Now I don’t know about you, but as a child and even now I love sports involving jumping and running and the benefits that come with them, but so many ladies avoid anything which involves impact like the Plague because of a fear of leaking. And it isn’t just ladies who have had children I’m talking about! I have many friends without children who report, quite casually, that they leak when they are doing double unders, running or using a trampoline (all whilst they queue for the loo before a session involving double unders).
So what’s going on here?! Leaking is actually caused by a condition called stress urinary incontinence (SUI). SUI is prompted by an activity or physical movement that puts stress on your bladder. For some people this can happen when they cough, sneeze or laugh, for others it may only show itself when they are running or jumping. Whilst immensely common, particularly in athletes who participate in high impact activities, SUI is never normal and thankfully can be relatively straightforward in addressing.
First, we need to address the strength and efficiency of the pelvic floor muscles themselves; you wouldn’t expect to get a new squat PB without putting in some training, so the same applies for you pelvic floor – it needs to be worked in order to be strengthened and to work more effectively. Kegel exercises are the best way to do this and whilst they’re not the most exciting exercise to exist, you can do them anytime and there is a wealth of evidence showing that they work. Not sure how to do them? Here’s how to get started…
1. Sit in a comfortable position, I find this easiest on the floor with my legs crossed or sitting on a chair with both feet flat on the floor
2. Imagine you’re sat on a perfectly flat tissue and the four corners are placed on each sit bone, the front of your pubic bone and your tailbone.
3. Now imagine you’re drawing the tissue from the middle up and inside you. You want to think about closing around the tissue and then lifting
4. Then relax completely flattening the tissue out to where it started.
5. Repeat this up to 10 times, holding for 10 seconds and then 10 times quickly.
The complete relaxation of the pelvic floor is important too, so making sure the tissue returns to its flattened state in between each lift is something you need to work on!
Let’s now think about what happens to the pelvic floor during high impact exercise and why it is under more pressure than normal. Your pelvic floor forms the bottom of your “core cylinder” along with your transverse abdominus (deep abdominal muscle) at the front, your diaphragm at the top and your multifidus (deep back muscles) at the back. When working efficiently our core cylinder is important in improving our pelvic stability and enables us to move more effectively. However, when we jump, the demand on the core cylinder increases and the intra-abdominal pressure increases too. It is when this intra-abdominal pressure exceeds the capability of our pelvic floor that the ‘trap door’ effect happens, and our pelvic floor is unable to withstand this pressure resulting in leaking. For some people this is a small amount, or for others this can be significantly more.
The great news is, that if you experience SUI during high impact exercise it doesn’t necessarily mean you need to stop it all together, as we know there are many benefits to exercise not least that endorphin release! You may just need to alter what you are doing slightly in order to manage your symptoms.
Here are my top 5 tips:
1. During high impact exercise remember to BREATHE! This allows our diaphragm to work and the intra-abdominal pressure to constantly adjust
2. Don’t clench your pelvic floor! Again, this helps to keep that intra-abdominal pressure lower and more controlled and enables your pelvic floor to act as a trampoline for the contents of your pelvis- cushioning its descent rather than smashing up against it.
3. Don’t brace your tummy muscles! This is again to do with keeping that intra-abdominal pressure under control
4. Take note of when you begin to experience symptoms! For some people this may be instantly, for others it may be after 50 double unders… Whatever it is for YOU just make sure that you work in a range that keeps you symptom free (so for the previous example 49 double unders) whilst you work on strengthening your pelvic floor with the exercises above!
5. Be disciplined with your Kegel exercises and don’t expect this to go away overnight! Evidence shows that you need to be doing your Kegel exercises 3x daily for 3 months in order to manage SUI symptoms. And even when your symptoms have resolved, keep them up perhaps once or twice a day just to really make sure the muscles stay strong and effective and are able to support you for your sport.
It can be all too easy to ignore pelvic floor symptoms, as we can often feel embarrassed or assume that it is normal. My greatest advice to you is to get on top of this as early as you can, just as you would any other injury. Improving your pelvic health will not only keep you dry when you exercise, it’ll improve your physical and emotional health too!