Stress Incontinence

Stress Incontinence

By: Rebekah Krieg, BLOC Exclusive Coach

The first time I experienced an episode of incontinence, I was a teenage girl—after drinking too much diet coke and giggling late at night at a sleepover. The second was in college. In the third overtime period of a late November playoff soccer game, I took off for one more run down the right flank after a ball. It was cold and I was in battle, so of course I didn’t stop, but my soccer socks were soaked and I was super embarrassed. Also mad. Because we lost 3-2.

I hardly experience incontinence outside the gym, but three kids (vaginal births) and a decade of CrossFit later, it was happening regularly while exercising. Eight weeks of pelvic floor PT helped a little but was not a complete solution for me. I would just wear a pad and soldier on like a warrior. But when I started strength training more regularly, it was happening more predictably with volume squat workouts and starting to affect my psychological performance.

I was literally told, “Well, maybe you shouldn’t lift heavy,” by a strength coach.

I was not satisfied with that answer. My experience has led me on a personal journey to figure out how to train without incontinence and still put more weight on the bar—both for myself and my clients. If you are reading this and are struggling with the same issues, please know you are not alone, and there is something you can do about it!

One in three women will experience episodes of incontinence in their lifetime. This statistic includes active and inactive women alike, and women of all ages. The elephant in the room is how often it is happening at gyms everywhere. When it comes to females lifting for strength, the occurrence is likely much higher. It often occurs when lifting heavy weights, jumping, running, or sprinting—though it can also happen with laughing, coughing, or sneezing.

Incontinence is leaking urine or feces and losing voluntary control. When this happens, there are typically one of two reactions: lifters may feel ashamed that it occurred and not want to discuss it. They may even consider not lifting anymore. Or, they celebrate it and see it as evidence of hard work, like how some CrossFitters feel about puking after an especially hard metcon.

Peeing yourself is not a trophy of accomplishment. It is a sign of too much stress and fatigue, and evidence that your muscles failed to do their job. It isn’t a death sentence either, any more than missing a heavy deadlift means you should stop training.

Different types of incontinence exist. Stress incontinence is the kind we normally talk about with exercise. For men, it usually involves fecal incontinence (because the male pelvic floor only controls the colon). For females, it can be urinary or bowel. Urge incontinence is caused by an overactive bladder. If your bladder isn’t emptying completely, this is known as overflow incontinence. There is also a nerve damage type of incontinence (neurogenic bladder) that involves a problem with parasympathetic signaling. Treatment is different for all of these types. It tends to be thought of as an “old lady” problem, but it’s important to note that it can happen to anyone.

Some characteristics tend to make this more likely to occur:

• Being female
• Having delivered children, especially two or more
• Wearing a belt
• Lifting at high intensities
• A particular portion of the monthly cycle

Don’t worry, though. There are ways to deal with this, beyond diapers or pads to absorb the issue. It is important to note that while occasional episodes can happen while being extremely active, it is not normal to struggle with these issues on a regular basis. Don’t keep it a secret! You can do something about it. Below are some potential ways to address incontinence.

Proper Bracing

This is the number one thing most people are doing wrong in the gym. Bearing down like you’re going to the bathroom is definitely not helpful. Learning proper bracing and Valsalva technique can help. Think of bracing as either tightening your core muscles like someone is going to hit your stomach, or drawing your abs up under your ribcage while you pull your pelvic floor up and in. While the glottis in the throat is the top seal of a full Valsalva bracing of the trunk, the pelvic floor is the bottom cap. With practice, you will better maintain these positions while lifting, and your abdominal muscles will strengthen. You may find that these muscles lag behind your prime movers, but you can still get seriously strong even if you need to limit stresses that tend to cause incontinence.

Kegels and other pelvic floor exercises can help, but they aren’t a substitute for a properly braced position during challenging squats or deadlifts. As a starting point, pelvic floor exercises are excellent for helping a lifter become more aware of the position and tightness of these muscles, but you must also challenge your “bracing” with weight on the bar.

Limit Rep Ranges or Intensity

Lifters may notice that it tends to occur at a particular fatigue or intensity threshold. In the best shape of my life as a college athlete, I lost control of my muscles from fatigue at the end of a long soccer game. It can happen to anyone! But you shouldn’t “train” every day or week at this threshold. Some women find that longer sets make it harder to prevent incontinence from happening. Lowering rep ranges and doing more sets can help, without affecting your ability to manipulate programming volume.

Other women may find that a certain level of intensity triggers it. In this case, simply limiting intensity can work. While this lower RPE may preclude max attempts, neuromuscular stress can still be accumulated at slightly lower loads.

Don’t Wear a Belt

Belts allow you to generate more intra-abdominal pressure. Simply removing it may put less pressure on the bladder and reduce the issue. Be careful that this is not done in place of learning proper bracing techniques.

Accommodate Menstrual Cycles

If you find that incontinence occurs during a certain portion of your cycle, adjust programming or exercise selection to accommodate this. Intermediate lifters could align deload weeks to fall on this phase. Novices could simply limit rep ranges or intensity. Alternate exercises could be substituted—like no belt, tempo, or supplemental variations that lower intensity and make the issue easier to control.

Stay Out of the Bathroom

Trying to empty your bladder before every work set likely only creates an expectation in your body that you must pee when you train. This is ultimately counterproductive. Use the bathroom when necessary, and don’t obsess about it.

Treat It Like a Form Error

Many coaches have found that incontinence often occurs alongside form breakdown—meaning, the body tends to adjust in certain ways before you pee. If this issue is approached like any other form error, you can learn to prevent those breakdowns and, of course, adjust programming when they occur.

Avoid Caffeine

Drinking caffeine before training may exacerbate this issue, so be careful to avoid it until after the session is complete.

It’s Not a Big Deal! But I Know it can Feel Like a Big Deal

There’s a mental side to this. You may feel embarrassed or upset that the platform or your clothes get urine on them. This anxiety can be a significant part of the issue and can really derail a training session. It can be exhausting and frustrating to fight this mental battle. Squats are hard enough without this stress! I promise you that you are already tougher than most dealing with this extra distraction and still training.

A well-meaning male coach may tell you, “I don’t care if it happens, you are strong!” And you appreciate their kindness, but know the deeper issue is that while you don’t care if it happens once in a while either, you do care if it happens a lot, and you don’t like it.

It’s a common issue that doesn’t need to cause fear or apprehension. Don’t let it ruin your training experience. It has broken my heart to hear women admit they didn’t even want to train anymore because it was happening frequently. “I just can’t,” they say. It can be incredibly distracting and feel gross and draining to feel like you have no control. But remember, you don’t just have to “endure” it. You can learn how to manage your training to build your control and confidence and strengthen your pelvic floor with all the rest of your muscles.

I have been there. You are not alone! Try some of the suggestions in this article and see if they work for you. Every person’s exact reasons for having incontinence vary, though. You may need some medical attention or physical therapy, depending on weakness and mechanical issues that exacerbate the symptoms. So if some of these strategies don’t work for you, reach out to a coach who has worked through these things before. Stay away from uninformed people who normalize it! Diapers do not have to be part of your gym attire.

Don’t miss our previous Strong Moms podcast episode where we dive deeper into the topic of stress incontinence in strength training, featuring expert advice and real-life experiences. Tune in to gain additional insights and perspectives to further support your journey towards overcoming this challenge.