Exercise & Peeing (yes, it happens)

crossfit and peeing, woman lifting weights in gym

Have you peed during a workout?

Maybe during a heavy squat, or perhaps during box jumps? In a YouTube video, Rory McKerman, an athlete and CrossFit Games host, discusses what he refers to as “exercise induced urinary leakage,” or stress urinary incontinence (SUI). He interviews women competing in the Central East Regional CrossFit Games, asking them if they pee during workouts. Almost everyone in the video responds that yes, they do pee during workouts, particularly during double unders (a kind of jump rope technique) and box jumps. One of the women he interviews is a gynecologist, who says that we need to “invent something to help these women.”

The video resounded with women worldwide. Peeing your pants is not your average “girl’s night out” talk. Finally, someone was recognizing that stress urinary incontinence was a real issue affecting millions of women. But the video sparked a huge online backlash. While it did a lot to get the conversation started, it also got a lot wrong.

Women are not Seeking Treatment for Leaks

In one blog post, physical therapist Tracy Sher says that while it’s great that the video brought about discussion and awareness for the issue, peeing during workouts is not normal. She expresses her shock at how 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. A full 80% would be 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.” Yikes.

How CrossFit leads to Stress Urinary Incontinence

As a culture, CrossFit emphasizes working as hard as physically possible. While this kind of effort is admirable, in some cases it can go too far. That is how peeing, puking, or even fainting can become normalized. Women who leak while they work out might not be inclined to seek medical attention if they think leaking urine during their workouts is because of strenuous effort. CrossFit culture emphasizes extreme effort. As we saw in the video from the CrossFit games, supposed indicators of extreme effort can be worn as a badge of honor – even if they are actually indicators of a medical condition.

Cherrilyn F. Richmond MS, WHNP-BC is a Women’s Health Nurse Practitioner who works with non-surgical incontinence patients.  She specializes in pelvic floor rehabilitation at the Yale University School of Medicine Department of Urogynecology and Reconstructive Pelvic Surgery. She says “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.”

The female pelvic floor is made up of tissue that supports a woman’s reproductive and excretory organs. When straining to make a big lift, the increased intra-abdominal pressure provides support to vital organs and the lumbar spine. Strengthening the pelvic floor muscles – whether through Kegels or E-Stim technology like ELITONE – can help support these organs and decrease instances of urine leakage.

Preventing Stress Urinary Incontinence

CrossFit emphasizes compound lifts and movements. This means that strengthening support muscles like the 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. When starting any new fitness regime, it’s important to assess weaknesses. Then, incorporate preventative strengthening and learn proper form before putting your body under extreme duress. Pelvic floor strength is just another part of building base strength. Discussing it as such is crucial to removing the stigma around the topic and fighting the perception that incontinence is a symbol of hard work. For more information on Kegels, including tips and tricks, read How to do Kegel Exercises.

If you are a fitness neophyte, start doing your Kegels early on. Make them a part of your daily routine, and aim for three sets of ten three times a day. You can use different cues throughout your day to remind you. For example, you can do them during your morning and evening commute, 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 that back for a few weeks while you work on improving your pelvic floor strength. If when you return to that activity you’re still leaking, consult your doctor. They can recommend you to a pelvic floor therapist, a urologist, or recommend an E-Stim product like ELITONE.

Health or Fitness Professional?

If you are a health and fitness professional, be sure to bring up the topic with clients who are at a greater risk for developing incontinence. It may seem awkward to discuss, so try bundling the conversation in with core strength. Try recommending that your clients do Kegels along with a core strength regime to prevent injuries. You can also recommend they consult a pelvic floor therapist. Additional information on ELITONE for Clinicians can be found on our Clinicians page.

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.