Picture this: You're powering through burpees, jumping rope or sprinting up a hill when suddenly you feel a little urine leak out onto your leggings. Peeing during a workout isn't something to be embarrassed about; it's actually a pretty common condition known as exercise-induced stress incontinence.
"Stress incontinence happens when physical movement or activity — such as coughing, laughing, sneezing, running or heavy lifting — puts pressure (stress) on your bladder, causing you to leak urine," according to the Mayo Clinic.
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And it occurs more often than you might think. Matter of fact, stress incontinence affects 24 to 45 percent of people with vaginas older than 30 years old, according to a September 2019 article published in American Family Physician.
While bladder leakage during exercise is common, it's not normal — leaking is likely a sign that something in your body isn't functioning optimally. Here, experts explain some causes of peeing during exercise and what you can do to stay dry when you work out.
1. You Have Pelvic Floor Dysfunction
The pelvic floor muscles are a basket of skeletal muscles that sit at the bottom of the pelvis — they are literally the "floor" of the core — and one of their main jobs is to control the passage of urine, Marcy Crouch, DPT, pelvic floor physical therapist and creator of The DT Method birth prep and recovery courses, tells LIVESTRONG.com.
When the bladder fills with urine, the pelvic floor muscles contract to close the urethra, so urine stays in. But if the pelvic floor muscles are weak and become even more fatigued during your workout, they won't be able to handle the increased dynamic load, Crouch says. That's why you may be okay at the beginning of a HIIT workout, but by the end, you may experience a little leaking.
You may also notice more leakage as you get older, since the pelvic muscles can weaken with age, says Jodie Horton, MD, a board-certified obstetrician-gynecologist and chief wellness advisor for Love Wellness. And yes, stress incontinence is more common after having a baby. "During childbirth, vaginal tissue and nerve damage can occur that can weaken the pelvic floor muscles," Dr. Horton says.
Other more serious pelvic floor conditions like pelvic organ prolapse (when one or more of the pelvic organs drops down or presses into or out of the vagina) can also cause leakage during exercise, especially the kind that involves running and jumping.
“Pelvic floor exercises (like Kegels) are a great way to make sure the bladder is supported, and urine is staying put,” Crouch says. “But Kegels are a lot harder to do than just squeezing your vagina at a red light — there's a proper way to do them, progress them and train them just like we would do with other skeletal muscle.”
For that reason, you might enlist the help of a pelvic floor physical therapist who can help you properly train and strengthen your pelvic floor muscles, Dr. Horton says.
“Timed voiding and bladder training are other measures you can take to help minimize urinary incontinence,” Dr. Horton says. Your gynecologist would be a great place to start for guidance on these treatment options.
2. Your Transverse Abdominals Need Strengthening
Your abs are more than just six-pack muscles. "The transverse abdominis muscle is a major core stabilizer, and in a perfect world, it works together with the pelvic floor muscles," Crouch says. "Studies show that we see a better, stronger pelvic floor muscle contraction (and in turn, improved support for the bladder and continence) when both these muscles work together."
That said, "if the deep core muscles are weak, or not firing at the correct time, the pelvic floor muscles may not be working optimally either," Crouch says.
The goal is to build strength and control in your deep core and pelvic floor muscles, so you should perform exercises that engage both. To that end, Crouch recommends movements like glute bridges, glute marches and heel slides.
3. Your Sphincter Muscle Is Weak
Located at the neck of the bladder and the urethra, the urinary sphincter is round, smooth muscle ring that act as a rubber gasket, contracting to hold in urine, Crouch says.
Sometimes these muscles can become stretched or weakened (during childbirth, for example). This can lead to a problem with the sphincter opening and closing, which can cause leaking when there is pressure on the bladder, especially when exercising, Dr. Horton says.
“Because the sphincter muscles are smooth muscle and lie within the pelvic floor, they can become more functional when we work the pelvic floor and implement other strategies such as optimal bladder habits and behavior modifications,” says Crouch, who adds that it’s best to do this under the guidance of a pelvic floor therapist.
In addition, “a doctor can insert a device called a pessary into the vagina that applies pressure on the urethra to keep it in its correct location and reduce urinary leakage,” Dr. Horton says. “Bulking agents can also be injected around the urethra to create resistance to gain control over urine flow,” she says.
4. You’re Constipated
Believe it or not, constipation can affect bladder control, especially if it happens often. "Constant straining due to chronic constipation can weaken the pelvic floor muscles that support the bladder," Dr. Horton says.
What's more, having a lot of "stool in the rectum will take up space in the vaginal canal, therefore making it more difficult for the pelvic floor muscles to contract and move optimally," Crouch says. Stagnant stool can also increase the load on the pelvic floor, putting excess pressure on the muscles or even pushing on the bladder and urethra, which can cause urine leakage, too.
To minimize constipation, increase your water and fiber intake, Dr. Horton says. You also want to make sure you poop in the optimal position.
“Sitting on a toilet causes a bend in the rectum that can make it more difficult to have a complete bowel movement and put more unnecessary pressure on the pelvic floor muscles,” says Dr. Horton. “The body is meant to be in a squatting position when having a bowel movement.”
To achieve this perfect squatting stance, use a short stool under your feet (like a Squatty Potty) to get your knees higher than your hips.
5. You Have Diastasis Recti
Remember, core muscles work in conjunction with the pelvic floor to help support the bladder. So if there's a separation of the abdominal muscles (known as diastasis recti), this can make the pelvic floor muscles less effective, contributing to incontinence (and even prolapse of pelvic organs), Dr. Horton says.
Most commonly, diastasis recti occurs during pregnancy when the uterus grows and stretches the abdominal muscles. Sometimes this stretching can cause your abs to separate.
Consequently, if you have diastasis recti, your muscles won't be able to accommodate the increase in abdominal pressure during exercise — which may generate even more downward pressure on the bladder and pelvic floor — and lead to urine leakage, Crouch says.
Plus, when there's a disconnect between the abdomen and the pelvic floor, your pelvic floor muscle contractions won't be very strong, she says. In other words, you won't have the capacity to control and squeeze these muscles effectively, and as a result, you won't be able hold in your pee.
Speak with your doctor or a physical therapist who can suggest corrective exercises to help heal diastasis recti and strengthen the core muscles, Dr. Horton says.
6. You Have a UTI or Bladder Infection
If you experience painful and/or frequent urination and you have a strong urge to pee along with stress incontinence, you might be dealing with a urinary tract or bladder infection, Dr. Horton says.
"Oftentimes we see an increase in leaking with an infection because the bladder is trying to expel the bacteria and the infected urine," Crouch says.
See a medical professional, ASAP. A healthcare provider can diagnose an infection through a urine sample and treat you with antibiotics, Dr. Horton says.
And if you experience the above symptoms, don’t procrastinate about visiting your doc. If not treated, a UTI can lead to other more serious problems like a kidney infection, Crouch says.
Find a Pelvic Floor Physical Therapist
Whatever the reason for your stress incontinence, you shouldn't have to resolve the issue on your own, especially since "it can be difficult to identify pelvic floor muscles and train the muscles properly to help alleviate urinary symptoms," Dr. Horton says.
To get the help you need, seek out a healthcare provider trained in pelvic floor conditions. "Discussing your concerns of incontinence with your ob-gyn is a great place to start," Dr. Horton says. Your ob-gyn will ask simple questions, perform a physical exam (to identify what type of incontinence you have along with possible causes) and may refer you to a pelvic floor physical therapist.
Crouch agrees it's always a good idea to see a pelvic floor physical therapist to find out what your baseline is. Every person's pelvic floor issues are unique, so an expert will be able to assess you and tailor a treatment plan based on your specific needs.
When choosing a pelvic floor PT, make sure they are qualified and have the proper training. PelvicRehab.com and the Academy of Pelvic Health Physical Therapy are great resources to help you locate a pelvic rehabilitation practitioner.
More Strategies to Reduce Leakage During Exercise
- Quit smoking. "Smoking, which can cause chronic coughing, can increase your risk of stress incontinence," Dr. Horton says.
- Lose weight. "Being overweight can also weaken the pelvic floor muscles because the fatty tissue places increased pressure on the bladder, so weight loss can significantly reduce the frequency — or even eliminate — stress incontinence," Dr. Horton says.
- Skip caffeine pre-workout. Caffeine is a bladder irritant and can increase urine frequency and leaking, Crouch says. So cut the coffee (or limit your intake) before a sweat session.
- Sip water throughout your workout. While it may sound counterintuitive, you shouldn't restrict fluids. This can result in dehydration, and concentrated urine irritates the bladder, which can cause more leaking, Crouch says.
- Empty your bladder before a workout. "And if you start to feel some leaking, stop, void again, and try to continue at a lower load," Crouch says.
- Use leak prevention products. While pads and leak proof underwear don't prevent you from peeing, they can be helpful as an interim tool to keep you dry during exercise as you work to resolve the root cause of your leakage, Crouch says.