For many women, the relationship with exercise changes the moment they experience a leak during a morning run or a sensation of “heaviness” during a heavy lift. Whether you are dealing with Urinary Incontinence (leaking) or Pelvic Organ Prolapse (the descent of pelvic organs), the initial instinct is often to stop moving altogether.
In fact, recent research found that 46% of women aged 18- 65 had ceased a form of exercise due to pelvic floor symptoms, most commonly urinary incontinence. Perhaps surprisingly, exercise cessation was commonly reported amongst younger women (18-25 years – 35%) and women who had not had children (31%), (Dakic et al 2021).
There is a common misconception that once these symptoms appear, your days of high-impact sports, heavy lifting, or long-distance running are over. This does not need to be the case. Your pelvic floor is a functional muscle group, and like any other muscle in your body, it can be trained to improve bladder control and organ support.
Understanding the “Pressure Valve”
To understand why symptoms, happen during exercise, think of your torso as a pressure canister. When you lift a weight, jump, or even take a deep breath, the pressure inside your abdomen (intra-abdominal pressure) increases.
Ideally, your diaphragm, deep abdominals, and pelvic floor work together like a coordinated pump to manage this pressure. If the pelvic floor is weak, uncoordinated or perhaps not good at relaxing when needed, that pressure finds the path of least resistance. This results in a leak or the “bulge” sensation associated with prolapse. The goal of physiotherapy isn’t to eliminate pressure—which is impossible—but to teach your body how to manage it effectively.
The Role of the Pelvic Floor Muscles
“Just do your pelvic floor exercises.” is something we have all heard as the way to stop leaking or support a prolapse. However, doing pelvic floor exercises is not as easy as it sounds – up to 30% of women will do the wrong movement when asked to squeeze their pelvic floor. Women need to do the exercises correctly and this is where a women’s health physio comes in.
Experts recommend an individualised and supervised pelvic floor muscle training programme which results in a significant improvement or cure rate in up to 70% of women with stress incontinence (leakage with cough, sneeze, run, jump).
Roadmap for improvement
- Consult your pelvic health physiotherapist
(We have an experienced team of four Women’s Health Physiotherapists at Total Physio).
By completing a thorough assessment, we can determine what your muscles need and how to achieve it. This may be:
- More strength
- Better endurance
- Better coordination – you might have a strong pelvic floor, but it might not be “firing” at the right time during a squat or when running.
- Ability to relax – Some women experience symptoms because their muscles are already “on” all the time. They are tight and fatigued, making them unable to react quickly when you jump or sneeze.
- Address movement strategies – sometimes, how you breathe or move through the rest of your body creates more impact on the pelvic floor.
Our specially trained women’s health physios can also advise on other strategies and tools such as pessaries that can provide symptom relief.
- Modify the load while we build your internal support.
You can do this by remembering to “exhale with effort”. By exhaling through the hardest part of a movement—like standing up from a chair or pushing a barbell—you help the pelvic floor naturally lift and dissipate that force. - Vary Your Form: Sometimes, narrowing your feet in a squat or leaning slightly forward can change the mechanics of your pelvis enough to eliminate the feeling of heaviness. Or use a hex bar rather than a traditional bar for a deadlift.
- Adjust Your Volume: If you start leaking at 2km of a run, your “fatigue threshold” is currently at 2km. We work on building your capacity so that kilometer three becomes symptom-free. This includes working on your calves and glutes as well as your pelvic floor muscles.
Leaking and heaviness are incredibly common, but they are not “normal”.
These symptoms are not a tax you have to pay for aging or motherhood. You don’t have to choose between your long-term pelvic health and the exercise that keeps you feeling like yourself and helps with all other aspects of health.
The first step is to consult a pelvic health physiotherapist. Contact our team on 9907 0321 or book online.
By Louise Henderson
APA Titled Physiotherapist (Continence and Women’s Health)
