A friend invites you to a boot camp class. Because you’re already in amazing shape, you’re flipping that giant tire like a beast and practically levitating through those push-ups. Your ego is pumped, your heart is pounding and, feeling like the rock star that you are, you grab a jump rope and begin swinging.
Then something terrible happens.
You pee yourself.
Or maybe you’re on the leg press, 450 pounds of plates loaded in an attempt to set a new personal record. You slowly lower the weight, and as you push the sled back up your concentration is blown by the hot sensation of urine suddenly spreading through your spandex.
What the hell is happening?
Chances are, you have what’s called stress incontinence. And you’re not alone. There are a zillion women who deal with this daily and Yours Truly is one of them. Join the club.
What do you mean I have incontinence?!
Believe it or not, bladder control concerns are not exclusive to Grandma and Grandpa Jones. In fact, according to the American Urological Association’s Urology Care Foundation, approximately one out of every three women will experience some type of incontinence condition (men are not exempt from this issue, though their numbers are far fewer than us ladies). The involuntary leakage of urine as a result of physical activity is known as “stress incontinence.”
Stress Incontinence: Why is this happening?
Our kidneys are constantly filtering blood. During this process, any fluid our body doesn’t need – otherwise known as urine – is sent down our ureters, which are tubes connecting each kidney to the bladder. The bladder is like a balloon, able to expand as more urine is collected and stored.
Luckily, our pee stays put because we have what’s known as a “urinary sphincter,” a muscle that surrounds and constricts the urethra so urine doesn’t seep through from the bladder above it. Typically we are in control of opening this valve: You go to the bathroom, pee, and voila! the valve opens (and then constricts again when you’re done).
However, for someone with stress incontinence, the urinary sphincter is not closing as tightly as it should.
Hammocks aren’t just for bananas: Introducing your pelvic floor.
Each one of us has what’s known as a “pelvic floor.” This is a hammock-like muscle that stretches from the front of the pubic bone to the base of the spine. Its role is two fold: To support the pelvic organs (bladder, bowel, uterus) and to help with bowel and bladder movements by compressing against the urethra and anus.
In other words, it’s what helps us “hold it,” be it pee, poop, or farts.
Clearly our pelvic floors are important.
Weak pelvic floor muscles are a major contributor to stress incontinence. This means that when we “hold it,” the pelvic floor doesn’t exert enough pressure to constrict the urethra fully. While it may be strong enough to prevent urine from leaking during general activity, once there is significant internal pressure being exerted on your abdomen and bladder – such as a sneeze, cough, jumping jack, leg press – it simply is not strong enough to prevent some urine from escaping.
How did this happen? I didn’t even know I had a pelvic floor!
For us mammas out there, look no further than our little cherubs to discover one of the primary causes of stress incontinence. Pregnancy and child birth (both vaginal and c-section) can result in a stretched and weakened pelvic floor. In fact, the more children you have, the greater the likelihood your pelvic floor is, shall we say, not in “optimal condition.”
But this is not the only culprit for stress incontinence. Other causes or contributing factors may include:
- Frequent and long-term coughing and sneezing
- Smoking (can result in frequent coughing)
- Excess consumption of caffeine or alcohol (both are diuretics, causing your urine production to increase)
- Hormonal deficiencies
- Long-term participation in high impact activities or heavy lifting
- Hysterectomies (for women) or removal of the prostate (for men)
I see “heavy lifting” on your list of causes. What does this mean for women who lift iron?
When we lift weights, especially during heavy pushing exercises such as squats and presses, our bodies experience a significant amount of intra-abdominal pressure. This pressure within the abdominal cavity can play a role in causing pelvic floor disorders like organ prolapse or urinary incontinence for those at higher risk. Who’s at risk? Those that have:
- a family history of prolapse
- chronic constipation with straining
- chronic cough
- significantly overweight or obese
- are menopausal
- recently had a baby
- had a baby at some point in their lifetime
- had a traumatic vaginal delivery
For those not at risk for pelvic floor disorders, I was unable to find a single scientific study that looked at the correlation between intra-abdominal pressure from weight lifting and stress incontinence in women. This might simply mean that I’m not a very effective researcher, but I suspect it’s more likely because weight lifting and women is not a common – or even encouraged – phenomenon in society in general. In fact, I found one scientific article that stated, “The assessment of activity-induced intra-abdominal pressure and its potential link to pelvic floor disorders is not a topic routinely addressed in the exercise science literature.”
True that, yo.
However, here is what I do know: Various sources have indicated that factors creating intra-abdominal pressure (pregnancy, coughing, heavy lifting) correlate with weak pelvic floor muscles. While weight lifting alone may not cause the pelvic floor to weaken, it certainly will not benefit someone who already has a problem.
Does this mean if you have stress incontinence you should not work out? Absolutely not. But here are some suggestions:
When working on core-strength, emphasize exercises that strengthen the transverse abdominus (TA) muscle. Our abs are more than just our “six pack.” In fact, we have layers of abdominal muscles, each targeted by various exercises. The rectus abdominus, better known as “the six pack,” is one of the most superficial layers of our abdominal musculature. While it’s okay to train them, doing so too often or too intensely can create an imbalance in our core that can negatively impact pelvic floor functioning.
Our TA muscle, by contrast, acts as a built-in girdle. A strong TA is responsible for a flat belly and also contributes to a strong pelvic floor. I found a great exercise guide from “Pelvic Floor First,” an initiative by the Continence Foundation of Australia. Click here for that guide called Bladder-Control-Pelvic-Floor-Muscles. They also offer a free pelvic floor app that provides instructional videos and workouts. What a fantastic resource from our friends down under!
You may also consider not using a weight belt. Unfortunately, I was not able to find concrete evidence that a weight belt does or does not increase intra-abdominal pressure. However, because weight belts are rigid and worn around our mid-sections, one would assume intra-abdominal pressure would be forced up into our diaphragms and down into our pelvic floors (thus, causing additional strain on these areas). Check out this article on the Effects of abdominal belts on lifting parameters so you can decide for yourself if a weight lifting belt is a device you should or should not use.
Back to stress incontinence. I’m sure I have it, but what do I do now?
Believe it or not, many people do not talk with their doctors about urine leakage either because they don’t feel it’s bothersome enough to warrant a discussion or they are too embarrassed to bring it up. You can’t rely on black workout pants or hope that people think you’re just a heavy crotch sweater forever. It’s up to you to take the first step.
Schedule an appointment with your primary care physician or gynecologist to have an evaluation for the presence and severity of stress incontinence. Your doctor will likely ask many questions, so be prepared by recording when and how urine leakage happens and what and how often you are drinking fluids. Your doctor may give you a physical exam to determine the strength of your pelvic floor and rectal muscles and/or have you undergo imaging and voiding studies to watch how your bladder is functioning.
But can it be fixed?
Yes. Depending on the treatment, stress incontinence can be cured or managed through a variety of measures. Some of the more conservative treatments are:
- Kegal exercises. Chances are you’ve heard of these and for good reason: They are essential in strengthening the pelvic floor muscles. Check out this guide: The_pelvic_floor_and_core_exercises for more information about kegals and how to do them.
- The Jade Egg or other vaginal “exercise equipment.” Seriously, if kegals aren’t for you, there are other options that offer the same results. Check out my review of the Jade Egg here.
- Controlling the type, amount of, and timing of fluid you consume each day.
- Bladder retraining; which involves urinating on a set schedule to promote better bladder control.
- Lifestyle changes such as diet, exercise, caffeine reduction, and smoking cessation.
- Vaginal pessary: A silicone ring that is inserted in the vagina and designed to help compress the urethra and support the bladder. This device can be inserted and removed by the user, though it does need to be correctly fitted by your health care provider. Click here for some helpful information on the benefits and different types of pessaries.
- Urethral inserts: This is like a tampon, but for your urethra. You insert it when you need it, pull it out when you are done. Ouch!
Isn’t there a surgery or something that can fix this?
Yes. Some cases of stress incontinence may require more aggressive treatment, and there are surgeries to permanently correct the issue. It is typically recommended that surgical repair be sought after a woman is done having children. While there are a few different surgical strategies, there are two options that appear to be the most common:
Sling procedures: This is a surgical intervention that provides permanent support to the bladder neck and urethra. There are a variety of sling procedures, but too complex for me to describe here (click on the image below for the specific deets). A couple descriptive terms stood out to me though, such as “vaginal and abdominal incisions,” “catheter,” and “long recovery periods.” Despite my queasiness over the discomforts involved with surgery (I mentioned the catheter, right?), it does permanently correct the issue.
Suspension procedures: This essentially does the same thing as a sling procedure as far as providing support to the bladder neck and urethra, but just using a different technique. To read about the specifics of this procedure, click on the image below.
Lifting, where do I go from here?
Aside from seeking help from a qualified physician and utilizing strengthening exercises like kegels or vag eggs, the biggest thing is to listen to your body. If general fitness is your goal, you can simply avoid or limit exercises that cause urinary leakage like dead lifts, deep squats, tire flips and jumping exercises like box jumps or the leg press.
When I say limit, I mean lighten up the weight. Work in higher reps ranges. You don’t have to load up the barbell to reap strength training benefits.
Instead of dead lifting 6 reps at 200 pounds, dead lift 20 reps at 100 pounds or 30+ reps at 50-75 pounds.
If you have power lifting goals, (again, seeking a physicians help first), there are products you can wear such as Confitex which are absorbent undies to keep you lifting away without the embarrassing leakage.
So there you have it. Stress incontinence explained.
While it’s easy to poke fun, the truth is that this is a disorder that can cause a deep level of embarrassment and avoidance of activities. The chance of experiencing stress incontinence increases as we age, but that doesn’t mean it’s because we’re old. It’s simply a result of significant internal pressure caused by heavy lifting, pregnancy, childbirth, obesity – things that are part of a woman’s typical life. But you don’t have to simply live with it. All it takes is a trip to your doctor.
Whether you are new to fitness or a veteran competitor, I encourage you to join my free FB forum where you can ask fitness-related questions or find support from women just like you. Fitness is a journey, and so much more fun when you have someone to share it with.
Prevalence of incontinence studies: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1476070/