Pelvic Floor Exercises and Bladder Training may be the best approach for that problem no one wants to talk about.

Someone in your box probably has this problem.

Leaking during some exercises (jumping jacks, double-unders have been mentioned) is a lot more common than you’d think. About 20% of women age 19-44 are believed to have a problem with urinary incontinence (aka “leaking). For women 45-64 the percentage increases to 25% (Sze et al. 2008). Chances are pretty good that someone in your box is having a problem. Chances are probably also pretty good that some women are avoiding CrossFit or exercise in general for this reason. There are a number of treatments including surgery, injection of “bulking agents” and drugs. Fortunately targeted exercises appear to be one of the most, if not the most, effective treatment for a large majority of women (Shamliyan et al. 2008).  

The Shamliyan article is a metastudy that looked at large numbers of different studies and reports on the most effective approach for regaining control of bladder function. Pelvic floor muscle training in combination with bladder training appears to be the most effective approach. Little research has been done to see if these are effective over time. However, since you can’t get in shape once, stop exercising and expect to be fit for the rest of your life, it makes sense that these exercises would need to become part of a woman’s long-term program. If you are experiencing leaking, or did at some point, you may need to keep up with your pelvic floor training. If you are a trainer you might consider putting up some information for people to see, or talking about it with your athletes. Men may also have a problem with urine control, especially if they have been treated for prostate cancer.

Here’s how to do the exercises:

Pelvic Floor Training (aka Kegel Exercises) 
  1. Isolate the target muscle group. Insert a finger inside your vagina (if you have one) and try to squeeze the surrounding muscles. You should feel your vagina tighten and your pelvic floor move upward. You can also try to stop urine flow mid-stream. If you succeed, you’ve isolated your pelvice floor muscles. Pee before you get started with your sets. Doing pelvic floor training with a full is not advised. Training on the pot might lead to incomplete emptying of the bladder, which can allow bacteria to increase and set you up for a urinary tract infection. Not fun.  
  2. Maintain your focus on tightening your pelvic floor muscles. Don’t hold your breath or let other muscles contract instead. You can work those out later. • 
  3. Work at it. Contract your pelvic floor muscles and hold it for five seconds and relax. Do 5×5 sets. Work up to keeping those muscles contracted for longer and longer periods of time. 

Bladder Training

Bladder training is a strategy to increase the amount of time you can go without feeling like you have to go. Sometimes people are so worried about leaking that they pee more and more frequently as a way to avoid problems. This can cause the brain to trigger “time to go” signals at shorter and shorter intervals. 

  1. Find your pattern. For a few days, keep a note of every time you pee and see how long you usually go from one trip to the bathroom to the next.   
  2. Extend your intervals. Wait before you go, rather than going as soon as you feel the need.
  3. Be disciplined. Pee when you get up in the morning, but then try to hold it until your target time. There’s no need to force yourself into an accident. If you think you can’t hold it then go. Your fellow gym members will appreciate it. 

 Sze EH, Jones WP, Ferguson JL, Barker CD, & Dolezal JM (2002). Prevalence of urinary incontinence symptoms among black, white, and Hispanic women. Obstetrics and gynecology, 99 (4), 572-5 PMID: 12039113  

Shamliyan TA, Kane RL, Wyman J, & Wilt TJ (2008). Systematic review: randomized, controlled trials of nonsurgical treatments for urinary incontinence in women. Annals of internal medicine, 148 (6), 459-73 PMID: 18268288

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