On June 16, 2013 CrossFit Games published a controversial video that started with the phrase, “We’ve seen blood today and now we see urine and that’s what it takes if you want to be the fittest woman on the planet.” You can see the video below.

CrossFit is a popular form of exercise that mixes aerobic exercise, gymnastics and weight lifting all in one. While the sport has its benefits, urinary leakage is not one of them and most certainly is not an indicator of fitness.

Stress Urinary Incontinence (SUI) is defined as an involuntary loss of urine when coughing, sneezing or exerting oneself physically. Besides CrossFit, athletes who run, spin, jump or participate in any type of physical activity are all at risk for leaking. One study analyzed the level of athletic performance and the volume of training with urine leakage in young female trampolinists. About 72.7% of the participants reported SUI during trampoline practice. A different study conducted on 105 female volleyball players found that 65.7% reported at least one symptom of SUI and/or urgency during sport or in daily life situations. Clearly, there is a relationship between sport and pelvic floor dysfunction, even in young athletes.

Urinary incontinence affects athletes, both men and women, of all sizes and ages--but no one wants to talk about it. Except for maybe Whoopi Goldberg who has been quite open about her “LBL,” which she says stands for, light bladder leakage. Whoopi says to embrace it! But why embrace it when you can change it?   

Just like any other muscle group, our pelvic floor muscles can be strengthened and trained to help prevent urinary leakage with sport or daily activity. As a pelvic floor physical therapist, I have worked with athletes of all ages struggling with incontinence. From my experience, I find incontinence during exercise can be caused by a few different reasons. The first, most common reason, is that your pelvic floor muscles are weak and unable to handle the demand that is required during exercise. The second reason can be the opposite issue- when the pelvic floor muscles are tight, overused and fatigue easily. This would mean the pelvic floor muscles would need to be down-trained and released before starting a strengthening program. The last reason can be attributed to a lack of coordination between your pelvic floor and core muscles. Our pelvic floor muscles are the first layer of our core and when the pelvic floor muscles and core muscles don’t work together, the result can be leakage with demanding exercise.

By working with a Pelvic Floor Physical therapist, athletes can ensure they are doing what their pelvic floor needs. A Pelvic Floor PT can teach each patient how to strengthen, relax, bear down and coordinate with diaphragm and core muscles for increased overall strength, less intra-abdominal pressure and less overall leakage. Throughout the CrossFit video mentioned at the top, the hosts ask multiple women to confirm if they pee during workouts. The majority say yes. He then says a product needs to be made to fix this. However, he does not realize, leakage is different for each person, which makes it difficult for one product to fix all. Pelvic floor physical therapy, although not a product, can help athletes train so they can become “the fittest woman on the planet.”  

 

Bo, K. & Borgen, J. S. (2001). Prevalence of stress and urge urinary incontinence in elite athletes and controls. Official Journal of the American College of Sports Medicine 1797-1802

Da Roza, T., Brandao, S., Mascarenhas, T., Jorge, R. N. & Duarte, J.A. (2015). Volume of training and the ranking level are associated with the leakage of urine in young female trampolinists 25(3): 270-275  

Schettino, M. et al., (2014). Risk of pelvic floor dysfunction in young athletes. Clinical and Experimental Obstetrics and Gynecology 41(6): 671-676


- Dr. Brooke David