Also called: Athletic incontinence; exercise-induced stress incontinence; leaking during CrossFit, running or trampolining
Exercise is the main treatment
Strength
Breathing
Leaking during running, jumping, skipping or heavy lifting - extremely common in active women and almost never discussed. In athletes the pelvic floor is often strong but slow, poorly timed with the breath, or held tight all the time so it has nothing left to give.
How common: 20-50% of women who exercise, including those who have never been pregnant; up to 80% in trampolining and gymnastics; most never mention it
What it is
Impact and heavy lifting spike intra-abdominal pressure fast - faster than the pelvic floor can respond to unless the response is pre-programmed. Studies of female athletes find leaking in a large minority to a majority depending on the sport, with high-impact sports like trampolining, gymnastics and running at the top.
The key point is that this is often not a weakness problem. Many affected athletes have strong pelvic floors on testing. What they have is a timing problem, a breathing problem, or an overactive floor that is already at maximum tension before the load arrives - and all three are made worse by simply squeezing harder.
What it feels like
- Leaking during running, box jumps, skipping, trampolining or heavy lifting
- Fine at rest and fine walking, only a problem at impact or under load
- Worse late in a session when everything is fatigued
- Worse with heavy lifting where you hold your breath and brace hard
- Quietly changing what you do - avoiding certain movements, emptying beforehand, wearing a pad
What causes it
Most people have more than one of these at once, and they feed each other. Read the
list looking for the two or three that sound like your week rather than for the one
true answer — the ones that describe you are the ones worth acting on.
- Pressure spiking faster than the floor can respond
- Landing from a jump or a heavy lift raises abdominal pressure in a fraction of a second. The pelvic floor contraction has to be anticipatory rather than reactive, and if it is not, the leak happens before the muscle arrives.
- A strong but slow pelvic floor
- Maximum strength and speed of contraction are different qualities. Many athletes test strong and still leak, because the fast twitch response has never been trained specifically.
- An overactive, chronically held pelvic floor
- Athletes commonly hold the pelvic floor and abdominals tight all the time. A muscle already near maximum has nothing left to add, and it fatigues. More squeezing is exactly the wrong prescription here.
- Breath-holding under load
- Bracing hard against a closed glottis raises abdominal pressure enormously and directs it downward. Learning to manage breath and brace changes the pressure the floor has to resist.
- Poor coordination with the deep trunk muscles
- The pelvic floor, diaphragm and transverse abdominis work as one pressure system. If the diaphragm and abdominal wall are not coordinated with it, the floor takes the load alone.
- Pregnancy and childbirth history
- Even years later, and even after apparently full recovery, a history of pregnancy raises the risk substantially. Many women return to sport without ever having the floor properly assessed.
- High training volume and fatigue
- Leaking typically appears late in a session. The floor fatigues like any muscle, and volume matters as much as intensity.
- Low energy availability
- Under-fuelling in athletes affects hormonal status and tissue quality, and it is associated with pelvic floor dysfunction as well as with bone and menstrual problems.
- Never having been taught anything about it
- Coaching almost never covers this and athletes almost never raise it. Many women assume it is a normal cost of being active, which is why it goes untreated for years.
Who tends to get it
- Women in high-impact sports - running, gymnastics, trampolining, CrossFit, netball, volleyball
- Heavy lifters, particularly those who brace hard against a held breath
- Anyone who has been pregnant, regardless of how long ago or how they gave birth
- Athletes with high training volume
- Women who hold the abdominals and pelvic floor tight habitually, which is common in this population
What makes it worse, and what settles it
Makes it worse
- Doing more Kegels when the floor is already overactive
- Holding the breath and bracing maximally on every lift
- Increasing impact volume quickly
- Going to the toilet before every session just in case, which trains the bladder down
- Ignoring it and adjusting your sport around it, which is what most people do
Settles it
- Getting assessed by a pelvic health physiotherapist, who can tell whether the floor is weak, slow or overactive - the three need opposite treatment
- Fast, quick pelvic floor contractions specifically, not only long holds
- Breathing and bracing work - exhaling through the effort rather than holding against a closed throat
- Coordinating the pelvic floor with the diaphragm and deep abdominals rather than training it in isolation
- Managing impact volume and adding it back gradually
What actually helps
The short version: Impact and heavy lifting spike pressure inside the abdomen faster than the pelvic floor can match it. In athletes the floor is often strong but slow, poorly coordinated with the breath, or held tight all the time so it has nothing left to give. Breath-holding under load makes every one of those worse
Strength work: Core: Pelvic Floor - fast contractions timed to the landing or the lift, not long holds alone; Core: Diaphragm; Abs: Transverse Abdominis; Glutes: Max; Glutes: Med; Hips: Adductors
Stretching: Hips: Adductors; Hips: Flexors; Hips: Piriformis - a pelvic floor that is always on needs to learn to let go first
Massage: Not primary; Hips: Adductors and Glutes if the floor is overactive
Also worth doing: Exhale on the effort instead of bracing and holding; empty the bladder before sessions; reduce impact volume for a few weeks while the timing is retrained; a pelvic health physiotherapist if it persists after three months of training
What the evidence says: Pelvic floor muscle training is first-line for stress incontinence in athletes as in everyone else, with systematic reviews reporting reduced leakage and improved quality of life; coordination with breathing and the timing of the contraction to the impact is what distinguishes the athlete protocols from generic Kegels.
The names above are the Targets qFIT tracks —
the Muscle Guide explains what each one does, and
Quick Add switches on the Exercises you
already have.
The qFIT routine for this
Ready-made routinePelvic Floor & Core Recovery
qFIT already has this one built. It runs massage first, then stretching, then
strength — the order that works on a body that is already sore — and every
activity in it carries the reason it is there.
The button below opens your Checklist with this routine already selected, so instead
of your whole list you land on just its Categories, Targets
and Exercises, each with its checkbox, ready to tick as you work through
them.
Have more than one problem? Tick yours under My Problems on
My Profile and your Checklist's Routine list gains
Recommended for my problems — every routine for the problems you picked, merged
into one. Your picks stay private; that filter is the only thing they feed.
Get it checked if…
Leaking with pain, blood in the urine, a feeling of a bulge or heaviness in the vagina, or leaking that started suddenly - clinical review
And whatever the body part: chest pain or unusual breathlessness on
exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and
unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or
one calf that is swollen, warm and painful. Any of those, stop and get assessed.
How it usually goes
This responds well - often within eight to twelve weeks - but only when it is treated as the right problem. Guessing between weak, slow and overactive is a coin flip and gets it wrong half the time, which is why an assessment is genuinely worth it. It is common, it is treatable, and it is not something to organise a sport around. It is also not a normal cost of being active, however many people quietly assume it is.
Prevalence basis: Systematic reviews of urinary incontinence in female athletes (Sports Medicine; IUJ)
Others the same routine covers
These share the Pelvic Floor & Core Recovery routine, so the work is the same. If one of them also
sounds like you, that is a reason to expect more from it, not less.
This is general information, not a diagnosis, and it cannot examine you.
If it matches you, use it to ask better questions of a clinician rather than to replace one.