Reasons You Leak That Have Nothing to Do With Pelvic Floor Strength

Stress urinary incontinence is something that affects a TON of women, whether you’ve had a child or not. It has a strong prevalence in the athletic population that often causes issues with running, jumping, sprinting, change in direction, acceleration, deceleration, etc.

If you’ve googled “how to stop leaking with exercise”, you may read to strengthen your pelvic floor and do kegels. And, likely, if you’re reading this, you’ll discover that this advice did not solved your problems. In pelvic floor physical therapy, we need to look outside of the pelvis. There are so many components that contribute to how the pelvic floor work that have nothing to do with pelvic floor strength. Let’s dive into this below:

Hip Strength

We knows that strong hips help improve continence. Tuttle et al. (2016, 2020) showed that glute strengthening improves vaginal squeeze pressure. and Foster et al. (2021) found that urinary urgency and frequency were associated with hip muscle weakness.

Strengthening these muscles groups to support the pelvic girdle and control what’s happening down the chain is crucial for any athletic endeavor but especially if you leak.

Ribcage Mobility

If you are stiff in your ribcage - this includes how well to your ribs move with breathing but also how you flex, extend, side bend and rotate, it influences how much pressure is distributed below into the pelvis. If you don’t move in the ribcage, that pressure has to go somewhere and it is often forced downwards, making it hard to stay dry if the pelvic floor is the path of least resistance.

Work on breathing first. Your ribcage should expand 360 degrees like an umbrella when you inhale, and depress back down on the exhale. Most people struggle to find expansion into the sides and back of the ribcage so I would recommend focusing on this area first.

Then include ribcage movement into your workout routine: rotation is a big one here.

Eccentric Quad Control

Simply put, if you can’t control your landing mechanics with hopping/jumping, those high impact forces will be absorbed by the pelvic floor and contribute to leaking. Work on single leg control: bulgarian split squats, step downs, walking lunges. Tempo training is great here - working on slowing down the lengthening phase of the movement.

Uneven Terrain

Some people feel great on flat roads but the moment they step on a trail, they leak. Navigating uneven surfaces is something you may have to work up to. Train your body to control unanticipated movements. Some great drills include change in direction: agility ladder, bosu hopovers, shuttle runs, etc.

Shoe Wear

I don’t get into specifics with this because each person will be different for what shoe feels good for them. Generally speaking, if someone struggles with running and continence, we may look at a shoe with a wider toe box and less rigidity to allow the foot/ankles/toes to function without restriction.

Running Gait

Taking a look at your stride, trunk position, landing mechanics, etc can all be helpful in determining how to be the most efficient in your run without leaking. I’ll often see women who run with stiff trunks, decreased rotation, chest puffed/flared, long stride with heavy landing, poor glute access. As soon as we provide a few cues to change it up, you can notice a change in leaking levels.

Foot Restriction

The foot needs to be able to pronate with control when you jump and run. Making sure your foot has 1. the mobility to do so and 2. the strength to control the landing is important.

There are all factors to consider when training to stay dry with activity that have nothing to do with kegels or pelvic floor strength! If you’ve been unsuccessful in treating your urinary incontinence, consider this your cue to look outside of the pelvis.