • Jumping rope and “double-unders”
  • Box jumps
  • Squats with weights
  • Trampoline jumping
  • Thrusters
  • Basketball
  • Football
  • Gymnastics
  • Tennis
  • Hockey
  • Judo
  • Running
  • Softball

Low impact activities with reduced pressure on the pelvic floor

  • Bodyweight training
  • Walking
  • Water aerobics
  • Roller blading
  • Cycling
  • Hiking
  • Pilates
  • Swimming

What You Can Do

Don't be afraid to exercise, the key is to pick the right exercises that don’t cause you leakage. Choose exercises that off the “just right challenge” to your body.

Participate in lower impact activities if you are leaking

Low impact activities have less prevalence of urinary incontinence. Activities like weighlifting, cycling, hiking, pilates, yoga, and swimming are examples of low impact activities. If you are in an aerobics class that requires a lot of jumping, modify the movement to stay stationary on the ground: an example would be instead of jumping jacks, you could do squats or alternate bringing one leg out at a time.

Strengthen Your Pelvic Floor

Are you doing low impact activities and still leaking? You might need to strengthen your pelvic floor. Don't know how? Check out the Femina blog for articles about kegels.

Still confused? Come see us! The pelvic floor therapists at Femina PT are ready to help, make an appointment today.

Exhale with Movement

One common cause of incontinence and increased intra-abdominal pressure is holding your breath. Breathe when you move! Avoid exercises that make you bear down and DO NOT hold your breath while exercising.

Try exhaling with the following activities:

  • Exhale with exertion during exercise. Examples: when you bring a hand weight up into a bicep curl, exhale. When you push up from a squat, exhale.
  • Exhale while lifting (weights, baby, groceries)
  • Exhale while pushing anything (luggage, strollers, trash can, shoveling)
  • Exhale while you are bending over during exercise (stretching)
  • Exhale while reaching overhead (pull-ups, weight lifting)

Steady Breath While you Exercise

Practice a steady breath throughout your entire exercise session. This will help regulate your abdominal pressure and the pressure placed on your bladder.

Some Tips:

  • Relax shoulders and upper chest
  • Breathe in slowly to fill the lungs fully
  • Breathe out slowly through the mouth or nose
  • If you are feeling winded, bring your heart rate back down until you can breathe easily again

Use a pelvic brace and do your pelvic floor exercises daily.

Don’t know what I’m talking about? Find a pelvic floor therapist to help you. Pelvic floor therapists are trained to fully assess what is going on in your body in order to fully understand what is contributing to any urinary incontinence.

Resources

De Mattos Lourenco, Matsuok, Baracat, Haddad. 2018. Urinary incontinence in female athletes: a systematic review. International Urogynecology Journal 29 (12):1757-1763.

Yang, J, Cheng, JW, Wagner, H, et al. The effect of high impact crossfit exercises on stress urinary incontinence in physically active women. Neurourology and Urodynamics . 2019; 38: 749– 756. https://doi.org/10.1002/nau.23912

What Our Patients Have to Say

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Testimonial by A.W., age 32

I wanted to let you know that my pelvic floor held strong and gave me no trouble whatsoever in my trail race this morning (12 miles)! In a way, I felt like I ran better than ever because my core feels so rock solid from all the exercises you have me doing. That was especially valuable on the technical downhill - I just flew down the trail because I had confidence in my balance and form. Thank you for helping me get back to doing what I love.

-- A.W., age 32
(completed Post-partum Renewal Program using the InTone biofeedback/stim unit)

Testimonial by J.B.

My husband and I were having problems with painful intercourse. My therapist recommended that I go and get a pelvic floor evaluation from a physical therapist. Having never been treated by a physical therapist, I wondered how this really was going to help me. My husband who is a physician was very supportive and agreed that a PT evaluation would be a great idea. So i made the appointment and was blown away by what I learned. I had no idea that pelvic floor muscles could get tight and have trigger points just like any other muscle in the body. I'm a massage therapist and very familiar with tight muscles, and this new thought really amazed me. Heather's program to help relax and strengthen these muscles made such a difference. I can say that I am 100% pain free during intercourse now. Yippee! Going to the PT appointments and doing the at-home exercises was definitely a discipline, but it's 100% worth it! The rewards are amazing.

-- J.B.

Testimonial by R.M., Age 40

I can’t speak highly enough of the theapists at Femina Physical Therapy and how much they have helped me grow, discover, and love my body. I had had painful sex for my entire life, and didn’t know that there was anything that could be done about it. It was at the point where my husband and I were not having sex for MONTHs, because it was just too frustrating, and I hated feeling like I was the ONLY woman out there who had this problem, especially at my age. I finally brought it up to my doctor because I was turning 40 and my husband and I were barely having enough sex to conceive. And she brought up pelvic floor, PT. I didn’t even know this was a “thing”.

Read more: Testimonial by R.M., Age 40

Testimonial by Julie T.

Femina PT (née Fusion Wellness & Physical Therapy) has honestly changed my life. Before receiving treatment at Femina, I was going doctor to doctor to try and find the answer to my pelvic pain. It has taken me YEARS to find someone that can help fix this. It wasn't until my gynecologist recommended your clinic that I finally felt relief. My pelvic pain is almost gone, and granted I still have a lot more to work on with Laureen (my PT), my original problem is nearly cured. I am so grateful to her.

What is even better is she gave me practical exercises to do at home that were not tedious and provided instant (and lasting) relief. Although I mainly work with Laureen, my interaction with the owner (Heather) has been great. She is very generous, kind, and committed to her business.

It hurts to know there are women out there suffering who will never know or have the opportunity to work with women like Laureen and Heather because this issue is hardly talked about and this field is so rare. I hope more doctors and physical therapists see the value in this work and can relieve more woman of their pain.

-- Julie T., 12/4/16 via Yelp!

Testimonial by R.H.

No one could tell me why I was having pain during sex--sharp pain, not just uncomfortable, pain. I was referred to Heather Jeffcoat after researching several different options. I had seen a specialist who told me physical therapy would not help and my only option was surgery. I really didn't want to go that route, so when we got a referral, I decided to try it--it can't hurt, I thought. I am so glad I did. She diagnosed the problem right away, which was a relief in itself.

To know why I was having pain eased my mind immensely. And to hear that she could fix it without surgery was another relief. She said she could fix the problem in 6 weeks. I think it was actually 4 for me. She was very methodical, and treated me as an intelligent human being capable of participating in my own recovery. I would absolutely recommend her to anyone. She did not try to prolong my session numbers, she worked hard to accommodate my schedule (and the fact that I had to bring a baby to sessions), and she was completely honest the entire time. It is so hard to find someone with these characteristics, much less a professional who is so good at what she does. She has my highest respect.

-- R.H.

Testimonial by S.H., age 24

I just wanted to thank you for everything you've done for me for the past 19 months. I literally could not have reached my goals without you and your practice. You gave me the courage to keep moving forth with my treatment no matter how afraid and anxious I was. You were always there to answer questions and made this whole process so much easier than I expected it to be.

It's because of you that my marriage is on the right track, that I can get pregnant and that this part of my life is finally over. I really feel that Fusion Wellness is a team of people you can call family and are there to root for you and cheer you on until you reach your goals. There is nothing better than knowing I accomplished this with you guys by my side and as calmly and patiently as I needed. Thank you from the bottom of my heart for always being there and helping me reach my goals.

S.H., age 24

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