Let’s talk about female athletes and pelvic floor muscle health! 

One of the most common conditions we see here at our pelvic physical therapy clinic is stress urinary leakage with jumping, running or heavy weightlifting. The second type of pelvic floor dysfunction we see prolapse symptoms with those same activities. 

So these are both different in nature as to why they are caused and the symptoms involved, but can have some similar reasons as to why they’re happening.

In this blog post we are going to address urinary leakage with female athletes. We will also be posting another blog about prolapse and female athletes! 

First, female athletes can range anywhere from preteen years all the way to 50 years old and beyond. AND I consider an athlete anyone who exercises regularly and moves their body in ways that make them happy and stay active. 

Stress urinary leakage can happen for several reasons. The pelvic floor muscles support the organs, bladder, bowel, uterus, and are very important when it comes to helping you support the bladder and not leak urine while you are exercising, jumping or running.

Here are some main reasons why you could be having urinary leakage:

1. Overactive/Tense Pelvic Floor Muscles. When it comes to the pelvic floor, there can be a length tension relationship that’s not supporting the urethra very well. Let’s talk about length tension relationships. If the pelvic floor muscles don’t have the ability to fully relax, because yes, relaxing pelvic floor muscles is just as important as contracting them, then you may not be fully emptying or getting good support to the urethra, because the muscles are always staying high and tight.

2. Power or Endurance Of Pelvic Floor Muscles. There can be weakness of the pelvic floor muscles due to several reasons. It could be from fascial connective tissue changes, such as having any tearing during a vaginal delivery, or strain on the pelvic floor with a pregnancy. A strain or tear pelvic floor muscles could create changes and how those muscles are again supporting the bladder and the urethra. Changes of muscle performance through time with hormonal changes, with history of low back pain/hip pain, and not using the pelvic floor muscles effectively. The pelvic floor muscles not only provide support externally with closing to support the urethra and internally with lifting to support all the organs in the pelvic floor. So if there’s a strength deficit, meaning you can’t create enough force around the urethra and support the bladder, then there can be urinary leakage with running and jumping and heavy weight lifting. 

3. Coordination Of The Pelvic Floor Muscles. The other reason could be pelvic floor muscle incoordination or dyssynergia. The muscles are not effectively coordinating with your movement and breath. This could affect your intra-abdominal pressure management– pressure between your diaphragm and pelvic floor. You could be leaking because you’re not coordinating those muscles again and not supporting the urethra well. 

4. Difficulty Managing Intra-Abdominal Pressure Management. This is the pressure within your abdominal cavity, between the diaphragm and the pelvic floor muscles, which we envision like a canister or a soda pop can. If we have a difficult time managing our pressure in our abdomen, whether that’s through coordination, difficult to get in a deep breath for rib cage expansion. You could also have difficulty supporting enough pressure and force in your abdominal activity from the pelvic floor muscles below (i.e. power of the muscles). The impaired intra-abdominal pressure can contribute to urinary leakage due to pressure above in the abdomen not being 

5. Biomechanics With Movement. Your form during running, lifting or jumping can contribute to why you may be leaking as well. There may be something you could be doing changing with your running form,  jumping form or lifting form to optimally again help you with the intra-abdominal pressure management and decrease the urinary leakage. Your form can effect how you are optimally using your pelvis/spine, legs, and muscles with your type of exercise. 

6. Bladder/Bowel Health Contributions. Bowel health such as chronic constipation could also be a contributing factor to urinary leakage with exercise. This can contribute to internal pelvic floor congestion due to the ability for the colon to expand and in some cases become a megacolon. There could also be difficulty with completing emptying the bladder associated with overactive pelvic floor muscles. This could be either not emptying all the way, or over holding your urine throughout the day. As a general guideline, urinating every 2-4 hours is a good interval to urinate even when hydrated really well. 

Just to be clear you didn’t see that doing Kegels will help you from not leaking urine. That would imply you are weak in the pelvic floor muscles which is why you are leaking urine. But as you see above pelvic floor muscle weakness may only be one reason, but not the reason you are leaking during exercising.

If you are struggling with urinary leakage while exercising or working out, it is important for you to know you can continue to do the movements you love WITHOUT leaking urine. A pelvic physical or occupational therapy evaluation is important so you can find the primary drivers to your leakage. So we can fix it without depending on medications or having to wear a pad while you are exercising! 

If you want to know if pelvic physical therapy is a right fit for you or you would like to book an appointment you can reach out to us here. You are not alone if you are leaking urine! If you are experiencing symptoms of endometriosis, please reach out to us via a phone call or fill out a form here.

I have had this question so often… how do I know if I need to relax my pelvic floor muscles?

So, let’s talk about what that means and who needs to be doing that.

First, the pelvic floor muscles again support organs, control sphincters (pee, poop), they stabilize the spine/pelvis and everything that attaches to the pelvis and spine, they help with healthy sexual function, they allow for good circulation through the pelvis. The pelvic floor muscles don’t just do the lifting contraction also known as a kegel.

So, you may have found on social media and through Google searches that it’s important to relax the pelvic floor muscles. What does that mean?

Relaxing the pelvic floor simply means that you know how to lengthen or elongate the pelvic floor muscles so that you can have good bladder emptying and bowel emptying, allow for penetrative intercourse, good stability of the spine and pelvis, and allow for a delivery of baby vaginally.

The reason why this is so important is otherwise you might struggle with constipation, urinary leakage and pelvic pain, including pain while sitting, walking, moving, and pain with penetrative intercourse or the use of tampons or menstrual cups.

Women and men alike struggle with overactive or hypertonic pelvic floor muscles.

Who needs to relax the pelvic floor muscles?

The people that need to relax the pelvic floor muscles are struggling with some of these problems:

Pain prior to bowel movements and relief of pain after

Constipation, which means firm stools almost like pebbles, difficulty getting out your stool.

Urinary leakage or urgency of having to use the bathroom and frequency.

People with interstitial cystitis

People with vulvodynia,

Tailbone pain

Pain in the testicles, penis or vulva.

It’s so important to get assessed by a pelvic physical therapist when you’re struggling with any of these issues. Again, a pelvic physical therapist is one that assesses the entire body, and assesses the pelvic floor muscles internally and externally.

If you see a general orthopedic physical therapist that does not assess these muscles, you are not going to fix the problem efficiently. It may take longer and you may not get full resolution.

If you don’t struggle within these problems, lengthening the pelvic floor is still important to do.

First to avoid any of the above problems from happening.

How do you lengthen the pelvic floor muscles?  

Some of the ways to do that are going through different types of exercise. Squats are phenomenal for strengthening but also lengthening or relaxing the pelvic floor muscles. So I always tell clients to squat!

Exercising the body is a great way to not only exercise your heart, your brain, your bones, and joints, but also a really great way to maintain great pelvic floor, health and strength. And do not focus on doing “Ab work”.

Another key thing is always to stay hydrated, drinking enough water. Making sure to drink half of your body weight in fluid ounces.

Certain hip opening and rib cage mobility exercises found in yoga, pilates or stretching programs can help.

In conclusion… 

If you have ever been told to just relax the pelvic floor muscles, it may not be something you can control and resolve on your own, and is just poor advice!!  So trying to do these things at home without getting an assessment, again can lengthen the duration in which it might take to resolve your symptoms. A pelvic physical therapy can give you better answers to what is causing your tight pelvic floor muscles.

So, we offer free consultation to see if you’re a good fit for pelvic physical therapy here with us. We would love to hear from you!

Oftentimes we think– or society has ingrained in our brains– that leaking urine because we are a mom or aging woman is normal. And it most definitely is NOT normal!! Yes, it is very common, but you do not need to just give up and wear pads– there are answers!

When we look at the the trunk or your “core”, we see that it is not just your Abs… your core is represented in the picture right below. The top of the canister or “can” is your breathing diaphragm, the back side consists of the spine, spinal muscles and small mutlifidi muscles, the front is the abdominal wall muscles (rectus abdominus, obliques), the bottom is the pelvic floor muscles, and the side walls in the deepest layers are the transverse abdominus!

Lots of muscles! Boom! But you do not need to memorize these, the bigger picture is that you see there is a system…. like a “can” it helps maintain a pressure system, but there is not air, there are organs, connective tissue and fascia, and fatty tissue.

And when we cough, laugh, sneeze, or jump we change the dynamics of this pressure system or the intra-abdominal pressure (IAP) changes. We know that this varies from one person to another and with different types of activities.

A mentor/teacher of mine, Julie Wiebe has come up with a wonderful way of looking at the core and (IAP) in this video here. AND this is a blog with her in an interview on intra-abdominal pressure .

There is a study Julie Wiebe discusses Cobb et al 2005– this study evaluated where pressure increased the most with functional activities, and jumping coughing created the highest IAP.

So if pressure increases does this mean your pelvic floor is too weak to keep in the pee or sometimes poo? No, sometimes you have weakness, but sometimes you may have poor coordination, a prolapse, diastasis recti, muscle performance issues that may be leading to the leaking.

And do you have to live with leaking? NO! You don’t have to live with it because if there is a root cause to your leaking — which there is 100% chance there is…. we need to discovery it so we can help fix it.

You saw I stated there are several reasons to leaking

• Poor timing or coordination of the core muscles
• Prolapse
• Diastasis Recti
• Posture or technique of movement
• Power or endurance of pelvic floor muscles

So if you are leaking, and sick of wearing a pad during the day or even during your workouts… know you do not need to leak, and pelvic physical therapy focuses on finding the answers to why you are leaking so that you can stop leaking… Boom!

Here’s a few tips to stop leaking– this is of course guessing what your primary issue is:

• Do NOT hold your breath — make sure to breathe while you jump repeatedly
• EXHALE with EXERTION — make sure you make an audible exhale “shhh” “sss” when you push weight overhead, stand tall out of squat, jump in the air with tuck jumps, star jumps, squat jacks, plank jacks, etc.
• When you feel the urge of leaking or you start to leak– breathe and modify your jump into squats or slow your pace down while jumping as you BREATHE
• SOFT landing will help the whole body absorb the ground reaction force– not just the pelvic floor absorbing it all!
• Bladder and bowel habits CAN play a role so make sure you are hydrated AND you have daily poops that are soft & formed!

If you want to end leaking you can set up a free phone consultation with us here at this link and see what could be a root cause for you.

Cheers to not wearing pads as we age!