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Physical Therapy | Women's Health

Incontinence During Exercise: How Can Physical Therapy Help?

December 16th, 2022 | 5 min. read

Incontinence During Exercise: How Can Physical Therapy Help?
Leah Lee

Leah Lee

Licensed Physical Therapist, PT, DPT // EW Motion Therapy Hoover

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Whenever you’re working out, there are probably a few different thoughts going through your mind. You’re trying to remember which rep you’re on, which muscles need to tighten with the exercise you’re doing, and probably thinking about what else you need to get done after your workout. For some athletes, especially women, a constant thought during exercise is whether they are leaking or not. But why can urinary leakage be such a problem during exercise? What can you do to help? 


While leakage can feel embarrassing to discuss, it is essential to get the help you need so you can continue your workout routines without that burden. Leakage can come from a pelvic floor that is not working correctly, and a pelvic floor physical therapist can be a great professional to see. The physical therapists on our women’s health team at EW Motion Therapy are experts in restoring pelvic floor function and reducing leakage, and they can help women of any age leave their pelvic floor issues behind. Even if you decide our services do not fit your needs, we still want to discuss why some women leak during exercise and what can be done to help. 


This article discusses why incontinence is common during exercise, some risk factors involved, how physical therapy can help, and other ways to maintain your pelvic health. With this information, you can find the best professional for your needs and continue your exercise routine without worrying about incontinence. 


Your pelvic floor is an important muscle group at the base of your core. Learn more about how to manage pelvic pain here. 


Why is incontinence common during exercise? 

If you leak during exercise, that is a common form of stress incontinence, which is directly caused by exertion or physical activity. Many exercises, including squatting, aerobics, and running, increase intra-abdominal pressure. This pressure influences abdominal organs like your stomach and bladder, and if your pelvic floor is not strong enough to manage the increase in pressure, you might leak a little. Many female heavy weightlifters wear pads while lifting due to this phenomenon - they continually put high levels of pressure on their abdominal organs, and their pelvic floor weakens over time as a result. 


While exercise is a common trigger of stress incontinence, there are others that you may experience even more often, like sneezing, coughing, or laughing. You can read this article to learn more about stress incontinence.


Incontinence risk factors 

Some people are more prone to leakage for one reason or another. We cited those who do frequent high-level exercise as being at a higher risk, like weightlifters or distance runners, but there are other things to keep in mind as well. You could develop stress incontinence due to childbirth - as your pelvic floor heals after giving birth, it can be challenging to regain the strength and control you had before you gave birth. Also, any kind of pelvic surgery or hysterectomy can weaken your pelvic floor, as can the normal aging process, especially for post-menopausal women. Obesity can be another risk factor, and if you have a previous condition that causes a chronic cough, it can be hard to control your bladder.


How can physical therapy help? 

While surgical and prescription treatments exist for extreme stress incontinence cases, pelvic floor physical therapy is one of the best conservative treatments for the condition. When you come in for your evaluation, your physical therapist will assess you to rule out diagnoses like prolapse and the ability to activate the right muscles voluntarily. They may also perform an internal pelvic exam to determine whether your pelvic floor is too weak or too tight to function correctly. Your pelvic floor must contract and relax at appropriate times to control your ability to urinate and have bowel movements voluntarily, and this system not working properly is likely the primary cause of your leakage.


In many stress incontinence cases, your pelvic floor is not contracting correctly, either because your pelvic floor is weak or it is too tight, which impacts the ability to achieve an effective contraction. Your therapist will need to assess whether you need to improve strength and coordination or the length of the muscles. To help with strengthening, your therapist will walk you through strengthening exercises for not only your pelvic floor but also your core, lumbar spine, hips, and glutes. To improve your muscle length as well as strength and coordination, your therapist will implement stretches and other interventions to help your muscles relax. 


Your therapist will also teach you to synchronize your pelvic floor contractions with your breath and exercises to control your leakage. Ultimately, you can train your pelvic floor to combat the pressure that builds in your abdomen. This can look like doing squats while contracting your pelvic floor to check your form and practice contractions. In some cases, reducing your fluid intake before exercise can help your bladder not feel as full, and keeping a bladder diary can be helpful to keep track of leakage and rule out any irritants in your diet that could be exacerbating your condition, like spicy or acidic foods.


How else can you maintain your pelvic health? 

Now you know more about leakage during exercise and how physical therapy could help you strengthen your pelvic floor. Learning to synchronize pelvic floor contractions/relaxing with your activity is essential to pelvic health, but leakage can be a problem in other areas as well, not just in the gym. It is important to discuss symptoms with your doctor so they can refer you to the right specialist and you can get the help you need. 


Wearing a pad during exercise may seem like a viable solution for leakage, but in reality, you are putting an external bandage on an internal problem. Proper pelvic floor function is an essential part of going about your day, especially in the gym - you should not have to worry about leakage as you’re just trying to keep yourself healthy. While surgical and medication options do exist for controlling incontinence, one of the best conservative approaches for the condition is pelvic floor physical therapy. If you choose EW Motion Therapy for your treatment, our women’s health team can help you retrain your pelvic floor to contract and relax while you exercise, so you can leave your worries about leakage and your pads at home. If you are interested in working with us, fill out the questions in our Program Match Tool to see which of our programs is the best fit for you.


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