The document provides a cheat sheet for coaches on why female athletes may experience urinary incontinence during exercise and lifting. It discusses that incontinence is often due to hypertonic pelvic floors in female athletes and breaks down factors like breath holding, belt use, tension, pre-lift routines, and form that can contribute. The cheat sheet offers adjustments to lifting techniques, breath work, and positioning to help distribute tension and support pelvic floor health.
The document provides a cheat sheet for coaches on why female athletes may experience urinary incontinence during exercise and lifting. It discusses that incontinence is often due to hypertonic pelvic floors in female athletes and breaks down factors like breath holding, belt use, tension, pre-lift routines, and form that can contribute. The cheat sheet offers adjustments to lifting techniques, breath work, and positioning to help distribute tension and support pelvic floor health.
The document provides a cheat sheet for coaches on why female athletes may experience urinary incontinence during exercise and lifting. It discusses that incontinence is often due to hypertonic pelvic floors in female athletes and breaks down factors like breath holding, belt use, tension, pre-lift routines, and form that can contribute. The cheat sheet offers adjustments to lifting techniques, breath work, and positioning to help distribute tension and support pelvic floor health.
The document provides a cheat sheet for coaches on why female athletes may experience urinary incontinence during exercise and lifting. It discusses that incontinence is often due to hypertonic pelvic floors in female athletes and breaks down factors like breath holding, belt use, tension, pre-lift routines, and form that can contribute. The cheat sheet offers adjustments to lifting techniques, breath work, and positioning to help distribute tension and support pelvic floor health.
CHEAT SHEET Learn why your clients are peeing during exercise - and what to do about it. Hi there!
Welcome to the most helpful free coaching tool you’ve ever downloaded. I’m excited to see you improving your coaching skills by learning some simple strategies that can be incorporated immediately - helping your clients who are managing incontinence.
If you are looking for more guidance on how to coach female clients during pregnancy and postpartum, or those who are experiencing symptoms of diastasis, prolapse, or incontinence, I invite you to check out the Pregnancy & Postpartum Athleticism™ Coaching Certification.
P&PA coaches like Bethany recognized there is a severe lack of knowledge about training pregnant and postpartum clients after navigating the experience herself.
We see so many generic or extreme recommendations like:
● “Don’t lift more than 20 lbs”
● “Just do yoga and walk”
That advice doesn’t resonate with athletic women who like to lift heavy and train with intensity.
Tess knew that wasn’t going to fly with her CrossFit clients which is exactly why she sought this certification out.
The Pregnancy & Postpartum Athleticism™ Coaching Certification course connects the dots between core and pelvic health, fitness performance and psychology during pregnancy, postpartum, and beyond.
We’d love to have you join us when enrollment opens again in April, 2024. Visit here to add your name to the waitlist.
I am with you,
(As promised, keep scrolling for The No-Pee Cheat Sheet.)
It’s talked about, joked about, and sometimes totally dismissed, but peeing during impact exercise, lifting, and in general, is a thing. We often see this at CrossFit classes, where women run to the restroom before the workout, or pee their pants mid workout. We see incredibly strong women peeing on platforms at lifting meets.
Contrary to popular belief, this symptom is not exclusive to pregnant or postpartum
people.
Teenagers, elite athletes, mothers, and menopausal women can also experience incontinence doing high impact exercise - like jump rope and box jumps - or while lifting heavy.
We are not here to shame this symptom, rather, we would like to bring attention to what we as coaches can do to help troubleshoot it from the outside in, just like we would with any other form or mechanical “breakdown.”
Let’s start by defining incontinence.
To put it simply, it’s leaking urine (or sometimes feces) unintentionally. This can happen from a sneeze, a heavy lift, during high impact exercise and/or the inability to “hold it” for longer periods of time.
Core + Pelvic Floor Basics
The pelvic floor works in coordination with the
diaphragm and abdominal muscles.
Coordination is a key word because most
athletes have a hypertonic (tight) pelvic floor, even postpartum.
see the core system lengthens. On exhale the core system will gently and reflexively contract and shorten.
We see that female athletes experiencing incontinence are hypertonic. There is no
opportunity to lengthen; the pelvic floor basically lives in an isometric, holding pattern.
The core system is unable to coordinate the task at hand because it is static, instead of dynamic.
You don’t have to get neurotic about breathing or expect your clients to get it perfect. This is just helpful context for you to understand because the solution isn’t, “Do more kegels,” or “Do these 5 exercises.”
Why Do Female Athletes Pee?
It is rarely about “weakness” and most often about a breakdown of one of the following factors:
● Too much tension held in the abdominals/pelvic floor/body during activities of
daily living and lifting ● Position of the pelvis at different points in the movement pattern ● How intra abdominal pressure (IAP) is distributed ● Constriction (i.e. ab belt) ● Reaching max capacity (your pelvic floor threshold)
Most female athletes will experience stress incontinence when they are at the sticking point of the lift. They may also have variables that “predispose” them to symptoms prior.
Those variables could include:
1. A Breath Hold
HOW they’ve been taught to valsalva.
Potential solutions: ● Change how they are breath holding ○ I like the cue, “breathe into your lats” ● If they tend to pressure down (sets in to generate force), encourage a more distributed brace
See this reel for a visual and more details.
2. A Weight Belt
A weight belt helps provide the feeling of support, stability and feedback for lifting heavy. This alone is not a problem, but it can be when athletes experience incontinence while lifting. A belt constricts the abs and sends intra-abdominal pressure down into the pelvic floor, making it harder for the core system to coordinate.
Potential solutions: ● Temporarily pause the use of the belt ● Loosen the belt ● Wear it (slightly) higher ● Improve intra-abdominal pressure distribution (high + wide, inhale + brace)
Potential solutions: ● Stop over-engaging the glutes and abs at the top of a lift (squat, deadlift) ● Slight positional shifts can help better distribute tension vs concentrating on one muscle group ○ Ex1: Getting your glutes behind you ○ Ex 2: Shift belly button under you (torso moves forward)
4. Their Pre-Lift Routine
A pre-lift routine is a series of ticks an athlete follows before a lift. You may see them get the slack out of the bar, slide their feet on the ground, breathe and brace a certain way, etc. This routine has a lot of mental and performance benefits.
It also needs to support what her pelvic health needs vs counteracting it.
A pre-lift routine should optimize their body to absorb and produce force without peeing. Sometimes the set up routine creates system and tension problems for someone who has incontinence. It can predispose them to symptoms, rather than preparing them to manage symptoms.
Potential solutions: ● Changing aspects of the routine ● Slow it down so it’s calculated
5. Their Form
We want to see an athlete's pelvis in a position to absorb and create force,
particularly if that athlete is experiencing incontinence. As a coach, looking at their form is a great place to start. Here are a few movements that often create symptoms to keep your eye on:
➢ The Clean ○ The catch of the clean, driving out of the bottom with a tucked under pelvis
➢ The Deadlift ○ The mid-shin pull and pee - the pelvis/low back is usually rounded
➢ The Back Squat
○ The drive out of the bottom (the transition from eccentric to concentric) and how stable the pelvis stays
Potential solutions: A helpful generalization is to involve the glutes more. The glutes can help absorb and create force to keep the pelvic floor in an optimal position.
Examples include
● Drive the hips back
● Get your butt back ● Keep your belly button under you ● Stack your ribs/hips
6. Pushing Loads Too Soon For Pelvic Floor Readiness
Sometimes muscular strength and mental readiness progress faster than pelvic floor capacity. When you reach the symptom threshold, train just underneath it with new strategies until you can slowly test and progress it.
This can be 5-10% under capacity. Adjust like you would if your knee or back was causing you pain.
For example, if your client pees at a 150 lb front squat, have them train at 135 lbs while they remain mindful of their form, breath and tension. You can gradually increase load and retest for symptoms.
If you have pelvic floor symptoms like slow urine stream, pain with sex or insertion, vagina or anus cramping, peeing when you sneeze or laugh, etc., don’t ignore it.
These are signs of a hypertonic pelvic floor that would benefit from downtraining so it can actually coordinate and absorb force (from a sneeze to catching a clean).
Exercise Adjustments To Improve Incontinence with Impact
Incontinence with running, jumping, and plyometrics is another common experience
coaches will see. The same mechanics from the core + pelvic floor section apply here.
Just like with lifting there are simple variables we can manipulate to create an improvement in symptoms for our clients.
Examples include:
1. Look At Their Tendencies
Are their ribs thrusted up?
Are their glutes squeezed and tucked under? Are they holding their breath?
Assess their tendencies and make adjustments as needed.
2. Encourage Them To NOT Suck In Their Stomach
When they suck in their stomach, the vagina also clenches and generates more tension. If this is a struggle, have them face a wall (to lessen distractions and social insecurities) and practice.
3. Cue A Forward Lean With Jumping
Have your client do a few revolutions then adjust that positioning into a slight forward lean.
instead of up - while maintaining this slightly forward position. (This position will feel slightly “forward” but will actually look more neutral).
A cue I like for higher impact exercise in respect to
pelvic health is, “tits over toes.” Hey, it works.
Watch this in action here.
4. Have Them Exhale More Often
This does not have to be timed with every single revolution, but an exhale helps the core system respond to higher demand, dynamic exercise. These can be short, quick breaths out.
5. Have Them Build A System Threshold
As we mentioned above, having your client train just below their symptom threshold is an effective strategy not only for lifting, but impact as well.
For example, if they start to leak at 20 double unders, have them stop, rest and make some of the adjustments above.
If they are not ready to do that many reps, can they break it up into sets of 5 or 10 at a time?
Perhaps single unders are less mentally and physically taxing for them, and therefore, less complex for the pelvic floor. Manipulate volume and intensity as needed. If they’re not ready or comfortable jumping at all, scale down with exercises that help build to impact (a few gentle jump squats to get comfortable absorbing force, for example).
Building a symptom threshold takes time and practice. As their coach you can give them the permission they need to approach impact in this way.
The Bottom Line
Pelvic health is complex and should be taken seriously. It may not feel like a big deal, but it can impact quality of life now and long-term, which is why making adjustments is necessary. As a coach you are their first line of defense and support.
You can and should refer them out to a consultation with a pelvic floor physical therapist, however, there is so much you can implement as a coach to reduce symptoms and improve performance.
Inside The Pregnancy & Postpartum Athleticism Coaching Certification we go
deeper into core and pelvic floor anatomy and physiology. We cover experiences like diastasis recti, prolapse, and even more about incontinence. This is in addition to understanding pregnancy and postpartum considerations and how to actually apply concepts to the clients in front of you.
On April 4, 2024, enrollment for the certification course re-opens. To read further about the course, and get extra savings when it goes on sale, add your name to the waitlist here.
Questions? I’d love to hear from you. Hit reply to my email and let me know how I can help you.
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The Impact of Exercise Therapy and Abdominal Binding in The Management of Diastasis Recti Abdominis in The Early Post-Partum Period: A Pilot Randomized Controlled Trial
The Impact of Exercise Therapy and Abdominal Binding in The Management of Diastasis Recti Abdominis in The Early Post-Partum Period: A Pilot Randomized Controlled Trial
