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Why Do I Have Leaking During Exercise?

Are you one of those athletes that grabs a pad before your run or workout? Do you avoid working out at the gym because you’re embarrassed that you pee your pants? Leaking during exercise can be very annoying and frustrating.

There are many things that can contribute to leaking during exercise. Some of those causes include weakness or tightness in your pelvic floor muscles or the muscles surrounding your pelvic floor, poor pressure regulation, overbracing or bearing down, shallow breathing, poor posture, or poor exercise technique. Let’s talk about each of these.

Tightness vs Weakness in the Pelvic Floor

Leaking can occur due to tightness (high tone) or weakness (low tone) in the pelvic floor muscles. Thus, it is important to figure out which category your muscles fall into in order to know how to fix it. The only way to truly know if you have high or low tone in your pelvic floor muscles is with an internal exam with a physical therapist. However, there are some questions you can walk yourself through to try and figure out what may be going on in your pelvic floor muscles:

1. Take a deep breath in. Do you feel a hard stop? Is it difficult to take a deep breath in and fill up your belly with air? If so, you may have tightness in your pelvic floor muscles.
   
2. Think about when you sit down to pee. Do you have a difficult time relaxing to begin urination when sitting on the toilet? If so, you may have tightness.
3. Try bearing down. Do you feel a downward motion of your pelvic floor? If you don’t, you may have tightness.
4. Do you get constipated often? If so, you may have tightness.

Many other symptoms or limitations, such as pain or difficulty performing a Kegel, may be caused by either weakness or tightness. Thus, those symptoms may not be the best indicator of what is going on.

How to End Leaking if Tight in Pelvic Floor

If you have tightness or high tone in your pelvic floor muscles, here are some tips to address your leaking:

• Try meditation and decrease stress. Some great apps to try are Calm, Headspace, and UCLA Mindful.
• Work on deep breathing.
• Stretch and relax your pelvic floor muscles. Try happy baby pose or child’s pose in the videos below.

How to End Leaking if Weak in Pelvic Floor

Our pelvic floor muscles are mostly endurance muscles. This means they are meant to be working at a lower level for a long period of time. However, you also need good strength for sudden high demands, such as jumping, sneezing, and lifting. During exercise, you need both. When jumping, weightlifting, or participating in CrossFit, you need good strength in your pelvic floor muscles during the impact or lift. You also need adequate endurance, as you usually are not just doing 1 or 2 jumps or lifts. You’re doing several (or many, many more). Adequate pelvic floor endurance is also especially important for longer activities, such as running. Thus, no matter your exercise of choice, you should work on both strength and endurance of your pelvic floor muscles.

Your daily Kegels to address your leaking may look like this:

1. Strength: 10 quick, max contractions
2. Endurance: 10 second sub-max holds x10

Check out the video below on how to perform a Kegel correctly.

Breathing and Posture

Our diaphragm moves in tandem with the pelvic floor. Thus, breathing plays a big role in pelvic floor function and intra-abdominal pressure management. When you breathe in, your diaphragm and pelvic floor both move down. As you breathe out, your diaphragm and pelvic floor move up. Using shallow breathing patterns (shoulders moving up and down) during exercise places extra pressure on your pelvic floor. That extra downward pressure can contribute to leaking. To practice proper deep breathing, check out the video below.

Check Your Technique

Ending your leaking with exercise may be as simple as cleaning up your technique with running, lifting, or jumping. Here are some specific tips for high impact activities, such as running and jumping, and weightlifting/CrossFit.

Tips for leaking with running and jumping:

• Focus on staying tall.
• When running, lean forward slightly. This does not mean slouch! Lean forward like you are running uphill.
• Take good, deep breaths in and out. Avoid shallow breathing, especially when fatigued.
• Land lightly on your midfoot or forefoot versus your heel. This will decrease the impact on your pelvic floor.
• Avoid ab gripping or keeping your core too tense.
• Try a short, small breath out when landing during jumping.

Tips for leaking during weightlifting or CrossFit:

• Maintain a neutral spine throughout the whole lift. Avoid flaring your ribs as you lift overhead or tucking your butt under as you squat down.
• Never bear down when bracing. The pressure in your abdomen should feel more evenly distributed among your pelvic floor, diaphragm, back, and abs.
• If you’re having issues with leaking or heaviness when breath holding, try bracing at the middle or end of an exhale. Your pelvic floor has an easier time staying engaged during an exhale versus an inhale.

When to Scale Back if Leaking

What if you have refined your technique and breathing, are working on your pelvic floor muscles, and you are still experiencing leaking? This is your body’s way of telling you what you are doing is too much for your pelvic floor muscles. It’s the same thing that happens in every other muscle in our body. Let’s say you’re doing an overhead press, and you can’t quite straighten your arms on that last rep. Your muscles are too tired at that point, and they just can’t perform what you are asking of them. That is what’s happening in your pelvic floor muscles when you leak. They are too tired, weak, tight, etc, so they are unable to hold your sphincters shut and you leak.

If this is the case for you, then try scaling back. Decrease weight, impact, running distance, or reps to find a threshold in which you don’t have symptoms. You are then going to progressively load from this threshold.

Build volume at that sub-leaking threshold for about a week – do that same weight, running distance, reps/sets on 3 days that week. Then increase one intensity factor (distance, weight, reps, etc) at a time each week. This should be done slowly, such as increasing running distance by 10% or increasing weight by 5-10#. Then repeat. Build volume for a week, then increase one intensity factor.

When to See a Physical Therapist for Leaking

If these tips do not end your leaking with exercise, it is important to see a physical therapist who can evaluate why you are experiencing these symptoms. As discussed, there are so many factors that can play a role in leaking with exercise. We can evaluate and treat everything that may be contributing to your leaking and guide you in returning to the exercise or sport you love to do! You don’t have to live with leaking during exercise!