Why do I pee when I jump or run?
I previously wrote a blog about stress urinary incontinence when it comes to coughing and sneezing. I often see patients who experience urine leaking with both things like coughing, sneezing, laughing AND with things like running, jumping, and lifting weights. Sometimes the reason for loss of urine with these two scenarios are the same, but sometimes there are other factors that are specific to leaking with running and jumping that need to be addressed.
Who experiences leaking with running, jumping, and lifting?
Stress urinary incontinence has been normalized in the postpartum population. So many moms have been told that peeing their pants is the cost of having babies. This could not be further from the truth, and my hope is that one day all mom’s will be referred to pelvic floor therapy postpartum so they can properly rehab and no longer experience leaking.
That being said, stress urinary incontinence is often due to pelvic floor dysfunction, pressure management issues, or weakness in the hips or feet. You do not have to have had a baby to experience these things, meaning that women who have never had children may leak, as well as men.
What does pressure management mean?
When most people think of the “core”, they think of ab muscles. The core is actually made up of your diaphragm, pelvic floor, and muscles in the abdomen and back. Imagine that your core is a soda can. The top of the can is your diaphragm, the bottom of the can is your pelvic floor, and the cylinder is made up of your back and ab muscles. Managing pressure in your “soda can” means there is a balance between these muscles and they are coordinated and working together for optimal function.
When you inhale, your diaphragm lowers to pull air into your lungs. As your diaphragm lowers, your pelvic floor muscles lengthen. When you exhale, your diaphragm ascends back up and your pelvic floor lifts. At the same time, your deep core gently engages.
This coordination of the diaphragm and pelvic floor, as well as the abdominal muscles, is key in managing pressure. It is also important that your pelvic floor muscles are resting at a normal baseline tension. Your pelvic floor muscles should be like a trampoline, with just enough tension to support your pelvic organs while absorbing forces well.
If the pelvic floor muscles are disconnected and uncoordinated with the diaphragm and pelvic floor muscles, sometimes they are unable to support the bladder properly during jumping or lifting activities when abdominal pressure or stress on the pelvic floor muscles increases. Imagine if your trampoline had a few of the springs cut off – it wouldn’t be able to absorb forces as well. This can lead to a loss of urine if the bladder isn’t being supported properly.
On the other hand, if the pelvic floor muscles are very tense, they won’t be able to absorb forces well either. Imagine if the springs on your trampoline were pulled really tight. It would be more like jumping on concrete, which would place a lot of pressure on your bladder as you land, and again can lead to a loss of urine.
Breathing, pressure management, and your pelvic floor function can play a big role in stress urinary incontinence. However, there are other factors that can play a role as well!
What other factors can affect how my pelvic floor functions?
1) Posture – posture has become a bit of a funny topic amongst PT’s the past few years. In most discussions around posture, I believe that moving and avoiding one position for too long best. However, there are certain positions that someone could experience leaking and assessing posture can help. In order to optimize pressure management, it is beneficial to stack your ribs over your pelvis. In activities such as jump rope and running, small postural adjustments can make a huge difference in reducing leaking.
2) Pelvis and hip strength and mobility – as mentioned above, your pelvic floor muscles should be at a nice baseline resting tension to support your pelvic organs. During movement and activities, the pelvic floor muscles should react to forces without much thought from you (you shouldn’t have to kegel or contract your pelvic floor for it to do its job). That being said, the pelvic floor muscles will take on more if you have weakness in surrounding muscles. Improving hip strength (especially hip rotators) can help to reduce stress urinary incontinence.
Also consider the position of your hips during activities. When your hips are externally rotated, your pelvic floor muscles are on slack. When they are internally rotated, they are lifted. This means if you are running, jumping, or lifting with your hips in an externally rotated position, your pelvic floor muscles are not naturally supporting your pelvic organs as well as they could be.
3) The foot and ankle – the foot and ankle is often overlooked when it comes to the pelvic floor. Your foot needs to be able to absorb forces well to reduce stress on your pelvic floor. Imagine if you were jumping on a stilt. The pressure through your pelvic floor would be much more than if you landed softly and absorbed the force with your foot. Improving foot strength and control can also reduce stress urinary incontinence.
As you can see, a whole-body assessment and approach is key in finding a long-term solution to leaking with running, jumping, and lifting.
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Blog post written by Dr. Alexis Hutchison, PT, DPT, OCS
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