Stress Urinary Incontinence Doesn't Have to Interrupt Your Workouts

Bladder control problems are very common. However, they have the potential to make sufferers feel self-conscious when exercising.

It's an issue that especially affects women, with 24 percent to 45 percent of women older than age 30 experiencing stress urinary incontinence at some point. Other factors that can put you at risk for incontinence include:

• Diabetes
• A high body mass index (BMI)
• Being pregnant or in the postpartum period
• Menopause

If you're suffering from incontinence, you're not alone, and there are ways to treat the problem through exercise.

Understanding incontinence

Leaking during a run or when exercising can be due to stress urinary incontinence or urge incontinence. Stress urinary incontinence (SUI) is the leakage of urine during physical activity that increases abdominal pressure, according to the U.S. Food and Drug Administration (FDA). Urge incontinence is urine leakage as you feel a sudden, intense urge to urinate, or soon afterward, according to the United Kingdom's National Health Service (NHS). It is also possible to have both conditions at the same time.

"We need the pelvic floor muscles to react at the right time with the right amount of force to close off the opening, and if they don't, we leak," explained Kim Vopni, P.T., a pelvic fitness instructor at the Vagina Coach in Port Moody, British Columbia.

Many factors contribute to incontinence and these include diet, fluid intake, pregnancy, birth, hormone fluctuations due to menstruation, perimenopause, menopause, back pain, activity level and type of exercise, Vopni said.

"If you are leaking during an activity, it is the body asking for something to change," she said.

Treating leaks with exercise

The bladder, uterus and bowel are all supported by the pelvic floor muscles, explained Amanda Olson, D.P.T., a pelvic rehabilitation practitioner and president and chief clinical officer at Intimate Rose, a women's health products company headquartered in Medford, Oregon.

"Exercises that stretch, strengthen and condition the gluteals, hips and spine can help maintain postural support and better control of the bladder," Olson said.

She recommended seeing a pelvic floor physical therapist but added that there are many steps you can take yourself, especially in terms of exercise.

According to Olson, a pelvic floor physical therapist can devise a program that includes manual therapy, biofeedback training, bladder retraining, and specialized exercises specific to your medical history and condition. A pelvic floor regimen may include Kegels (contractions of the pelvic floor muscles), hip and spine exercises, as well as other ways to stabilize the bladder.

Any exercise can benefit bladder health, explained Aleece Fosnight, a board-certified physician assistant in private practice in Asheville, North Carolina, and medical advisor for Aeroflow Urology.

"Physical activity increases blood flow and circulation, helping with kidney filtration and eliminating waste in the body," Fosnight said.

This process brings more oxygen-rich blood to vital organs, including the bladder, which keeps them healthy. She added that regular exercise also helps to ease constipation.

Expert tips for bladder control

Olson believes it is entirely possible to work on bladder problems while maintaining a fitness regimen. These are her top tips to do just that:

• Use a removable bladder stability device. This device is placed into the vagina during exercise and helps to compress the bladder neck to prevent leakage while exercising.
• Strengthen the pelvic floor using Kegels or vaginal weights. For Kegels, imagine you are shutting off the flow of urine and then hold that muscle for three to five seconds. Aim to do three to four sets, 10 times per day. Vaginal weights are placed into the vagina, and the pelvic floor muscles work to hold them in. They can be used for 10 to 20 minutes, one or two times a day.
• Wear compression shorts to help support the perineum and mask any accidental light leakage.

She also shared her advice for maintaining good bladder health in general:

• Avoid going to the bathroom "just in case" as this can make the bladder think it's full when it isn't.
• Don't hover in the bathroom. Relax on the toilet to allow your bladder to fully empty.
• Avoid beverages and foods that irritate your bladder.
• Avoid constipation because this can put extra pressure on the bladder. Drink 48 to 64 ounces of water per day and eat plenty of soluble fiber (26 grams per day) to keep constipation at bay.

Vopni agreed, explaining that drinking water 30 to 60 minutes before exercise can ensure hydration and help you avoid the concentrated urine that can irritate the bladder. Aim for urine to be a pale yellow color as anything darker can signal a degree of dehydration.

She said some people choose to wear pads or black pants to mask leaks, but it's important to keep working on the problem. For running, she recommended wearing clothing that allows you to breathe freely and is not overly restrictive, because this can put pressure on the bladder.

In terms of training, Vopni advised stretch-and-release exercises to connect with the pelvic floor. These can be posterior pelvic floor releases, hamstring stretches or the happy baby yoga pose.

Focus on breathing during these exercises because increased abdominal pressure from holding your breath applies extra pressure on the pelvic floor muscles, causing them to weaken and leak, Fosnight said.

During training exercises, Vopni said you should inhale when the pelvic floor is lengthening and relaxing, and exhale when the pelvic floor is contracting and lifting. She also tells clients to try exercises such as bridges, squats and lunges to retrain the pelvic floor. After that, try dynamic movements that use the core breath, such as single leg running man, single leg hops and forward bounds.

According to Fosnight, there are many ways to modify an exercise to alleviate pressure on the bladder. She recommended exercises that you can do while sitting or lying down, because they can be a great way to support the core, hips and glutes as well as the pelvic floor. A pelvic floor physical therapist can help scaffold intense exercises until your core and pelvic floor build strength, she added.

"Some may need medications as a bridging therapy while they are building up their strength and coordination with pelvic floor muscles," Fosnight said.

Talk to your doctor

Always take the advice of your healthcare provider if your symptoms are not improving. There may be circumstances when someone needs to temporarily stop running or attempting certain exercises in order to work on a pelvic floor problem, Vopni said.

Change can happen very quickly when working on urinary incontinence that affects running regimens, Vopni said. However, once the problem is addressed, it's important to keep working on your pelvic floor to keep it strong and protect it from developing problems again. As Vopni put it, "Pelvic floor exercise is a lifestyle, not a quick fix."