Before I dive into this very riveting topic about pee, pelvic floors, and pressure management, let’s get a few things out and on the table:
- Growing and birthing a human is a miracle and all pregnant persons should be given a lifetime achievement award
- Sometimes we experience incontinence at 70 years old because of natural wear and tear, and sometimes we experience it at 20 years old because we’re strong and active but misled or misinformed on how to stay safe during our respective activities
- Peeing or leaking during exercise or exertion is common, but it is not normal
Contrary to popular belief, peeing while you workout (or sneeze or cough or laugh) isn’t some rite of passage or badge of honor. It pains me to see people—especially pregnant/postpartum women—tag each other in the comments under some fit-fluencer’s Instagram workout video of box jumps or 1,000lb sumo deadlifts with something along the lines of, “LOL I’d need a diaper for this!! ????”
Pee or leakage during physical exertion is actually a sign of poor pressure management and/or a weak pelvic floor (which is different from pelvic floor dysfunction), and this issue isn’t exclusive to pregnant/postpartum women (though they are typically the leaders of this pack); both men and women of all shapes and fitness backgrounds can experience symptoms of a weak pelvic floor, and those symptoms can be caused by a whole heap of things, like genetics, previous injury, age, or poor technique in sports and fitness.
Our pelvic floor is a very important but often-overlooked hammock or dome-shaped group of muscles and ligaments located within the pelvis. Beyond bladder/bowel control and winning the award for Best Supporting Role during Pregnancy and Birth, our pelvic floor is responsible for working with the rest of your core (think: abdominals, obliques, and spinal erectors) to stabilize and protect your spine during everyday life, as well as exercise. So if we possess weakness in our pelvic floors, we will commonly experience incontinence as a symptom. But as active humans who run and jump and push and pull and throw, ignoring symptoms of a weak pelvic floor may be putting our bodies at risk for serious and/or long-term injury.
So, how do you know if you have a weak pelvic floor? Here’s a quick checklist. Do you regularly pee or leak when you:
- Sneeze, cough, or laugh
- Jump (single unders/double unders, box jumps, etc.)
- Run (either during sprint sessions or long distance)
- Lift heavy weight or max out a lift
- Perform an explosive movement where you have to land at the bottom of a squat (squat cleans, snatches, sometimes heavy jerks)
- Or any of these other, more severe and personal circumstances
If you said yes to any of the above bullets, you may have a weak pelvic floor. And guess what? It doesn’t go away on its own, and—similar to all the other muscles in our bodies—if we don’t use them, we lose them. Just like we have to rehab a knee after ACL surgery, we have to diagnose this as a weakened body part and treat it with corrective and strengthening exercises.
Who knew I needed to care so much about my muscle hammock? Okay, tell me what I should do next.
I’d argue that the best thing we can do to help identify or mitigate pelvic floor problems or even solve some that may already exist, is to first see a pelvic floor physical therapist (PFPT).
Yes, hello and welcome to the first time you’ve ever heard of a pelvic floor physical therapist.
Just like any other medical professional with a specialty, PFPTs assess and address impairments specifically related to pelvic health—which includes the low back, pelvis, and pelvic floor. If you’re experiencing symptoms, they zero in on why they’re happening, what’s causing them, when they happen most, and how to rehab those muscles.
Then, when you’ve been cleared by your PFPT, or if you’re not experiencing symptoms but you want to be preventative and protect your pelvic floor from exercise-induced weakness or injury, my next suggestion would be to work with a coach who specializes in this arena who can offer you personal training to get those muscles right and get ‘em tight. These trainers work with you to provide an individualized prehab program (in that they are preventative versus rehabilitative) that can (and should) include tactical ways to develop control, strength, and endurance within your pelvic floor. The goal of this particular type of training program is to retrain our mind-muscle connection as it pertains to our total core function; understanding how to appropriately or better manage your breath and internal bracing/pressure during movement (otherwise known as intra-abdominal pressure) in order to prevent or prolong pelvic floor-related weakness as we age.
And how do you appropriately manage your intra-abdominal pressure during exercise? Well, that’s a story for another time. Until then, let’s take tender, loving care of those precious muscle hammocks.
Sadie Flynn is a CrossFit Level 2 Trainer and former collegiate athlete with a penchant for power lifts. As a new mom, Sadie is deeply passionate about pregnant and postpartum fitness and wellness, and works hard to help women take care of their bodies before, during, and after birth. When she’s not coaching at CrossFit Renew, making jokes at your expense, or forcing her 90s alternative music beliefs upon you—you can find her somewhere outside with her husband, two dogs, and their chonky new baby.