How to stop leakage with lifting - at home and at the gym
I recently chatted with a group of really strong women whose main complaint was leaking with lifting. A lot of these women would see the workout of the day - jumping jacks, box jumps, jump rope, deadlifts, back squats, and their first thought was ‘I’ve got to run to the bathroom!’ This is a common experience with many women when they are lifting kiddos at home or weight at the gym, jumping, etc. Leakage with lifting is very common, yet it is NOT normal. This leakage is a sign of dysfunction with your pelvic floor and should be addressed to decrease chances of further damage to your body.
Why do I leak while lifting?
The pelvic floor is a trampoline of muscles that helps to support your internal organs and prevent leakage with activity. There are two types of bladder leakage - stress (impact) incontinence and urge (irritable bladder) incontinence. Bladder irritants that can contribute to urge incontinence include: alcohol, juice, citrus fruit, milk products, sugar & artificial sweeteners, coffee, tea, tomatoes, spicy foods, carbonated beverages. Not everyone is sensitive to all of these irritants, but it is important to identify what increases your leakage. The second type of incontinence is stress incontinence. This occurs when the pressure on your pelvic floor is greater than the strength of your external urethral sphincter, the muscle that helps hold back pee.
Three techniques to prevent leakage:
#1 360 degree breathing
The first technique that I address with all of my clients is 360 degree breathing. I like to use the image of an umbrella opening. When an umbrella opens, it opens low in a 360 degree pattern, meaning when you breathe it’s important to inhale thru your nose and breathe into your belly, side body, and back body. Take a breath now; what do you notice? Many people notice that their chest expands, or they feel it in their neck and shoulders, or their belly expands. Now try this - round your trunk forward and inhale thru your nose, trying to focus on feeling expansion through your side and back body. Is it really tight, restricted, easier to do with rounding forward?
#2 Posture
The second thing that is important to address is posture. For optimized pressure management within your core we need to have our ribcage stacked over our pelvis. Try this: stand sideways in the mirror and look at your posture. Is your ribcage flared forward? Is your pelvis tucked under? Posture is vital because we need feedback from our diaphragm, core, and pelvic floor to regulate pressure within our core to be able to lift weight without leakage.
#3 Engage Pelvic Floor Muscles
Finally, it is important to learn how to engage your pelvic floor and core. The goal with pelvic floor engagement or a kegel is to think about picking up a blueberry with your pelvic floor and drawing those muscles up and in. It is very important that there is no pressure downward as this can cause further dysfunction and leakage. Try this: sitting with your trunk rounded forward inhale into your sides and back and then with your exhale see if you can picture picking up a blueberry with your vagina. You should be closing the opening of your vagina and drawing the muscles of your pelvic floor up and in.
Application of techniques at the gym and in life
The pelvic floor is a group of muscles too and it needs work just like other muscles in the body. The pelvic floor can be tight, weak, or on vacation (i.e. not showing up to the party). The goal is working towards automatic function of pelvic floor engagement, but when there is leakage (i.e. dysfunction) it is important to thoughtfully connect with this area of your body. What are the exercises that cause leakage for you? As mentioned earlier, for many of us it is jumping, squatting, deadlift, etc. Let’s jump into some ‘how-to’ on pre-bracing for lifting.
Four Steps:
#1 360 degree inhale thru nose
#2 Long exhale thru mouth and kegel/lift blueberry up and in with your vagina.
You should feel pelvic floor (PF) engagement and a gentle tightening through the lower abdomen - your transversus abdominis, the deepest core muscle.
#3 Bring your ribs down and in as you continue to exhale and maintain PF engagement
#4 Maintain this PF and core engagement and LIFT!
Learning a new technique can take time, effort, and energy, but it is so worth it! It is important to note that nothing supplements expert advice from a pelvic floor physical therapist. An individualized assessment can be vital to identify the specific cause of your leakage. Try this technique and let us know how it goes and if you have specific questions!. Know when to back off and when to seek further help. We hope you enjoy learning how to strengthen your core and pelvic floor!
All my best,
Dr. Kara