Most of you have been there, you're doing the HIIT routine that you used to rock before pregnancy or you are jumping at Bounce Zone with your kids at a birthday party for the 10th weekend in a row. All seems well when suddenly you realize you have no control of the drops of urine trickling out of you.
This is one of the most common complaints I hear when I tell women that I am a pelvic floor physical therapist and the kind of work I do. Sadly too many women have been told stress urinary incontinence (leaking urine with activity) is normal and it makes me want to scream. While there is no substitute for having your pelvic floor muscles evaluated and given a customized plan by a trained physical therapist, I know that not everyone can make it to see a specialist. In that light, I'm here to share my top tips for preventing leaking with exercise as well as some specific exercise recommendations.
1. Ensure good bladder habits. This includes: having a normal voiding interval of every 2-4 hours, avoiding just in case voids, stop hovering over the toilet, try not to rush in and out of the bathroom without giving your body a chance to empty.
2. Avoid bladder irritants before exercise (caffeine, acidic fruits, carbonated drinks, spicy foods etc)..... yes that means coffee! I know, I know--- only before exercise, you can do it!
3. Get enough water! Do not restrict fluids. Dehydration can cause your bladder to become irritated and increase risk of leakage. If you are exercising aim for half your body weight in ounces plus 10-15%.
4. Do NOT hold a pelvic floor contraction or “kegel” during exercises. Our muscles are not meant to be held in a constant contract. If they are working constantly they will fatigue and eventually fail, causing you to leak.
5. Decrease repetitions. Many of my patients find this can help by giving your body time to build strength. Example: if you always leak on your 12th squat, 5th double under or 3rd mile of your run, back off to just below that mark for a few weeks and work your way back up.
6. Don't forget to breathe. Your breath plays an important role in how your pelvic floor and core muscles function to prevent leaking. For optimal function it is important to be able to inhale fully filling your belly and letting your ribcage expand (forward/back and side to side). Many people find it helpful to perform the working part of the exercise with an exhale.
7. Belly pooching- if you can feel your belly pooching with an exercise, this can mean that there is pressure down on your pelvic floor as well. Avoid this by decreasing weight/reps and ensuring you are not holding your breath.
8. While holding pelvic floor muscles during exercise is not recommended, practicing isolated pelvic floor contractions (kegels) on their own can be beneficial. Start with a squeeze and hold for 5s and then relax for 5s. Perform 10 reps, 3 sets per day. If you have difficulty feeling yourself relax these muscles, you may have pelvic floor tightness and should discuss this with a pelvic floor therapist.
Exercise specific recommendations:
1. Running- ensure a good foot strike with your mid foot. Avoid striking with your heel which can cause a stopping motion. Imagine pushing off with your back foot instead of pulling with your front leg. You may find it helpful to lean slightly forward as your run. You may also find it helpful to decrease stride length.
2. Box jumps- start with a good full inhale and begin your exhale just before you leave the ground.
3. Jumping rope- try short quick exhales as you come in contact with the ground.
4. Overhead exercises- If there is a sitting version you can back off to this modification. Next progress to half kneel position and then work up to standing.
These tips are by no means a substitute for medical advice and you should always ask your healthcare professional before changing your exercise routine. If you would like to discuss more about pelvic floor issues, email me at firstname.lastname@example.org to set up a consult.
Stay safe and well.
Source: Chisholm, L., Delpe, S., Priest, T., & Reynolds, W. S. (2019). Physical Activity and Stress Incontinence in Women. Current bladder dysfunction reports, 14(3), 174–179. https://doi.org/10.1007/s11884-019-00519-6