Experiencing urinary leakage while running or lifting heavy weights can be stressful, embarrassing and frustrating. It is often blamed on a "weak" pelvic floor, but this is an oversimplification. While pelvic floor weakness can contribute to stress urinary incontinence (SUI), it's far from the whole picture. Many other factors, including how you breathe, your posture, and even the load you're lifting, can play a significant role in leakage.

Understanding the Continence Mechanism

The body’s continence mechanism involves a delicate balance between various structures:

• Pelvic floor muscles: Support the bladder, uterus, and bowel, controlling the release of urine.

• Abdominal muscles: Assist in stabilising the core and pelvis.

• Sphincters: Circular muscles around the urethra that contract to prevent leakage.

• Fascia and ligaments: Provide structural support.

Urinary continence relies on proper coordination between these elements. When pressure in the abdomen (intra-abdominal pressure) increases, like when you run, jump, or lift weights, your body needs to counterbalance it effectively. If this mechanism is disrupted—not necessarily by weakness, but by poor coordination or mismanagement of pressure—leakage can occur.

Why Women Might Leak When Running or Lifting

1. Intra-Abdominal Pressure (IAP): Lifting heavy weights or sprinting increases intra-abdominal pressure significantly. If the pressure overwhelms your body’s ability to manage it, leakage can happen. This isn’t always because your pelvic floor is weak—it could be that your bracing technique, posture, or breathing pattern is making your body work harder to contain this pressure.

• Breath-Holding and Valsalva Maneuver: Many people brace by holding their breath during a heavy lift. This strategy increases intra-abdominal pressure but can also push down on the bladder, overwhelming the pelvic floor.

2. Over-Tension in the Pelvic Floor: Sometimes, the pelvic floor is too tight, leading to a lack of flexibility in response to stress. When muscles are overly tense, they can become less responsive to changes in pressure, increasing the chance of leaking.

• Pelvic Floor Tension: A tight, overactive pelvic floor doesn't necessarily mean it's strong or functional. Over-tension can lead to poor coordination with the rest of the core muscles.

3. Posture and Positioning: How you position your body when lifting matters. A forward-tilted pelvis or poor spinal alignment can place extra stress on your pelvic floor, making it harder for the muscles to function optimally. Equally, a few slight tweaks in your running posture may take pressure off your pelvic floor.

• Lifting Posture: If you tend to arch your lower back (anterior pelvic tilt) during deadlifts or squats, your pelvic floor may be in a disadvantaged position, reducing its ability to manage the pressure from your lift.

4. Lifting Belts and Bracing Strategies: Lifting belts are designed to help stabilize the core by increasing intra-abdominal pressure. However, if used improperly, they can lead to excessive pressure on the pelvic floor, increasing the risk of leakage.

• Bracing Technique: Learning how to brace without pushing down on the pelvic floor is crucial. A balanced engagement of core muscles, including the diaphragm and pelvic floor, is key to effective lifting.

Running and Continence: More Than Just a Pelvic Floor Issue

Running poses its own challenges, especially due to the repetitive, high-impact nature of the movement. Leakage when running can be influenced by factors beyond the pelvic floor:

1. Foot, Ankle, and Hip Mobility: Your lower limbs play a big role in absorbing shock and distributing forces during running. Poor mobility or strength in the ankles, knees, or hips can lead to increased pressure on the pelvic floor as your body compensates.

• Footstrike and Load Absorption: If your feet aren’t absorbing load properly—due to poor technique, tight calves, or inadequate foot strength—this can increase the pressure on your pelvic floor with every step.

2. Single-Leg Strength and Control: Running is essentially a series of single-leg hops. Weakness or poor control of the lower limb muscles can force other parts of your body, like the core and pelvic floor, to compensate, leading to leakage.

How We Can Help at Eureka Health

At Eureka Health, we are passionate about assessing your strength, technique, and overall movement patterns to help you understand the root causes of your leakage. Our clinicians will analyse factors like your posture, breathing strategies, mobility, and strength to create a personalised plan to improve your continence mechanism. Whether you're experiencing leakage during running, lifting, or other activities, we can help you find effective solutions.

Book a consultation today at Eureka Health to learn more about how we can support you in regaining control and confidence in your body!

References:

• Bø K, Frawley HC, Haylen BT, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) Joint Report on the Terminology for the Conservative and Nonpharmacological Management of Female Pelvic Floor Dysfunction. Int Urogynecol J. 2017.

• Nygaard I, Shaw JM. Physical Activity and the Pelvic Floor. Am J Obstet Gynecol. 2016.