What Can I Do About Leakage With Impact Activities?
This blog post was inspired by our our January Knowledge Drop after deciding it deserves more attention all on it’s own. If you read that piece, here’s a new, improved and expanded answer to the question of “What can I do about leakage with impact activities?”
When people come to pelvic floor physical therapy for leakage with running, jumping and other impact sports, they typically assume the reason is pelvic floor muscle weakness. Maybe they’ve already started doing kegels and have noticed some improvement but not enough. Maybe they’ve started doing kegels and leakage has gotten worse with time or made no impact at all. Click here to learn why kegels aren’t good enough to address urinary incontinence with exercise.
Leakage with exercise CAN be about weakness, but that’s not the only cause. Here are the 5 most common reasons people leak with impact exercise.
Pelvic floor weakness or tension
Poor coordination of the pelvic floor
Pressure management
Suboptimal form
Suboptimal bladder habits
Let’s dive into how each of these can impact your leakage and what you can do about it:
1. Pelvic floor weakness and tension
Your pelvic floor muscles are responsible for contracting to hold pee in when you want to and relaxing to allow pee out when you want to. If you’re leaking with jumping and running but not with any other activity, this may be because your pelvic floor is struggling to live up to the demands of that activity. Jumping and running create a lot of force downward that your pelvic floor needs to be strong enough to hold against. Did you know that running can create 7 times your body weight of force on your pelvic floor? Weakness and tension are two reasons they may fail at living up to the demands of these activities.
If weakness is the problem for your pelvic floor, the answer is strengthening the weak muscles. This can include strengthening the pelvic floor itself as well as strengthening the muscles that support the pelvic floor like your glutes, hip rotators, transverse abdominis, rectus abdominis and obliques. Your pelvic floor is part of your core, so strengthening all of these muscles together helps build the most support for your pelvic floor muscles.
If tension is the problem, we may need to focus on stretching and relaxing these tight muscles. Using tools like a pelvic wand or dilators can help.
I’ll explain this with my favorite biceps analogy. If I want to drink water from my water bottle, my bicep needs to be flexible enough to allow me to stretch my arm out and reach the bottle, and it needs to be strong enough to lift my big, heavy Yeti to my face. If my bicep is tight, I can’t reach the bottle so I can’t drink. If my bicep is weak, I can’t lift the bottle so I can’t drink. It needs to be flexible AND strong to do it’s job. The pelvic floor is no different.
Weakness and tension also tend to be a feedback loop. Weak muscles get tight because they’re overworked and tired. Often a tight muscle IS a weak muscle.
2. Poor coordination of the pelvic floor
Some folks have excellent pelvic floor strength but they can’t access it because their muscles don’t turn on when they ask them to. Coordination is all about your brains ability to utilize your muscles strength at the times they’re needed.
Let’s go back to my bicep analogy. If my bicep is flexible enough to reach my bottle, and strong enough to lift it, but my brain doesn’t know where my bottle or face are in space then even with all the flexibility and strength in the world I still can’t drink because I can’t get the spout to my mouth. Once again, your pelvic floor is the same.
We need our pelvic floor to be coordinated so that it naturally engages when we need it to and relaxes when we’re not using it. If your muscles aren’t automatically engaging and relaxing of their own volition when you’re running and jumping, this can contribute to leakage.
If coordination is where your problem lies, I recommend working with a pelvic floor physical therapist who can help you figure out what’s going on and what you can do about it. Because coordination is about teaching your brain how to optimally utilize your muscles, having a coach (in this case, a pelvic floor PT) can make a huge difference.
3. Pressure problems
Once again we’re going back to my bicep. Even if my muscles are strong, flexible and coordinated, they could still get overpowered. Say I’m bringing my water bottle to my face and all of a sudden, my waterbottle turns to lead. I’m going to drop it because my bicep wasn’t expecting to suddenly control so much weight.
Pressure works similarly. If your pelvic floor muscles are strong, flexible and coordinated but you’re holding your breath as you jump, it’s like adding that 50 pound dumbbell to your pelvic floor. By simply exhaling or counting out loud while exerting yourself, you can significantly reduce the amount of force your pelvic floor has to work against to maintain control of your bladder.
Breath holding during exercise is a big factor when it comes to leakage.
4. Suboptimal form
This is for my runners, specifically. While everyone does something slightly different, there are a few common movement patterns runners fall into that may contribute to leakage, heaviness in the pelvis, knee pain and other symptoms during running. Some of these movement patterns include:
limited thoracic rotation
sucking in your gut and keeping tension in the abdomen
producing a lot of up/down movement rather than channeling that force forward
reduced hip extension at push off
landing behind your foot instead of over the foot
clenching your pelvic floor the entire run
Figuring out which of these common patterns you’re defaulting to and how to modify your form can significantly reduce the stress on your pelvic floor, allowing your muscles to more successfully do their job of supporting your bladder while running.
5. Supoptimal bladder habits
This one is for my friends who pee twice a day, or every hour. For my friends who don’t drink any water or who drink 200oz a day. For my people who push to pee or don’t listen to their bladder cues. Treating your bladder poorly can contribute to leakage. Fortunately, the bladder is very trainable and getting your bladder habits under control can make a big difference.
Here are some general rules of thumb for healthy bladder habits:
Drink half your body weight in ounces of water each day
Pee every 2-4 hours
Breathe and relax while sitting on the toilet but don’t push to pee
Go when you need to go
Don’t bee “just because”
Drink more water and less bladder irritants (alcohol, caffeine, sparkling water)
And as always, if you’re struggling with bladder, bowel or sexual symptoms, remember that working with a pelvic floor PT can make all the difference. Call us at 512-766-2649 or send us a message here to work with one of our amazing pelvic floor physical therapists.
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.