A few years ago, a video from CrossFit HQ went viral and showed female athletes at a CrossFit Games competition admitting that they leak during workouts.
In some ways, this acknowledgment was refreshing, stigmatized as UI is. But in other, bigger ways, the video was alarming, advocating wearing UI as a badge of honor and not-so-subtly suggesting that peeing during a workout means you’re working out harder.
The video cast a pall over the world of women athletes living with UI by creating the false equivalence between leaking and strength. And even though some time has passed since then and UI has become something we talk about more now, that false equivalence still exists to some extent and still permeates gyms and studios.
But let’s be clear: UI is not a normal result of being strong or working out. And it’s not a limit to push.
Troublingly, the video also featured a gynecologist, playing up her medical expertise, who advocates for this line of thinking, saying that peeing during workouts is normal or OK. But it’s not. This is getting a little nuanced, but nuance is important here. UI is common, which makes it easy to call normal, but it’s the signal of a medical condition. It’s not something to be gritted through.
That’s why, in response to the video and other media like it, a flurry of responses popped up all over the internet from pelvic floor physical therapists, gynecologists, and others, all saying that the video’s message was bad for female athletes. After all, there are solutions for workout leaks superior to simply grinning and bearing it during double unders or box jumps. Most importantly, the responses said, women should know that peeing during workouts is not normal.
So what if you do leak while exercising—whether you’re doing CrossFit, taking a class at the Y, or just jogging around your neighborhood?
First of all, it’s important to understand why UI might occur during exercise. Stress urinary incontinence (SUI) happens when the pelvic floor (i.e., the muscles that form a base for your pelvic organs, like the bladder, vagina, and rectum) weakens and doesn’t tighten around the urethra. Under normal circumstances, the pelvic floor holds the urethra shut until it receives a signal from the bladder that it’s time to pee, and it loosens its grip, allowing the urine to flow. When those muscles are weaker, pee might leak out an unexpected times, especially when pressure (i.e., stress) is placed on the bladder. Such stress can come from laughing, sneezing, running, or lifting heavy things. (Sports physical therapist Meghan Rovig more thoroughly explains the anatomy of the pelvic floor here and how stress from sports plays a role in UI.)
And CrossFit (and other exercise) is super stressful for the pelvic floor! To lift a heavy weight, the body builds up intra-abdominal pressure, which must then be released in some way. For some people, that comes with a scream or a grunt; for others, the pressure might be released through the back, resulting in a slipped disk; for others, the easiest release comes through the pelvic floor, resulting in urination.
The key to stopping UI during exercise comes with knowing your limits. Even though your arms might be able to lift more weight, your pelvic floor might not be. And if you’re peeing yourself, you need to know that you’re past your body’s limit. But that limit can be changed with some training—and pelvic floor muscles can be trained just like any other.
In response to the CrossFit controversy, physical therapist Antony Lo offered some great solutions for training safely to mitigate UI during exercise and strengthen the pelvic floor. These solutions include:
- Training “raw.” Training without belts, tape, or other supports lets your own body be your limiting factor. Plus, wearing synthetic belts doesn’t let pressure leave through your back or belly, nor does it require those stronger muscles to bear the weight. Therefore, what’s left is the small, pelvic floor muscles—both to hold the weight and to serve as the release valve for the pressure.
- Working with a physical therapist. A physical therapist—especially a pelvic floor physical therapist—will help you understand your own body, both its capabilities and its limits. A therapist can also prescribe pelvic floor exercises to strengthen those muscles in particular.
- Stopping before you leak. If you can do five sets before you leak, stop there. Don’t push yourself beyond that limit until you can do it without the leak or urge.