Does the idea of double unders, box jumps or running make you need to rush off to toilet before you start your workout?
If you've ever leaked, or felt like you might during these movements or things like sneezing or laughing, you might have something called Stress Urinary Incontinence (SUI).
SUI is a pelvic floor issue that affects many women (and men!) whether you've had kids or not, and is common in sports that have movements involving jumping/high impact or heavy weights.
While it is common, it does not mean it is normal.
There are exercises and strategies you can learn that can teach your pelvic floor how to function during these more demanding activities.
What is the Pelvic Floor?
The culprit is likely to be the trampoline-like group of muscles at the bottom of your pelvis called the Pelvic Floor.
The pelvic floor is important when it comes to controlling when, and when you don't go to the toilet. It is also important for supporting and keeping all your abdominal and pelvic organs inside you, as well as during sexual function.
If this group of muscles isn't working correctly and the pressure in your abdominal area increases suddenly - for example if you lift heavy/jump/cough/sneeze or bend over quickly, the control and contraction it normally puts around the urethral and anal sphincters to stop you going, can be overcome by the pressure, which can lead to leaking either urine or faeces.
What can you do about it?
Traditional pelvic floor exercises, sometimes known as "kegels", are the ones that are recommended most often. These are the ones where you squeeze as if you're trying not to go to the toilet, and are usually encouraged while you’re relaxing in sitting or standing, like at traffic lights or queue at the checkout.
While these can be a good first step to creating awareness of these muscles, they don’t give you the full picture. This may be why you can you still have problems when it comes to intense exercise and coughing/sneezing, even if you are religiously doing them.
Pelvic floor “weights” have also become quite popular recently, however these also have their limitations (see below).
Make sure you are able to contract, and relax correctly.
It may be that you are weak, the muscles are too tight, or you are not using the muscles correctly.
It is important that you are able to gently “lift” the muscles. The action is the one you would use to stop yourself going to the toilet, you should have awareness and be able to control both the front and back passage. Often people will have more control of one but not the other so it may give the perception of good function, but in reality there is a lack of control where it matters.
The ability to relax when required is also just as important as this allows you to go to the toilet, for sexual function and also to rest the muscles.
A muscle that is always wound up and switched on will eventually become too fatigued to react and work when it is required. They can also cause pain with penetration in some cases.
*This is why pelvic floor “weights”, which you generally walk around with for a long time without getting that all important rest and relax time, are not recommended.
Try it.
1) Lie down or sit in a deep squat if you can.
2) Imagine you are trying to hold in a wee. A cue we love is “Pick up a jelly bean with your vagina”. For men a good cue is “Nuts to guts”. It should just be a small contraction, imagine it is moving about 5mm.
3) Relax and notice if it feels like the pelvic floor is dropping back down.
4) Now try it with your back passage, as if you are trying to hold in wind. Usually this one is easier so make sure you can differentiate between the front and back.
5) Then try and do them both at the same time. Making sure to relax in between.
6) You can build strength by performing a strong or hard contraction, for example a “1cm” lift which you can try to hold for 2-5sec.
7) For endurance try to hold a gentler contraction for a longer; 10-20 seconds for example.
A cue we don’t love is “belly button to spine” because this generally cues the upper abs and can create more downward pressure on the pelvic floor.
Test it.
A quick test you can try is attempting to stop a stream of wee while on the toilet, if you can then you’re likely to be contracting the muscles correctly.
If you can’t, or you end up “pushing down” then this is probably a sign that you lack strength and awareness and you’ll probably need some help from a Women's/Men’s Health Physiotherapist to teach you how to to activate correctly.
Make sure you only do this very occasionally as doing it too often increases your risk of urinary tract infections.
Combine it with functional exercise.
Once you are confident with this then the next step is to make sure your strength and timing is working well during more complex and intense activities.
As we explained before, instead of being constantly contracted, your pelvic floor should be able to respond fairly automatically to these sudden increase in pressure at the right time, and relax when the pressure subsides so that the muscles can rest.
Randomly squeezing and relaxing your pelvic floor, without training towards a functional goal can be likened to just tensing and relaxing your biceps, instead of using them to bend your elbow at the time you need to lift something up.
Functional Example
Gently squeezing and lifting right before you go for a 1RM squat.
Cueing a few “quick squeezes” before you start a round of skipping to get the muscles and nervous system ready for the type of contraction it will need to be doing.
Your body is also designed to work in movement patterns, as opposed to using single specific muscles. When there is a functional goal this cues a movement pattern that can create more force than an isolated contraction. For example your bicep will create more force by climbing up a rope than by simply tensing it as hard as you can. In the same way, your pelvic floor is better engaged during an action that has the context of a useful function.
Consider the big picture of technique.
To give your pelvic floor the best chance of being able to manage extra pressure, make sure the rest of your technique is spot on to put your body in the best position for the pelvic floor to work at its best.
For example if you are “donkey kicking” during your double unders (skipping) the force you are hitting the ground with a lot more, this means that the downward force of your abdominal contents onto your pelvic floor is also a lot more which can overcome even a relatively strong and coordinated pelvic floor.
Your running and lifting technique will also play a big part in this.
Train your pelvic floor like you would any other muscle.
Once your technique has been considered, train in a way that works within your body’s limits.
For example if you are leaking after 20 skips then this is more than your max. Instead try building up your endurance by starting with 3x10 skips and build up from there.
If you feel like you are about to leak with an 80kg squat, then maybe 79kg is your 1RM? Adjust your mindset so that even if you can lift the weight it doesn’t count unless your pelvic floor is able to lift it to.
This is how you’ll keep yourself safe and be able to continue the sport you love in the long run.
Where to from here?
We can only fit so much information in a blog, and this information might not be appropriate for your individual needs.
So as usual we’d suggest getting help from a professional to first help you figure out the reasons it might not be functioning correctly and address these issues first.
Once you’ve done that you can begin learn how to improve your awareness of it and incorporate it into your daily life or training. This is something we can help you with as it is often a lot more complex than what we’ve written here.
If you have any issues related to traumatic childbirth or have severe issues we’d suggest seeing a specialist Women’s Health Physiotherapist. Feel free to contact us for any recommendations.
By Lucia Tennant
Principal Physiotherapist
B.Sc. Physiotherapy
Director - Formotion Physio
lucia@formotionphysio.com
Formotion Physio is a Physiotherapy practice based in West Perth & Osborne Park, Western Australia