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How many times have you had to opt for dark-colored leggings because you were embarrassed that you might (or for sure) pee your pants during a workout?
What if you could workout in whatever-darn-colored bottoms you wanted to wear without fear of showing leaks? (and no I’m not talking about wearing a pad instead)
Stress incontinence is the unintentional leakage of urine as a result of increases in intra-abdominal pressure (think coughing, sneezing, jumping, etc) and it is incredibly common. It is estimated to impact 80% of trampolining athletes.
Stress urinary incontinence is often said to be a result of pelvic floor weakness. However, before coming to see us, many of our patients have tried kegels without much success. So, what gives??
Stress incontinence is a sign that your abdominal “canister” is not working properly, and can actually be the result of dysfunction in any of the "canister" muscles.
The muscles that can be contributing to your stress incontinence:
Diaphragm (yes, the muscle that helps you breathe)
The pelvic floor
Hip muscles (especially the booty muscles)
The abdominals
Lats and low back muscles
If you have a weakness (or tightness) in any of these muscle groups, that is a recipe for bladder leaks!
OK, Ok, Ok…But how do I stop peeing myself when I’m doing double unders (or jumping jacks, or running)??
The solution is simple…ish. Let’s break it down into steps:
Step 1: BREATHE.
Your abdominal canister is a lot like a soda (or “pop”) can. It is a pressure system! When the can is closed, positive pressure pushes out against the walls and makes it sturdy. It is hard to crush a closed can. Once you pop that baby open, it is wayyy easier to crush.
You can think of your diaphragm as the top of the can, your pelvic floor as the bottom, and the abdominal and trunk muscles as the walls of the can. Pregnancy and childbirth tend to wreak havoc on these muscles. It’s basically like popping open the can.
When you breathe in your diaphragm expands and descends, your pelvic floor also descends, and your belly rises. When you exhale, your diaphragm moves up, your pelvic floor contracts and your deep core muscles contract. If you have ever heard “do the hard part of the exercise on the exhale,” that is because you are most stable/strong as you exhale. If you are holding your breath, your muscles won’t be functioning the way they should. Thus, resulting in leaks.
To prevent leaking, don’t hold your breath. During certain exercises, exhale during the hard part. If you are jumping, exhale as you land.
Step 2: Work on posture and alignment during exercises and daily life.
Stacking your ribs over your pelvis will make sure the diaphragm and pelvic floor are working together.
If you are jumping, this might mean leaning slightly forward. Leaning back and flaring your ribs out probably won’t help.
When jumping, land s o f t l y on the balls of your feet and roll back to your heels.
Step 3: Strengthen the muscles that are weak (I’m looking at you glutes) and lengthen muscles that are tight.
Ok so maybe not everyone’s glutes are weak, but most people’s are. Between pregnancy and postpartum body changes (hello mom butt) and sedentary lifestyles, the glutes really don’t have much of a chance. The glutes are basically BFFs with the pelvic floor. If they are weak, there is a good chance your pelvic floor is doing double duty in terms of pelvic stability. Give a couple of these glute-strengthening exercises a try.
Bridge:
While lying on your back with knees bent and a neutral spine (small curve in your back), press through your
heels drive your knees forward to raise your buttocks off the floor/bed creating a "Bridge" with your body. Don't let your back arch or tail tuck when lifting. Hold and then lower yourself and repeat.
You should feel this primarily in the glutes. If you feel it in your back, press your back flat prior to lifting, not letting it arch as you lift.
Hip Hinge:
Stand with a tall posture 6-12 inches from the wall. Imagine a string attached to the ceiling is pulling your head and spine upright, ribs are stacked over the pelvis, spine is in neutral.
Hinge at your hips and reach your hips back to touch the wall. As you reach back with your hips, make sure you do not arch your back or round your back and tuck your tail. Maintain a straight torso with your rib cage stacked over your pelvis. Feel your glutes lengthen and your pants stretch as you sit back into your hips. You should feel your weight shift back into your heels but try to keep your toes on the ground. Your knees should not come forward as you sit back.
Press through your heels as you exhale and draw in abs to stand up straight without overly clenching your gluteals at the top.
Other muscles that may need some love: Gluteus medius (outer hips), Adductors (inner thighs), Latissimus Dorsi (It’s a shoulder muscle but also a back muscle), Hamstrings, Deep Hip Rotators, Quads…etc. Your best bet is seeing a pelvic PT so you can find out exactly which muscle groups to work on. Otherwise, you might be spending your entire life at the gym.
Step 4: Make sure your pelvic floor is functioning properly.
Truly, the best way to do this is to see a pelvic floor Physical Therapist for a pelvic floor assessment. You can try inserting a *clean* finger into the vagina (or anus) and feel for a muscle contraction and relaxation. Exhale and imagine sucking up a smoothie with the vagina to contract the pelvic floor. You should feel a lift and a squeeze around your finger as you do this (kind of like someone is sucking on your finger). You should also feel yourself relax completely when you let go. If not, you may have some underlying pelvic floor tension. You should be able to hold for 10 seconds (WHILE STILL BREATHING) 10 times in a row. If you feel any pain or pelvic pressure, you really should see a pelvic PT.
For more resources, head over to our cesarean blog, diastasis blog, severe tears blog, or our online school for our postpartum yoga classes and diastasis course.
Leaking with running or exercise may be common, but it is definitely not normal. Book at one of our two Richmond, Virginia locations or book a virtual visit for individualized guidance at any time.