Leaking During Workouts Is Not Normal (Even If Everyone Says It Is)
The Conversation No One Talks About
Have you ever noticed a small amount of urine leaking during a workout? Maybe it happens when you are about to press a weight overhead, land from a jump, or finish a run around the block. Many women are told that leaking during exercise is normal - especially after childbirth or as they get older. Because of this, it is often dismissed as something women simply have to live with.
Although urinary leakage during workouts is common, it is not normal. In many cases, it is a sign that the pelvic floor and deep core system are not managing pressure well during movement. The good news is that this is something that can often be improved with the right treatment.
The most important thing to know is this: leakage during exercise does not automatically mean your pelvic floor is weak. Sometimes the muscles are too tight, sometimes they are not activating at the right time, and sometimes they are simply not coordinating well with the rest of your core.
The Real Reason Leakage Happens During Exercise
During exercise, pressure naturally increases inside the abdomen. This happens when you jump, run, lift, squat, or even brace before pushing overhead. Your body relies on the deep core system to help manage this pressure. This system includes the diaphragm, abdominal muscles, and pelvic floor - to help manage this pressure.
One way to think about this system is like a soda can. The diaphragm forms the top of the can, the pelvic floor forms the bottom, and the abdominal and back muscles create the sides. When pressure increases inside the can, all parts need to respond together to keep it stable. If the bottom of the “can” is not responding well, that pressure may be pushed downward toward the bladder, which can lead to urine leakage during exercise.
This is why leakage often happens during movements like:
Jumping
Running
Lifting heavy
Quick changes in movement
The issue is often less about the bladder itself and more about how the body is managing pressure.
It Is Not Always Just Weakness
Leakage during workouts does not always mean the pelvic floor is weak. In many cases, the issue is how the muscles respond to pressure. Understanding how your pelvic floor muscles are not functioning properly helps guide treatment to help you combat leaking.
Your pelvic floor muscles could be underactive, overactive, or lack coordination.
Underactive pelvic floor: An underactive pelvic floor has a difficult time contracting their muscles to support the bladder - especially during activities that place a lot of pressure downwards on the bladder. When we are working out, there are a lot of quick, sudden movements that can make it difficult for a weak pelvic floor to contract to help support and stabilize the pelvis easily. Think of the pelvic floor like a trampoline. A healthy trampoline stretches and rebounds when someone jumps on it. But if the springs are too loose, the trampoline cannot provide enough support to handle the load. An underactive pelvic floor can behave in a similar way. When pressure increases during exercise, the muscles may not contract strongly enough to support the bladder, which can lead to urine leakage.’
Overactive pelvic floor: An overactive pelvic floor consists of muscles that are too tight and cannot respond dynamically.Imagine holding a jelly donut and squeezing it tightly in your hand. The more tightly you squeeze, the more pressure builds inside the donut. Eventually the filling has nowhere to go but out. An overactive pelvic floor can behave in a similar way. When the muscles are constantly tense, pressure inside the abdomen may not be managed effectively during activities like jumping, running, or lifting. Instead of being absorbed by the system, that pressure may be directed toward the bladder, which can lead to urine leakage.
Poorly coordinated pelvic floor: When it comes to a poorly coordinated pelvic floor, these muscles may be strong enough, but they activate too early, too late, or at the wrong time, so they fail to respond when pressure suddenly increases. The issue is not strength or tension, but it is more so the timing. Imagine placing a lid on a pot just after it begins to boil over. Even if the lid eventually seals, some liquid has already spilled out. A pelvic floor that lacks coordination can behave similarly. The muscles may eventually contract, but if they do not activate quickly enough when pressure increases during activities like jumping or coughing, urine leakage can occur before the muscles respond.
Why Kegels Are Not Always The Answer
Now, depending on whether or not you are experiencing urinary leakage due to an underactive pelvic floor, overactive pelvic floor, or poorly coordinated pelvic floor, your treatment may differ. Kegels are often recommended, but they do not address every cause of leakage.
Kegels target strengthening your pelvic floor contraction. Kegels would help strengthen an underactive pelvic floor muscle as it will help build up that strength in the contraction that would be required to meet the increased pressure demands that occur when jumping, running, or lifting heavy.
However, when it comes to an overactive pelvic floor, these muscles are already too contracted so overdoing kegels may worsen the issue. Why contract a muscle that is already contracted? It is not going to make you any stronger. Women who have an overactive pelvic floor would benefit from relaxation training. I call this the “reverse kegel”. This would allow your muscles to have a greater range so they would be able to meet the demands of the increased pressure within their abdomen. They would be able to dynamically meet the increased pressure within the abdomen without allowing urine to pass through.
For the poorly coordinated pelvic floor, you would need to work on the timing of when you would need to contract or relax your pelvic floor to meet the demands of the pressure your abdomen is being met with. This includes performing a kegel when you are about to lift heavy, maintaining a kegel when jumping, or being mindful and making sure you are relaxing your pelvic floor in between exercises.
In my experience, most individuals need to work on coordination and relaxation instead of just working on the contraction.
Signs Your Pelvic Floor May Be Struggling During Exercise
Leakage is one sign that the pelvic floor may be struggling during exercise, but it is not the only one. Other examples include:
Feeling pressure or heaviness in the pelvis when working out
Pelvic pain when working out - deep pelvic pain or pain in the buttocks
Difficulty maintaining core stability during lifts
Breath holding during workouts
Hip or low back discomfort during higher intensity exercise
Intense, immediate need to urinate when working out - even without urinary leakage
How Pelvic Floor Physical Therapy Helps
Pelvic floor physical therapy treatment can encompass a variety of different treatments but overall treatment should focus on restoring coordination and pressure management. Improving this coordination and pressure management will help ensure the muscles are able to contract and relax automatically with breath and movement, to support your bladder and prevent leakage.
During a pelvic floor physical therapy session, your treatment can include:
Low back, hip, and pelvic floor assessment: The low back, hips, and pelvic floor work together. Limitations in one area can affect the others.
Breathing and pressure management: Making sure that you are breathing appropriately when working out is crucial. You may find yourself holding your breath when working out, which would totally disrupt the deep core system.
Deep core coordination training: Going off making sure that you are breathing appropriately when working out, it is also important to make sure that you are allowing your diaphragm, pelvic floor, and abdominal stabilizers to work optimally together when you are able to work out with no issues.
Gradual return to impact and lifting: When returning to working out, you do not want to jump right back to where you were before you started to experience leakage. It is important that you know how to contract, relax, and coordinate your pelvic floor muscles before integrating them into exercises where you would have to coordinate other muscles within your body. As you slowly start to coordinate these muscles to work together, it helps set you up for success in future workouts.
The main goal is to return to workouts confidently without worrying that you might leak your pants.
The Takeaway
Leakage during workouts may be common, but it is not something women have to live with. When the pelvic floor and deep core system work together effectively, they can manage pressure during movement and support the bladder.
If you notice leakage during exercise, it may be a sign that the system needs support. With proper treatment, many women are able to return to running, jumping, and lifting confidently — without worrying about leaking.
DISCLAIMER
Disclaimer: This article is intended for educational purposes only and should not be used as a substitute for medical advice, diagnosis, or treatment. While urinary leakage during exercise is common and may be related to pelvic floor dysfunction, it can have many contributing factors. Every individual is different, and the underlying cause of leakage may vary. If you are experiencing urinary leakage, pelvic pain, pelvic pressure, or other concerning symptoms, consult a qualified healthcare provider or pelvic floor physical therapist for a comprehensive evaluation and personalized treatment plan. If you experience sudden urinary incontinence accompanied by severe pain, numbness, weakness, or loss of bowel or bladder control, seek immediate medical attention.
