I’m a Pelvic Floor Therapist—Here’s My Advice for Staying Active When You Have Bladder Issues

While it’s not the most comfortable topic to discuss, bladder issues are a common health concern, particularly among women. Bladder control problems can be the result of a weak pelvic floor, which can occur for a variety of reasons: Pregnancy, childbirth, obesity and even heavy lifting in some cases.

“In the past, with any sort of bladder issue, the blanket statement was just to ‘do Kegels,’ a pelvic floor contraction to learn how to strengthen those muscles. But not everyone benefits from them, because the pelvic floor isn't always weak when you have symptoms—it can be hypertonic or not coordinating well with other muscles,” says Dr. Kelley Koontz, PT, DPT. 

“Your pelvic floor is on a team and it works with deep back muscles, deep abdominal muscles, hip muscles and the diaphragm. If something is going on with the entire team, it will likely affect your pelvic floor.”

How to Stay Active When You Have Bladder Issues

“It can be common, but not actually normal to have bladder leaking with exercising, especially if you had kids,” Dr. Koontz explains. “This is a sign of pelvic floor dysfunction and is something you don't have to live with. It has been found that nearly half of women with urinary incontinence stop or modify their exercise due to their symptoms.”

Bladder leaking during exercise can also happen for those who have never had kids. CrossFit athletes, runners and power-lifters can all struggle with this same issue, whether they have had kids or not.

All these and more can be a cause for bladder leaking, and the answer is not always doing Kegels, says Dr. Koontz. Meeting with a pelvic health physical therapist is valuable in finding the "why" of your leaking. The first step is to first find out what is causing your symptoms. Is it weakness of the pelvic floor? Is it tightness of the pelvic floor? Is it because of improper bracing mechanics with lifting? Is it because of other weak or overactive muscles around the pelvis? Do you have scar tissue from either a c-section or vaginal birth that is affecting your muscle activation?

Tips For a Healthy and Strong Pelvic Floor

Don't hold it!

This can cause many different urinary health issues.“When you hold urine, the bladder muscle thickens and cannot contract and squeeze all the pee out, which can lead to UTIs, which can weaken the pelvic floor muscles. When you go upon feeling an urge, you allow the pelvic floor muscles to lengthen and contract which keep them strong and working efficiently,” says Quiara Smith, MOT, OTR/L, Holistic and Integrative Pediatric Pelvic Health Occupational Therapist.

Be mindful of your breathing

Your breath is essential when you exercise because the pelvic floor works with your diaphragm.“The pelvic floor moves up (contracting the muscles) when you exhale, and then it moves down (or relaxes/lengthens) with you inhale,” Dr. Koontz explains. “So, with any lifting, pair your breath, make sure you don't ‘bear down' on the pelvic floor, and also learn to brace your core correctly to improve symptoms.”

Smith recommends this breathing exercise:

Take two to three belly breaths after you sit on the toilet, before your urine stream starts to help relax the pelvic floor muscles and sphincter around the bladder. This allows for the diaphragm ( your breathing muscle) to move in an efficient way, which allows the pelvic floor muscles to lengthen and contract in the appropriate way.Belly breathing/diaphragmatic breathing also allows for proper intra-abdominal pressure to help void, which helps people empty their bladder and rectum completely, which prevents downward pressure on the pelvic floor muscles and keeps them strong and working efficiently.

Stay hydrated

If you find yourself purposely not drinking more water because you don't want more bladder symptoms (such as leaking or going to the bathroom frequently), this can actually worsen symptoms. “Decreasing water intake makes the contents of your bladder more concentrated, irritating your bladder,” says Dr. Koontz. “Bladder irritants, such as caffeine, soda, alcohol, and sparkling water (to name a few) can worsen symptoms. When you start adding more water to your day, try to not ‘chug’ a lot of water all at once. Small and frequent sips throughout the day will help your urinary system.” 

Avoid constipation

This can help with bladder symptoms.“The pelvis isn't that big, so with any chronic constipation, it can either irritate your bladder or go into a cycle of making the muscles overactive, making controlling your bladder more difficult,” Dr. Koontz states.

Make sure you can do Kegels correctly (if you need to do them)

That means not squeezing your glute muscles, inner thigh muscles, or abdominal muscles while contracting your pelvic floor muscles, Dr. Koontz explains. Also, don't hold a Kegel during your entire workout. This can make symptoms worse.

Work on lengthening/relaxing the pelvic floor

“A tight or hypertonic pelvic floor can actually cause bladder symptoms. If you struggle with a tight pelvic floor, working on lengthening/relaxation of the pelvic floor can help,” says Dr. Koontz.

Insert diaphragmatic breathing with stretches, really focusing on your inhalation. Exercises can include happy baby, deep squat, inner thigh stretches, and child's pose.