You know how it is when a big sneeze catches you by surprise, and all of a sudden you’ve peed yourself a little? Incontinence, or leaking, happens when you lose control over your bladder and the ability to hold in urine.
“It can be caused by a myriad of issues, like pelvic organ prolapse or an actual issue with the neurological function of the bladder,” says Amelia Ponchur, DPT, a lead physical therapist at Genesis PT & Wellness in Dallas, Texas, with a specialty in pelvic health and restoration. Leaking can also be due to urge urinary incontinence, where you’re rushing to the bathroom but can’t make it in time.
When it happens from sneezing, or other movements like coughing, laughing, jumping, running, or twisting, it’s most likely stress urinary incontinence, where the motion puts pressure on your bladder, causing a little bit of urine to come out. “Your nervous system and certain muscles are not coordinating well with one another to be able to take on the force or pressure exerted, and so this allows urine to exit the urethra,” she explains.
This is all too common during exercise, with HIIT training, running, and lifting being three top offenders. And anytime there’s high impact from jumping or plyometric work, such as with high knees, mountain climbers, or squat and tuck jumps, you’ll be even more susceptible.
Exercises that are most likely to cause you to pee
Squat jumps
Jump squats can lead to greater risk of leaking due to the biomechanics required. “The increase in the force of gravity downwards on the pelvic floor causes extra work on the pelvic floor, both in force absorption and coordination of the muscle group, and this can cause leakage,” Dr. Ponchur says.
To minimize your risk of leaking during squat jumps, try this:
- Inhale as you go down into the squat, keeping the ribs relatively stacked over the pelvis.
- Exhale as you go up into the jump, continuing to exhale until you land.
- As you land, don’t stop abruptly and hit the floor, but rather “absorb” down into the next squat.
And don’t use kegels when doing squat jumps. “It’s not needed for proper pelvic floor action in this activity,” Dr. Ponchur says.
Sprinting
Due to the quick acceleration, how much muscle recruitment it requires, and the oxygen demand, sprinting can lead to peeing during your run. “Here’s where increased oxygen demand/cardio effort causes a change in breathing mechanics (like more mouth breathing and less O2 getting into lungs) and typically less proper diaphragmatic breathing occurs,” Dr. Ponchur says.
The increased hip flexion you need for proper sprinting form also increases the risk due to the change in pelvis position, as does quickly pushing off the ground, which causes more force and work on the pelvic floor muscles.
That said, sprinting, other running, and walking all to some degree have an effect on the pelvic floor and hips due to the impact of our feet on the ground. “They’re all connected; if your feet/ankles cannot do something, then your pelvic floor and/or hip muscles are going to have to compensate for that to try to achieve the goal/movement of what you are attempting to do,” Dr. Ponchur says. That compensation could also potentially put more pressure on your pelvic floor.
Barbell back squat
The requirement of the barbell on top of the shoulders can lead to the flaring of the ribs (as if you’re puffing your chest forward), which can then increase intra-abdominal pressure and lead to poor pelvic floor pressure management and leakage.
As the weight increases, the risk does, too. Make sure to maintain your breathwork and form to limit leakage as best as possible. With each squat, inhale on the way down, then exhale on the way up. “In general, you want your feet around hip-width distance and going parallel, and it is okay to let your knees drift over your toes,” Dr. Ponchur says.
Really, any major compound weight-lifting movement like this can increase your risk of leakage because it requires more work from the core and pelvic floor and increases intra-abdominal pressure.
Jumping jacks
Another plyometric move, jumping jacks may trigger leakage as a result of the increased force of gravity as well as the added bonus of both the abduction of the hips (where legs move out to the sides and cause pelvic floor lengthening) and the speed of the movement. “All of these things put more work on the pelvic floor, and if your pelvic muscles cannot handle that, it causes leakage,” Dr. Ponchur says.
You can try not opening the legs as wide, or working with your breath so the jump is timed to your exhales, she says. “Or just slow it down to improve the reaction time of the pelvic floor muscles,” she adds.
So how can you avoid peeing during exercise?
If you’re finding leakage to be problematic, consider working with lighter weights until you’re better able to control your core. “Decreasing the weight decreases the amount of effort and work required by your overall core and pelvic floor, making it easier,” Dr. Ponchur says.
Diaphragmatic breathing during training can also make a huge difference. “Diaphragmatic breathing is the key to proper pressure management, and promotes proper pelvic floor range of motion, which we need for good core function,” she explains.
Here’s how to do it:
- Inhale through your nose, as your rib cage moves laterally, for about two to four seconds.
- Exhale out through your mouth (as if you’re blowing through a straw) for a count that’s at least twice as long as the inhale, so about four to eight seconds.
Prioritizing core work—including your pelvic floor, which makes up the bottom of the core—can also help you build the strength needed for proper functioning. “The core’s job is to pressurize (aka stabilize) your trunk so that your limbs can move off of a sturdy base,” Dr. Ponchur says. “So anything that creates a disruption or mismatch in the pressurization can lead to leakage.”
What about kegels? A kegel is a pelvic floor muscle contraction, which basically means holding tension in a muscle. While Dr. Ponchur says that kegels can be important, she feels they are generally overemphasized and viewed as the only treatment for pelvic floor issues. “In reality, I rarely tell people to kegel for their PF problems,” she says. Kegels can backfire if you’re not doing them with proper form, or if you’re thinking they’re the only solution available, so you never find a real fix.
How do you actually activate your pelvic floor properly? Find out—and follow along—here:
One product that may offer temporary relief is the pessary, which is a prosthetic device that is inserted into the vaginal canal to help with incontinence and pelvic organ prolapse. Basically, it resembles a tampon.
“There are over-the-counter brands like Revive or Poise Impressa, which look sort of like a tampon, or you can be specially fitted for one by healthcare professionals,” Dr. Ponchur says. “It is not something I recommend often as I typically like to exhaust other options first.”
Before investing in any products, Dr. Ponchur says your best bet is getting an assessment from a pelvic floor PT. They’ll be able to recommend a solution that’s right for you.
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