Have you ever peed during a workout?
You’re at the gym doing your best to take care of your body, but you’re dreading those weighted squats and box jumps. You know when you push yourself physically, you’ll end up with bladder leakage during exercise. This scenario may be common among women, but it’s not normal.
In a YouTube video, Rory McKerman discusses what he refers to as “exercise-induced urinary leakage,” also known as stress urinary incontinence (SUI). The athlete and CrossFit Games host interviews women competing in the Central East Regional CrossFit Games, asking them if they pee during CrossFit. Almost every woman in the video says they do pee during workouts, particularly during double unders (a jump rope technique) and box jumps. One of the women he interviews is a gynecologist and says that we need to “invent something to help these women.”
The video hit a chord with women worldwide. Finally, someone was recognizing that SUI was a real issue affecting millions of women. But the video sparked a huge online backlash, and even though it got the conversation started, it also got a lot wrong.
Why women aren’t seeking treatment for exercise-induced incontinence
In her blog post, physical therapist Tracy Sher applauds the video for bringing awareness to SUI but emphasizes that bladder leakage during exercise is not normal. She expresses concern that a medical condition has become “a goal to achieve as a marker of intensity.”
Another blogger and physical therapist, Julie Weiebe, created a survey in response to the video. She found that about 60% of her respondents leaked urine during exercise, but only 13% sought treatment. In contrast, about 65% of individuals who experience joint pain sought treatment. Despite the low percentage of women who sought treatment, only about 4% of individuals actually thought leaking during exercise was normal, and 80% were interested in integrating pelvic floor exercises into their workouts.
The Australian Physiotherapy Association posted an article titled “CrossFit Games sends disturbing message” in response to the video. The article cites Shan Morrison, a women’s health physiotherapist and continence specialist, who says, “This video is shocking … It is not normal to lose urine during exercise or at any other time. It should certainly not be seen as a ‘badge of honor.’ For a company that prides itself on promoting exercise, CrossFit Inc is not sending a positive health message.”
As a culture, CrossFit emphasizes extreme effort. Although this kind of effort is admirable, in some cases it can go too far, normalizing peeing, puking, or even fainting. Women with bladder leakage during exercise might not be inclined to seek medical attention if they think leaking urine during their workouts is because of strenuous effort. As seen in the video, the indicators of extreme effort are worn as a badge of honor, even if they actually indicate a medical condition.
How workouts can lead to exercise-induced incontinence
Let’s take a quick look at our anatomy. The female pelvic floor acts as a kind of hammock, with layers of muscle supporting the bladder, bowel, and uterus. When lifting heavy weights, the increased pressure can lead to bladder leakage during exercise, particularly for women who have weakened, stretched, or damaged pelvic floors due to childbirth or aging.
Cherrilyn F. Richmond is a Women’s Health Nurse Practitioner who works with nonsurgical incontinence patients. She specializes in pelvic floor rehabilitation at the Yale University School of Medicine Department of Urogynecology and Reconstructive Pelvic Surgery, and she explains how weight lifting affects the pelvic floor.
Stress urinary incontinence can result from intra-abdominal pressure from squats with heavy weights and high-impact movements, such as burpees, which sets off a chain of events. The pressure applied to the bladder can cause the base of the urethra to rotate, which can decrease the pressure in the urethra.Cherrilyn F. Richmond, MS, WHNP-BC
Preventing stress urinary incontinence
CrossFit emphasizes compound lifts and movements, so strengthening support muscles (e.g., your core, rotator cuffs, and ITB bands) is essential to prevent injury. Pelvic floor muscles are no different, especially for athletes who are predisposed to pelvic floor weakness. To offset pelvic floor weakness and minimize bladder leakage during exercise, try to incorporate Kegel exercises and learn proper form before putting your body under extreme duress. Pelvic floor health is a crucial part of building strength, and talking about it reduces the stigma around incontinence and changes the perception that bladder leakage is a symbol of hard work. Learn more about tools that strengthen your pelvic floor by reading about these devices.
If you’re new to working out, start doing your Kegels early on. A daily routine should include three sets of 10 Kegels done three times a day. You can use different cues throughout your day as reminders. For example, do Kegel exercises during your morning and evening commutes, while you’re brushing your teeth, or while you’re preparing meals.
If you experience urine leakage, try to identify what’s causing it. For example, if you leak when you are lifting heavy or doing a particular kind of cardiovascular activity, try scaling back for a few weeks while you work on improving your pelvic floor strength. If you’re still leaking when you return to that activity, consult your doctor. He or she can recommend a pelvic floor therapist, a urologist, or an at-home electrical stimulation (E-stim) solution like ELITONE.
Are you a health or fitness professional?
If you’re a health and fitness professional, try to bring up the topic with clients who are at a greater risk for developing incontinence. Bladder leakage during exercise may be awkward to discuss, so bundling the conversation with a core strength discussion can help. Try recommending Kegels, along with a core strength regime to prevent injuries. You can also recommend clients struggling with SUI consult a pelvic floor therapist or try an over-the-counter Kegel device. Check out ELITONE for Clinicians for more information.
Disclaimer: Information posted here is designed to act as a guideline. It is not medical advice. Consult your doctor before starting a fitness routine, and remember that leaking urine is a medical condition that can be addressed and treated by a medical professional.