Curing a Case of the Workout Pees

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“I ask every single woman I treat if they ever have incontinence. They always get this deer-in-the-headlights look,” says Ann Wendel, PT, ATC, CMTPT, founder of Prana Physical Therapy in Alexandria, Va. “Most say no initially, but I go down the list: ‘So, you never, ever leak — even a tiny bit — when you exercise?’ They say ‘Um, no.’ I ask ‘How about when you cough, sneeze, jump, run, do a box jump, a double under, or you jump on a trampoline?’ Then they say ‘Well yeah, of course, I’ve had kids!'”

Do you consider peeing during deadlifts, rope skips or running a fact of your life, and more specifically, a fact of your lift?

I have news for you: You shouldn’t have to. You don’t have to.

“We’ve just got to keep educating,” says Wendel.

In this interview, she does just that, explaining what causes stress urinary incontinence (SUI) and listing several drills (including a great one in the accompanying video) to help prevent it.

Wendel goes on to point out that it’s not a one-size-fits-all approach, as the cause can be different from person to person, so it’s worth seeking out a practitioner willing to work with you to solve the problem. Wendel herself has offered to answer any questions you have in the comments section of this post.

JS: Judging by the conversations I have in the gym, leaking urine during workouts seems to be fairly common. Is this the case?

AW: Leaking urine during exercise — called stress urinary incontinence, or SUI — is common, but not “normal.” In the U.S., the national average of women who experience incontinence is 1 in 3. A 2002 study done by Thyssen et al. surveyed 291 elite female athletes competing in a variety of sports from basketball to ballet regarding their history of urine loss during participation in their sport or day-to-day activities.

A full 151 reported leakage of some kind. Of the 151, five discussed it with a medical provider, and only six got pelvic floor training. Can you imagine only 5 out of 151 athletes with an ACL tear seeking treatment? That would never happen! Incontinence is very prevalent in the athletic community, yet most women do not seek treatment because they are either embarrassed or they assume it’s normal because everyone else they know has the same issue.

As a physical therapist, I treat women every day who say that they leak urine when coughing, sneezing and exercising. The most common activities that lead to SUI are box jumps and double-unders (some women also experience SUI with deadlifts). In a physical therapy evaluation, women nearly always follow up admitting to SUI with a statement like, “Of course I leak, I’ve had two kids!”

While it is true that childbirth can be one of the factors that contribute to pelvic floor dysfunction, not all women experience incontinence after childbirth; and, it can be treated if it occurs.

Drops2

JS: So, SUI is common; but, you say it’s not “normal,” right? Why is that? What does it indicate about your body?

AW: Any women’s health physical therapist will tell you that it is not OK to leak urine when working out (or coughing or sneezing). It is a sign that the whole system is breaking down, and the pelvic floor is just the place it shows the most at the time.

My colleague Julie Wiebe, PT, explains it this way:

“Incontinence is just one way of identifying a pelvic floor insufficiency. It is a signal that an imbalance in the deep core exists. The deep core is a closed-pressure system, and insufficiency in any component will impact the capacity of the whole. A female athlete may not be incontinent, but do they have any hip pain? Or low-back pain? How about osteitis pubis? Pain, joint instability and incontinence are all just signals that the system as a whole needs attention.”

In my own practice, I rarely have a patient that comes to me specifically for incontinence. Many female patients come in with complaints of low back, hip or knee pain. As part of my initial evaluation, I ask every woman if they ever experience any incontinence. Over half of the women will say no, until I press, and then they admit that they do.

What they don’t understand is that pain in the knee may be related to weak and/or uncoordinated pelvic floor, diaphragm and hip muscles. Chronic groin strains, IT band syndrome, trochanteric bursitis, low-back pain and patellofemoral syndrome are a few of the common diagnoses that female patients seek treatment for — and an integrated approach is necessary to identify the root cause of the issue and to successfully treat the problem.

BackPain

If you experience incontinence with running, box jumps or double unders, STOP. Seek help from a qualified women’s health physical therapist, even if your gynecologist states that you don’t need physical therapy. Be an advocate for yourself and seek treatment. The Section on Women’s Health of the American Physical Therapy Association has an index of providers.

JS: What kinds of things cause SUI?

AW: There are many factors that can lead to SUI and/or pelvic pain.

  • The muscles of the pelvic floor may be weak from being stretched during vaginal delivery or even from the weight of the baby during pregnancy. They may also be weak due to postural habits (standing with a posterior pelvic tilt) and lack of exercise.
  • The muscles may be hypertonic (overactive) and unable to relax, which decreases the strength of the contraction when they do fire. So they are overactive, but weak.
  • The pelvic floor muscles may be overactive but strong; yet, the client has stronger abdominal, back, diaphragm and glottis (voicebox) muscles. Women who leak while lifting a heavy load may be in this category — holding their breath leads to a rigid thorax, yet they can’t contain all of the pressure, so they either grunt/yell, leak urine, or sustain an abdominal hernia or herniated spinal disc. The pressure escapes the system through the weakest link. (For more on this topic, check out this post from Physio Detective on pelvic floor dysfunction.)
  • The pelvic floor may have been damaged (think episiotomy, forceps, vacuum extraction of baby, cancer/radiation) and the scar tissue affects the ability for the muscles to contract properly.

It is important to work with a therapist who can evaluate your specific condition and treat you with appropriate exercises and manual techniques. The answer to pelvic floor issues and SUI is not always “more Kegels.”

If the muscles are hypertonic or the issue is with breath holding, Kegels in isolation won’t solve the problem. Central stability (commonly called core stability) requires a balance of muscular strength and a neuromuscular strategy for engagement to meet physical demands. The respiratory diaphragm, deep abdominal muscles, spinal stabilizing muscles and pelvic floor need to work perfectly together.

JS: This problem isn’t limited to women, right?

AW: Right. While we most commonly associate incontinence and pelvic floor issues with women, men also suffer from these issues and are less likely to seek help. Men with pelvic health issues struggle with incontinence, sexual dysfunction, pudendal neuralgia, pelvic and rectal pain, and prostatitis. Experienced physical therapists can address men’s health issues as well as women’s health issues.

JS: Say you’re not full-blown peeing your pants. What are some other indicators that pelvic floor stability is an issue?

AW: In a workout environment, a few indicators are:

  • Avoidance of certain exercises (you say, “I can’t do double-unders/burpees/box jumps/deadlifts).
  • Limiting intake of water to keep the bladder empty (bad strategy due to possibility of dehydration and the fact that concentrated urine/dehydration can irritate the bladder and increase urgency).
  • Running to the bathroom immediately before box jumps or double unders begin (need to completely empty the bladder one last time before attempting these exercises).

JS: How can we improve the strength and function of our pelvic floors?

AW: Helping women (and men!) with pelvic floor dysfunction often requires a team effort. First, women and men with SUI/pelvic floor dysfunction need to seek treatment. I encourage anyone with these issues to have an evaluation with a gynecologist or urologist, and/or a physical therapist who specializes in pelvic health. Through evaluation, we can identify what is causing your issue and work with you to treat it.

Though each case is different, there are a few general suggestions I can make regarding things to do to improve the function of your pelvic floor muscles. We know that for any muscle in the body, there is an optimal length/tension ratio; the pelvic floor muscles are no different. We also know that a muscle needs to relax fully in order to then generate a strong contraction — we wouldn’t walk around with our biceps flexed all day, so the notion of constant firing of the pelvic floor is incorrect. Here are some pearls of wisdom:

  • Learn to completely relax your pelvic floor. To do this, get into a deep squat and let your pelvic floor completely relax as you inhale. As you exhale, lift through the pelvic floor as if you were stopping the flow of urine. Do this 10 times, several times a day.
  • SQUAT. A lot. Weak glutes are prevalent in women who stand in a posterior pelvic tilt (tucked bum). A posterior pelvic tilt causes the sacrum to move anteriorly, putting slack in the pelvic floor muscles. Strong glutes balance the anterior pull on the sacrum and restore normal lumbar lordosis.
  • As much as you may love stilettos, they are not doing your pelvic floor any favors. High heels contribute to a posterior pelvic tilt in order to adapt to the torque at the ankles. As we know, posterior pelvic tilt is no bueno. Save the heels for special occasions.
  • Stretch and do mobility drills for your hamstrings, calves and adductors (groin muscles). When the pelvic floor is weak, folks use the glutes and adductors to keep the bladder closed (instead of the sphincter muscle of the bladder). Many women I work with tell me that they cross their legs when they sneeze to avoid leaking urine. This conscious and subconscious gripping with the adductors can lead to tight muscles. Learn to relax the adductors and fire the pelvic floor muscles.
  • For more exercise ideas, check out the book Primal Moms Look Good Naked: A Mother’s Guide to Achieving Beauty Through Excellent HealthI contributed a chapter on exercise for the deep abdominals and pelvic floor muscles.

JS: How often should we do these drills, and how soon can we expect results if we follow the plan diligently?

AW: Bodyweight squats with integration of breathing and relaxation of the pelvic floor muscles can be done daily — several times a day, even. We need to get comfortable in this position. Then we need to integrate the motor pattern of being relaxed on inhale and contracting the pelvic floor on exhale into our functional activities — lifting children or lifting heavy bags of dog food, etc. For some women, strength may show a measurable increase after several weeks of training (provided that the correct techniques are utilized — this is where evaluation by a professional comes in to play).

JS: Here’s a weird question: I’ve recently purchased a Squatty Potty — OK, three — for my house because I was intrigued by the promises of a healthier pelvic floor. Is this a useful investment on the incontinence front?

AW: Squatting deeply while you urinate or defecate allows the puborectalis muscle to relax. This in turn allows the anorectal angle to straighten, leading to easier bowel movements, without straining. Squatting also activates your glutes, which in turn bring the sacrum posteriorly, allowing the pelvic outlet to open. Squatting in a relaxed position helps the pelvic floor muscles to relax, decreasing the need to “push” to force urine out.

The habit of “hovering” over the toilet seat contributes to tension in the pelvic floor muscles. The Squatty Potty allows everyone (even folks with decreased hip and ankle range of motion) to relax with using the toilet, so that they can empty the bladder and bowels completely, without straining. 

So, yes, I think that the Squatty Potty can be beneficial as part of your overall plan for pelvic floor health.

Let’s start a dialogue in the comments section!

Ann Wendel is a Certified Athletic Trainer (ATC) licensed in Virginia, a Licensed Physical Therapist, and a Certified Myofascial Trigger Point Therapist (CMTPT). She utilizes trigger point dry needling as a treatment modality, along with Pilates, lifting weights, and nutrition and lifestyle consulting in her holistic physical therapy practice, Prana Physical Therapy in Alexandria, VA. She can be contacted through her website: Prana-PT.com.

 

[image credits: Alberto Bondini; akenator; Kendall Barton]


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Author:Jen Sinkler

Fitness writer and editor, workout connoisseur, meditator, proponent of spandex, former rugby player; never, ever without lip gloss.

275 Responses to “Curing a Case of the Workout Pees”

  1. December 11, 2013 at 7:50 am #

    Holy Cannoli. This was beautiful! I’m excited to get this stuff out there more because I feel like it’s rarely discussed! The first time I heard mention of pelvic floor function was with Kate from Aligned and Well. She’s a voice against the whole “Kegal” craze – and rightly so as “tighter” doesn’t mean “stronger.” Even being an “out of the box” and functional thinker – I didn’t recognize that kegals are really just an attempt to fix a problem thats a symptom. Just with hormonal disfunction – it’s never the symptom (in this case – the peeing during workouts) that needs to be treated… but the cause. I have a whole private discussion board I’m a part of with my local gym with women talking about this time and time again and seeking advice. Crazy! (Side note: Squatty potty was on my christmas list this year – but I took it off to avoid looking cray cray with my in-laws and extended family.) Ha!

  2. Whittney
    December 11, 2013 at 7:57 am #

    I think a fit into the

    “The pelvic floor muscles may be overactive but strong; yet, the client has stronger abdominal, back, diaphragm and glottis (voicebox) muscles. Women who leak while lifting a heavy load may be in this category — holding their breath leads to a rigid thorax, yet they can’t contain all of the pressure, so they either grunt/yell, leak urine, or sustain an abdominal hernia or herniated spinal disc. The pressure escapes the system through the weakest link. ”
    …..category.

    Every time I pull a deadlift max I tinkle (just a few drops). So gross and embarassing. I never realized how many other women it happened to. I haven’t even had children!

    • December 11, 2013 at 2:50 pm #

      Whittney,
      Don’t be embarrassed! As you can see from the conversation here, this is very common, even among women who have not had children. Please find someone in your area to work with – you may just need a few strategies for building strength or coordinating your breathing with your lifting.
      Ann

  3. Danielle
    December 11, 2013 at 8:36 am #

    So excited to read this article. I always wanted to try this squatty potty thing, I usually just put my feet up on my trash can in front of the toilet….totally funny but helps alot! i’ve seen a lot of improvement but is a bit…funny sometimes. I never thought about trying that for urination though….I tend to force myself to pee a lot of the time I’ve realized and I know that just can’t be good. I will have to ask my gyno about any tips she may have or anything she can assess on her end at the next appt. Because I am only 28 and never had children, the topic really never comes up and I am embarrassed because why the heck am I this young and this happens? Great to hear some encouraging words. I will have to try this squat and relax!

    • December 11, 2013 at 2:52 pm #

      Danielle,
      Glad that you were helped by reading the article. Definitely talk with your gyn during your visit – many gyn’s have physical therapists in the area that they recommend.
      Ann

  4. December 11, 2013 at 8:39 am #

    I had 3 kids in 4 years. My mom has this issue, my grandma has this issue. I have had friends have surgery for this issue and I had started to look into having the surgery myself. I LOVE this post!
    I have avoided dead lifts, jump rope and so many more exercises because of this.
    Great post!

    • December 11, 2013 at 2:54 pm #

      Meg,
      Please see a women’s health physical therapist before you think about surgery. A full evaluation will give the therapist clarity as to what the underlying issue is, and allow them to design a plan of care specifically for your issue. Physical therapy is often what is needed, not surgery. Use the link to find a therapist near you.
      Ann

      • December 12, 2013 at 11:24 am #

        Thank you Ann. I will pass on the info to my family too. It would be great to reminisce and laugh with the women in my family with out all of us having to race to the bathroom 🙂 I really though surgery would be the only answer and I didn’t want to have to go that route. Thank you for the information.

  5. Stephanie
    December 11, 2013 at 8:40 am #

    Is it useful to use something like Lelo’s Luna beads (http://www.lelo.com/index.php?collectionName=femme-homme&groupName=LUNA-BEADS) for people who have SUI? I haven’t had kids (or abortions) but I’ve been noticing some SUI when I sneeze or cough and it’s quite distressing! Would any physical therapist (I’m in Canada) be able to help with this issue? Thank you for the article!!

    • December 11, 2013 at 2:58 pm #

      Stephanie,
      Sometimes it is appropriate to use weighted cones or beads as part of the treatment plan; however, you really need an assessment to figure out what the underlying issue is. I’m not sure about the education that Canadian physios receive; in the US, PT’s learn the anatomy and very basic treatment for pelvic floor issues. Most of the education is done as post graduate or continuing education work. It’s best to ask around and research the therapist’s background. You really want a physio who specializes in women’s health.
      Ann

      • Stephanie
        December 11, 2013 at 6:38 pm #

        Thanks Ann! I asked the physio I usually go to and he directed me to the Order of Physiotherapists website for my province and from there I could search for physios in my area that specialize in pelvic floor rehabilitation. I have an appointment with one in the new year. Really happy that I’ll have someone helping me resolve this issue!!

  6. December 11, 2013 at 8:50 am #

    Jen: Great article/interview with Ann! A great start to opening up the world of pelvic health via physical therapy. Ann, I am going to pass this along to my trainer (I am focusing on TRX right now) who is in the process of applying to PT schools, she is eager for every bit of information to help her training clients!

    The video was great, and would love to see more in the series Ann!

    • December 11, 2013 at 3:00 pm #

      Thanks, Nancy! I always appreciate your feedback and support. I’m happy to talk with your trainer if she ever wants to chat. I do hope to do a follow up post on this topic for Jen.
      Ann

  7. December 11, 2013 at 8:53 am #

    Noelle,
    I’m glad that you liked the article! Please share with everyone you know. So many women (and men!) have no idea that help is available for this issue.
    Thanks,
    Ann

  8. Jen N.
    December 11, 2013 at 8:56 am #

    Very interesting stuff! I’m going to pass the info along to a friend ay my gym who cringes every time we have to do any kind of jumping.

  9. December 11, 2013 at 9:02 am #

    This is a great article. Thank you for sharing and getting the message out.
    Ann- Your video with the exercises provides some excellent ideas on how to coordinate a pelvic floor contraction in conjunction with the “pressure system” in these functional/exercise positions.
    I wanted to highlight a suggestion you made. If possible, it would be an excellent idea to have a musculoskeletal pelvic floor evaluation by a qualified pelvic floor physical therapist (and any other screenings by GYN) if one is having any urinary leakage. The reason is that some women cannot activate the pelvic floor muscles or push down in the wrong direction rather than contracting and lifting.

    Furthermore, as you stated, if the muscles are shortened and tight OR very weak OR both – an individual may benefit from direct treatment to the pelvic floor muscles (they won’t necessarily just relax on their own. Squats don’t always have a relaxing); or they may need to start a pelvic floor program lying down or sitting rather than standing (if their pelvic floor strength is not appropriate for standing yet).
    This is one of the issues I see most often. Women are attempting to perform high level activities and trying to activate the pelvic floor against these other “pressures” from the abdomen, diaphragm, etc., but when I assess the ability of the pelvic floor to activate properly with or without these pressures, they simply cannot. So, this article is a reminder for us to look at the WHOLE patient and not just parts…but sometimes we must address the specific part first and then integrate into a full body workout that’s more optimal.

    Thanks again!
    Your supporter and colleague,
    Tracy

    Tracy Sher, MPT, CSCS
    http://www.sherpelvic.com
    http://www.pelvicguru.com

  10. December 11, 2013 at 9:15 am #

    Great, great article. As a women’s health PT and Pilates trainer I see this all the time, and SUI especially is really ‘treatable’ with the right exercises and education. It’s a shame more women aren’t getting the help they need.
    Thanks for the info on the Squatty Potty – never heard of it before.
    And of course, here’s one more good reason women should be incorporating squats into their exercise programs!

  11. Judith Winner
    December 11, 2013 at 9:18 am #

    I’ve experienced this problem, although, thankfully not with my deadlifts. But jumps and the whole sneezing problem is annoying. Like many other women, I attributed it to having given birth to two children, with episiotomies and just a fact of age (I’m now 50).

    I won’t say I’m glad to know it”s not normal and saddened to realize that it has been thought to be so. Now I’m looking forward to addressing the issue so that I can comfortably jump-rope again, as part of my workout routine.

    Thank you for the information!

    • December 11, 2013 at 3:03 pm #

      Judith,
      Wouldn’t it be great to jump rope and sneeze without worrying about this! I hope you receive the treatment you need. Please let me know if you need help connecting with a physical therapist near you.
      Ann

  12. Ann
    December 11, 2013 at 9:19 am #

    I can’t tell you how valuable this information is….Thanks for addressing the problem that my clients and I refer to as “the squirts”. I am often embarassed to have to stop during jump rope sessions or switch my jumping when I’m asking clients to rock them out full blast. But I know that the majority of us ladies deal with this issue. I appreciate the fullness of the education you shared!

    • December 11, 2013 at 3:05 pm #

      Ann,
      Glad you found the information helpful. Please share it with your clients!
      Ann

  13. Donna Y
    December 11, 2013 at 9:30 am #

    I’d love to be able to do jumping jacks without being paranoid!

  14. December 11, 2013 at 9:36 am #

    Thanks for taking on an important, yet rarely discussed topic!!

  15. Kelly
    December 11, 2013 at 9:38 am #

    Interesting perspective! I am in the “I’ve had 2 kids of course I leak” camp, and thought it was “normal”. Deadlifts and sneezing are my triggers. Guess it’s time to have a chat with my doctor!

    • December 11, 2013 at 3:06 pm #

      Kelly,
      Yes! I encourage you to talk with your doctor about it, and to ask if your doctor has a physical therapist in the area that they recommend. If not, the link to find a therapist should help.
      Ann

  16. Terri McClinton
    December 11, 2013 at 9:39 am #

    At the age of 50, overweight and way out of shape, I decided to get healthy. I adopted a Paleo diet, banned wheat, and hired a trainer. Four months later, I am 40 lbs down, but have gained muscle mass. Several clothes sizes later, I am moving forward still. I most definitely enjoyed this article! I’ve birthed four kids, been in 4 wrecks, and am a physical wreck myself, but here I go on this journey. I have looked at the Squatty Potty and have been tempted. After this article, I think it is a must! Now to find me a physical therapist that specializes in this!

    • December 11, 2013 at 3:09 pm #

      Terry,
      Congratulations on making such amazing changes! That’s a lot of progress! I do encourage you to speak with your doctor, and/or use the link to find a physical therapist near you. Wishing you all the best in your journey to health!
      Ann

  17. December 11, 2013 at 9:41 am #

    I’ve been wanting to test out a Squatty Potty and would love the Ecco 7″.

    Thanks for this post, I often hear women at my box complain of this issue, especially during jumping rope. Now I can direct them here.

  18. Michelle
    December 11, 2013 at 10:04 am #

    I love the idea of the squatty potty!

    I have been training harder and lost a ton of weight this year (~50lbs). I’ve never before had any problems, and I’ve never had kids, but I sneezed a little while ago and damn near peed my pants. I’ll definitely be checking into this…

    • December 11, 2013 at 3:10 pm #

      Michelle,
      Yes, please check out the links and information provided. Great job on your healthy changes this year!
      Ann

  19. Rosemary Whelpdale
    December 11, 2013 at 10:14 am #

    What an awesome article! We have a ton of ladies who complain and literally a line-up at the bathroom before double unders. This will be posted to our gyms Facebook page! Thanks!! And squatty potty’s for the whole house is my goal as well!

  20. Beth
    December 11, 2013 at 10:15 am #

    I’ve has this issue on occasion during heavy deadlifts, but did believe it was normal. It makes sense that all the abdominal pressure is leaking from somewhere else, so interested to see if fixing the leak could help my dl strength. Also, been looking at the squatty potty for some time, nad just havent pulled the trigger.

  21. Kat
    December 11, 2013 at 10:26 am #

    Wow I had no idea this affected so many people. I thought it was just me, and I’ve learned to live with it. Kegals have never helped me, so I’m glad for this info about other things to try. Thanks!!!

    • December 11, 2013 at 3:13 pm #

      Kat,
      It’s definitely not just you! Glad that the article was helpful!
      Ann

  22. December 11, 2013 at 10:31 am #

    As a leading educator in the Pilates industry for over 20 years, I’ve been stressing the value of natural squatting (like a “wild” human, not a domesticated one) for a long time. It’s basically what Joseph Pilates was saying way back in the 1930s.
    Amy

    • December 11, 2013 at 3:15 pm #

      Amy,
      Joseph Pilates was way ahead of his time. My interest in this topic started during my Pilates teacher training through Core Dynamics. Pilates exercises are great as part of the treatment for SUI.
      Ann

  23. Jennifer Foley
    December 11, 2013 at 10:53 am #

    Love the article! Love double unders, but hate being nervous about having to run to the bathroom! Nice to read of ways to help get this under control, I know the women are always talking about this problem at our gym. Thanks for the info!

  24. Marie VanderWeyst
    December 11, 2013 at 11:02 am #

    This was very informative. I definitely need to seek medical help for myself as I have been wearing incontinence pads every day for several years and the issue truly prevents me from exercising. I’m also very interested in the Squatty Potty. I have a 7-year-old son who is autistic. Although he is potty trained, he refuses to defecate in the toilet. He chooses instead to put on a pull-up and squat, then removes the pull-up and throws it away and redresses himself. I think the squatty potty might be exactly what he needs to finally use the toilet to defecate and be able to no longer need the pull-ups.

    • December 11, 2013 at 3:18 pm #

      Marie,
      Yes, please have a talk with your gyn and/or speak with a qualified women’s health physical therapist. It’s really important to find out what is causing the incontinence and to develop a treatment plan.
      Ann

  25. brandee
    December 11, 2013 at 11:04 am #

    I love this article! The more I work out the better problem is but its still there. I have a daughter who has accidents, and we are thinking that this is her problem too. I think I will be investing in a squatty potty soon.

  26. Vanessa Parsons
    December 11, 2013 at 11:07 am #

    Thanks so much for this informative article. Nice to know there are other ways to improve this situation besides just kegals!!

  27. Gina
    December 11, 2013 at 11:10 am #

    My drs have told me to do kegels, I’ve had friends try to excision, but unless i an actually urinating, i can’t feel/feel like i am moving any muscles. I’m leaking often when i sneeze or cough and it’s so frustrating. What can i do?

    Love the squatty potty!

    • December 11, 2013 at 3:20 pm #

      Gina,
      I really recommend that you work with a physical therapist who can evaluate the function of your pelvic floor, and teach you exactly how to contract the muscles. Then, the therapist needs to teach you how to integrate that contraction into your everyday activities.
      Ann

  28. Kimberly Mills
    December 11, 2013 at 11:14 am #

    Early on in my training I did have a lot more problems with leakage during workouts. As time has gone by and my training has become more advanced, I have had fewer and fewer issues with it…too the point that it rarely happens at all any more…unless I am pulling 315lb partial deadlifts, of course! 😉

  29. Dustienne Miller
    December 11, 2013 at 11:16 am #

    Hi Ann,
    Thank you for contributing such a concise and valuable article. As a fellow pelvic floor physical therapist I appreciated your highlighting the fact that the pelvic floor muscles could be weak, overactive, have restricted mobility/scarring/difficulty coming back to baseline. For women (like Kat in the comments above) who have always thought they have to “live with it” there is hope!
    Warmly,
    Dustienne

  30. December 11, 2013 at 11:30 am #

    I LOVE all the comments and questions so far! I have set aside time this afternoon to sit down and answer every one of them! I look forward to continuing the conversation, and thanks to Tracy Sher for again highlighting the importance of working with a trained physical therapist to identify what your particular situation involves, to develop a personalized program of treatment!
    Ann

  31. December 11, 2013 at 11:37 am #

    Thanks Ann and Jen for continuing to shed light on this CRAZY important topic. This takes us one step further from the idea that a sustained low squat is all that is required to get the PF to smarten up. It is the use of it alongside its functional partners (Diaphragm, glutes, etc) in a functional pattern like squats, or sit to stands that optimizes its function!! Alignment makes the muscles available, but we have to make them work as designed in order to see carry over into our daily life and fitness.

    Point well taken Tracy, and I think Ann provided a great resource for that via the APTA Section of Women’s Health link at the start of the post. However, as we have discussed on many occasions, not everyone will seek care for a host of reasons. Kegels have been the go to for so long. Most have heard of Kegels, tried Kegels etc and not always had a very positive response. Yet the internet is full of Kegel how-to articles, and videos. We could argue that those women following the advice of the Kegel how to videos on the internet should also seek care. Folks go to the internet for self-care. So articles like these provide a balance, offer women alternatives, and promote a more integrative approach…and I think give hope to those who have tried and failed at Kegels. There are other options. We have told women Kegels aren’t enough, so we need to show them new alternatives.

    Julie Wiebe, PT
    http://www.juliewiebept.com

    PS Crossing my fingers for a Squatty Potty to call my own!

    • December 11, 2013 at 3:25 pm #

      Thanks, Julie, for being one of my mentors on this journey! Yes, we need to get information out there and let people know that there are ways to treat incontinence. This article just scratches the surface of everything we could say about evaluation and treatment of pelvic floor dysfunction – and yet, if it even spurs one woman to seek help for this issue, then I feel like I did a good job! I want everyone to know that they are not alone in this, and there IS help!
      Ann

  32. Shannon
    December 11, 2013 at 11:40 am #

    I love the diversity in your blog posts, lady. Way to mix it up! I didn’t realized this was an issue, but it is certainly not surprising that a knee, IT band or other injury could be related to a pelvic floor problem and it’s good to be informed! Knowledge is power. 🙂

  33. Stacey
    December 11, 2013 at 11:42 am #

    Nice to know that we aren’t alone in this!

  34. Dre Khoury
    December 11, 2013 at 11:46 am #

    Love this article. Thanks for posting about an issue that is often not talked about. I especially liked the quote: “It’s common but not normal.” And the recommendation to seek professional treatment. I have many friends who have modified their workouts because of SUI instead of getting treatment. I will definitely forward this conversation along to them. Thanks, again!!
    Dre

  35. Teresa
    December 11, 2013 at 11:47 am #

    I thought the reason I always had to stop to run to the bathroom during jumprope intervals was from drinking too much water. It is such an annoying problem, I pretty much stopped jumping rope all together. Thanks for including tips to aid the issue

  36. Dan Ryan
    December 11, 2013 at 11:49 am #

    Excellent article.
    I have several female clients that i will be sharing this with!!

    And YES, I want to win the Squatty Potty…….

    • December 11, 2013 at 3:27 pm #

      Dan,
      Thank you for taking the time to read the article and comment! Please share the article with your clients – they may think they are the only one with this issue. I want everyone who needs help to find it!
      Ann

  37. Jeanmarie
    December 11, 2013 at 11:53 am #

    Yay! That is so exciting…I am not destined for SUI!! An excited to be momma now has one less thing to worry about! Thanks Jen for all you do!

  38. Laura
    December 11, 2013 at 11:53 am #

    Thank you for this article! I am a young woman who has never had kids yet still experiences this problem. A max lift dl or even heavy squat will make me wish no one is around! much less du or box jumps. Our female coach talks about this frequently but most of the guys just dont understand!

  39. Jacklyn
    December 11, 2013 at 12:05 pm #

    I’ve been to a physiotherapist that specializes in pelvic floor – my physio was sooooo much more than kegels! After having two kids I just thought it was normal to leak – now I think otherwise. I’m so happy to see more info about it, and I try (although not always successful) to talk openly about it. There’s so much shame, as though peeing a little with activity is somehow my fault – we need to fix that and look at it as the treatable condition that it is. Thanks for the article (and I’d never heard of a squatty potty before – it has me intrigued!)

    • December 11, 2013 at 3:32 pm #

      Jacklyn,
      I’m so glad that you received treatment and that you are now able to share your story with other women. The more we openly talk about this, the more we can offer support and encouragement to other women.
      Ann

  40. Beth
    December 11, 2013 at 12:09 pm #

    Love this article and it helps to dispel the myths that incontenence is just something you have to deal with after having children and that the only thing you can do is have surgery to fix it. I’ve had 4 children in the past 7 years and by working on strengthening my glutes and being able to relax the pelvic floor, I don’t have those issues. Squatty potty is next on my wish list!

  41. Sandy Lammer
    December 11, 2013 at 12:11 pm #

    Lots of great information..

  42. Corinne
    December 11, 2013 at 12:13 pm #

    Thank You! I am that woman always running to the bathroom before box jumps. I have always blamed it on my four pregnancies and like other posters figured it was “normal” for someone in her mid 40’s. 🙂 I will be incorporating these exercises immediately into my workout routine and will check with a professional if more work is needed. I am so excited that I might be able to sneeze and jump again without worrying! Yea!!!

  43. Sarah
    December 11, 2013 at 12:17 pm #

    Love this. Stood up in my office and did a deep squat as I read through som of the suggestions towards the end. Thank you for sharing!

    • December 11, 2013 at 3:35 pm #

      Sarah,
      Yes, it’s a great break to take from sitting at your desk. You can easily squat and breathe several times a day. I recommend that everyone at least stands up from the computer/desk every 30 minutes, stretches a bit, then sits again.
      Ann

  44. Hayley P
    December 11, 2013 at 12:26 pm #

    I knew it wasn’t ‘normal’, but I didn’t realize how common it was. Hopefully I can find someone in my area willing to work with me. I’ve ‘owned’ peeing during double unders and just gone with the flow (as it were), but Its not fun, comfy, or something I like.
    Thanks for the great article

    • December 11, 2013 at 3:35 pm #

      Hayley,
      See if you can locate a physical therapist in your area – if not, let me know!
      Ann

  45. Becky
    December 11, 2013 at 12:28 pm #

    Thank you for this article. So much great information that is never talked about.

    I’m fairly young (27) and haven’t had kids, but I’ve been struggling with SUI since I was in junior high. I used to pee my pants all the time when I laughed; now it usually “only” happens during double-unders or after hard sprints. Talk about embarrassing.

    As I was reading this, I kept thinking, I’m going to schedule an appointment with Ann immediately — until I saw she was based in Virginia. Ann or Jen, can you recommend someone who is based in the Twin Cities and has similar credentials and focus? I’d love to meet with someone and get this fixed, and this article really helped erase some of the stigma.

    Thank you!

    • December 11, 2013 at 3:36 pm #

      Becky,
      Let me ask around for a recommendation in the Twin Cities.
      Ann

      • Becky
        December 12, 2013 at 9:02 am #

        That would be great. Thank you!

        Using the link Jen provided, I found the person below who is pretty close. But again, for something like this, I would much prefer a good recommendation.

        Jill Marie Lawrence, PT
        Mn Sport and Spine Rehab
        14000 Nicollet Ave
        Burnsville, MN 55337

    • December 12, 2013 at 10:14 am #

      Ok, Becky! Here are the recommendations I received from friends who are PT’s:

      In Rochester, at Mayo Clinic: Dawn Underwood (@dawner65 on Twitter) I don’t have her contact info.

      In St. Paul: Beth Stidham 651 999-2734

      Hope that helps!

      Ann

      • Becky
        December 12, 2013 at 10:21 am #

        Thank you so much, Ann! I really appreciate it.

  46. Bri
    December 11, 2013 at 12:31 pm #

    Okay, this is a phenomenal post. I have always had difficulty with running or jogging because of incontinence. I have taken to wearing pads when I know I will be running a 5k. The only other exercise I have trouble with is jump rope or the evil double unders! I always run to the bathroom before doing these exercises, and I still leak sometimes! Where does it come from?!?!

    I am definitely going to talk to my gynocologist about this now. Also, I have never heard of the SquattyPotty, but I have read about the importance of an optimal squatting position while using the restroom. Sounds awesome, and it makes sense. Very cool.

    • December 11, 2013 at 3:39 pm #

      Bri,
      Definitely speak with your gyn, and check out the link to find a physical therapist.
      Ann

  47. Joyce Travis
    December 11, 2013 at 12:39 pm #

    I am still new to the squatty potty and am working at breaking it (or me) into this new concept. I do believe that the entire technique is the proper and natural way to go but it does take some getting used to. I would really like to have an extra one to share with a friend. Thank you.

  48. Kat
    December 11, 2013 at 12:42 pm #

    I think I may be one of the lucky ones – though I thought this was mostly a post-childbirth experience and am surprised to see the statistics. Have you ever checked out FemFusionFitness? She deals with this too. I would love a Squatty Potty – PayPal problems lost a SUPER deal on Black Friday and I was really bummed.

  49. December 11, 2013 at 1:04 pm #

    I thought I was exempt from this phenomenon, even though I’ve given birth to three kids (in five years). It wasn’t until jump-roping in Crossfit that I discovered my pelvic floor weakness. A squatty-potty is actually on my Christmas list! Would love to win!

    And thanks for the post – more ideas to add to my arsenal.

  50. Selina
    December 11, 2013 at 1:12 pm #

    Great read! I’m glad to see more refarding the utility of other exercises to improve pelvic floor function. Also enjoyed the mention of the primal moms book a been meaning to pck that one up and now I really need to grab a copy! And a squatty potty!

  51. December 11, 2013 at 1:17 pm #

    In response to Julie- I totally agree. This article offers balance. It’s wonderful to have this information available to so many. The comments indicate that many women will benefit from this. The video offers exact things to try – great!

    I also concur that it is not all about Kegels. But, sometimes we go so far away from actually touching or addressing pelvic floor function itself (and patients are still unaware even with videos and handouts from physicians) that we should still offer the option for patients to get this type of specialized hands-on pelvic PT treatment if they aren’t improving.

    It’s great to know that there are many different options available to women dealing with this and we can all collaborate and help – fitness professionals, PTs and more!

    To all: Here’s the Section on Women’s Health (APTA) link for finding a women’s health/pelvic PT in your area: http://www.womenshealthapta.org/find-a-physical-therapist/

    Respectfully,
    Tracy Sher, MPT, CSCS
    http://www.sherpelvic.com
    http://www.pelvicguru.com

    • December 11, 2013 at 1:28 pm #

      Thanks, Tracy. That’s the very same link included in the original post (under the photo of the woman holding her back), but reiteration of it is very useful.:) Important that women seek out the cause of *their* SUI and get appropriate treatment. Thanks for reinforcing that point!

  52. December 11, 2013 at 1:30 pm #

    All, BIG thanks for your comments and questions. So glad each and every one of you is brave enough to talk about this issue.

    Ann will be digging in here this afternoon to provide answers and more information!

  53. Julia
    December 11, 2013 at 1:41 pm #

    Glad to know I’m not the only one who pees during deadlifts! With baby #3 on the way I was worried that it would only get worse. Now I know its not just the Kegels I need! Great article.

  54. Tina
    December 11, 2013 at 1:55 pm #

    The first time I realized I had a serious leakage issue was when I went with my daughter, sister, and nephews to a trampoline place. After that, I realized I was unconcously crossing my legs when I sneezed or coughed.

    Now I know how to fix it! Thanks for this info :0)

    Also, I have been eyeing the squatty potty for a while now. It’s one of those things that I just haven’t mustered up the courage to buy yet.

    Thanks again for the info and the cool giveaway!

    • December 11, 2013 at 8:53 pm #

      Tina,
      Give the suggestions in the article a try, and if you are continuing to struggle with this issue, please find someone near you to work with.
      Ann

  55. Sara
    December 11, 2013 at 2:06 pm #

    Ahh! Squatty potty! I’ve heard so much about these and have been wanting to get one ever since I traveled to southeastern asia a couple years ago. Lots of the toilets there are squat pots…

  56. Lisa
    December 11, 2013 at 2:11 pm #

    As a student Physical Therapist, we spend some time learning about SUI and treatment options. I would highly suggest that anyone who is having issues contact a Physical Therapist specializing in pelvic floor dysfunction (found typically under Women’s Health, although they can treat men and women.)
    It is so good to see this discussed, as it is so common and still so secret. Finding the right PT made a world of difference for me. (Although not sure I’m up for trying out a trampoline place–I’m still a work in progress. Good for box jumps and DUs, not so much for DL.)

    • December 11, 2013 at 3:44 pm #

      Lisa,
      It’s always great to see students learning about these important issues. Thanks for reiterating the need for working with a physical therapist!
      Ann

  57. Toni
    December 11, 2013 at 2:13 pm #

    Amazing how often this conversation comes up with friends when we run. I’ve not had this issue (yet?), but I’ve already been thanked profusely for passing on this link. Thanks, Sinkler.

    • December 12, 2013 at 9:59 am #

      Glad to hear it, Toni. It’s rare and v. cool that your friends are so open about it.

  58. Angie
    December 11, 2013 at 2:31 pm #

    Wow. I think the stars aligned and brought me this post! I went to my first Crossfit class last night, and the WOD was deadlift and double unders. Of course, I couldn’t do double unders yet, but just jumping rope during each set a little pee came out. I was so mortified. Thank goodness I was wearing black pants! I came home and told my husband and looked at my 19 month old son and said, “well, thank you for that little treat!” Then I got on my email this morning and here was your post! It could not have been more timely for me!! I’ll definitely be talking to my doctor and practicing these exercises. I do a lot of squats and lift some heavy weights at home, and I’ve never had this issue, but if I’m ever going to be able to do a double under without embarrassment I’m going to need to solve this issue!

    • December 11, 2013 at 3:50 pm #

      Angie,
      It’s interesting and very common that women only leak during DU’s and heavy dead lifts. The issue with DU’s can be a combination of breathing dysfunction, pelvic floor issues and form. Many people fall into one of a few categories when learning DU’s: stompers (jump high/land heavy) and pikers (pike at the waist to clear the feet) are the most common. Both stomping and piking take us out of proper ribs over pelvis alignment, making it difficult to use the pelvic floor muscles to their full advantage. My friend Antony Lo http://physiodetective.com/ is working on a post on this topic now.
      Ann

  59. Amanda P
    December 11, 2013 at 2:33 pm #

    I would love to be able to jump on the trampoline with the kids without having to change my pants.

  60. Gina
    December 11, 2013 at 2:43 pm #

    Thanks for the post. I don’t think I would have ever talked about this. Glad to know it’s more common than I thought.

  61. Farra
    December 11, 2013 at 2:44 pm #

    Excellent article and so common!

  62. Rachel Ashley
    December 11, 2013 at 2:45 pm #

    Such great information. Thanks.

  63. karen
    December 11, 2013 at 2:48 pm #

    sneezing is my trigger – every once in a while one sneaks up on me before i have a chance to brace myself – darn nuisance. i’ve been intrigued by the squatty potty, but haven’t given it serious thought – got to get the husband on board!

  64. Danijela Dragosavljevic
    December 11, 2013 at 2:52 pm #

    Great article, great reactions. In regards to squatty potty thing I develpoed my own technique, I just stand on the whole thing and squat over the toilet seat. Mind you the toilet has to be the one that is on the floor not one of those fancy ones that are attached to the wall

  65. Amie
    December 11, 2013 at 2:57 pm #

    Thank you for this. I have struggled with uncomfortable jumping jacks for quite sometime. I will definitely follow up!

  66. Beth Harris
    December 11, 2013 at 3:00 pm #

    What a fantastic article! Thank you for your contribution to the ever evolving world of pelvic health. The more exposure we have for these concerns will help to improve awareness and allow people to recognize that treatment for these types of conditions is available. It isn’t normal and we are worth it!!
    All the best,
    Beth Harris PT, DPT

  67. Julie
    December 11, 2013 at 3:06 pm #

    This is great. I am going to share this with my college daughter so she can keep things in shape long before having kids or my age! Also what about the pelvic floor and the inter-related nature of connective pelvic tissue can affect tailbone soreness and tenderness right behind the outside of the hip bones. I know there are some form issues I work on when doing kettlebells to make sure I don’t hurt myself plus I always use a mat when doing floor work. Look forward to any feedback you may have. Thanks.

    • December 11, 2013 at 3:55 pm #

      Julie,
      I would highly recommend having an evaluation with a physical therapist. You may have tightness in the muscles/connective tissue of the pelvic floor which are pulling on the sacrum (spine) or coccyx (tailbone). Without seeing you, it’s impossible to know, so an evaluation with a therapist near you is invaluable. Sometimes patients need hands on treatment to release this tightness in order to feel relief.
      Ann

  68. JuJu
    December 11, 2013 at 3:10 pm #

    Since joining a Crossfit gym 7 months ago, I really just thought peeing was just part of the experience. Thanks for an enlightening article.

    • December 11, 2013 at 3:56 pm #

      JuJu,
      Oh dear! Peeing should never be part of any workout experience! Definitely seek treatment if you need it – we want women to be strong AND dry!
      Ann

  69. Cara
    December 11, 2013 at 3:17 pm #

    Wonderful article about strategies for, and the importance of, treating pelvic floor dysfunction. It is incredible how common this is among all women!

  70. LB
    December 11, 2013 at 3:33 pm #

    This is super helpful. I am doubly cursed as I have incontinence when I exercise, but occasionally I have MS-related urinary hesitancy. I will have to look into this more.

  71. December 11, 2013 at 3:39 pm #

    Nice read and thanks for the mention Ann.

    I will be working on my double-unders solution / program soon so keep an eye out on my blog about it (www.PhysioDetective.com).

    I am hoping to coordinate an east coast tour with Ann in 2014 so watch out USA – here we come!

    • December 11, 2013 at 3:57 pm #

      Woo Hoo! Thanks for commenting, Antony! I’m looking forward to seeing the post on DU’s on your blog.
      Ann

  72. robyn
    December 11, 2013 at 3:44 pm #

    this is a great article. i have to say that double-unders always cause some problems for me. its very annoying. thank you so much for the article, it was very informative!

  73. Stephanie
    December 11, 2013 at 4:38 pm #

    I have always wondered if the squatty potty works. I would love to win one!

  74. Diane
    December 11, 2013 at 4:45 pm #

    Great article. I have rare incontinence but want to eliminate even that!

  75. Michelle G
    December 11, 2013 at 4:55 pm #

    Thank you for this great article. I’ve had to stop running because of the constant problem with leaking urine. Love the information about kegel exercises and the exercises you recommend. Will start them today! I’ve looked at getting a squatty potty for awhile now and hopefully I can be drawn for this one, if not I will have to order one soon! Thank you for the great information that you continue to put out.

  76. Mary
    December 11, 2013 at 4:57 pm #

    This is such important info! I suffer from this as well. For me it manifests when I sneeze hard, do deck squats or go on the trampoline. I’ve seen a bit of improvement just recently, as I’ve recently started doing yin yoga several times per week. In yin you’re holding deep poses for several minutes while working on your breath, including squats (five minute holds!). It isn’t pleasant, necessarily, as it’s incredibly intense, but it’s tremendously effective and a lesson in letting go of muscle resistance to lengthen muscles and actually gain greater strength.

  77. Polly
    December 11, 2013 at 5:35 pm #

    Yes, this is me..age 48, 5 children. Any bout with bronchitis /coughing/sneezing sets me way back. I’m suffering now in my ballet class with any jumping. Also, a fall, or being startled.. ….going to check out that book.

  78. Cindy Noel
    December 11, 2013 at 5:37 pm #

    Great article! I thought it was just because I was getting older….but now you have me thinking. Someone told me that they went to “physical therapy” for this, and I remember her saying that everyone should go through that. I know where to go, now to just do it. Tired of telling the grandkids I can’t do things because I’ll wet my pants! Lol!

    • December 11, 2013 at 8:55 pm #

      Yes, Cindy! Go talk with the physical therapist! It’s not just something we have to “accept” with age.
      Ann

  79. April A.
    December 11, 2013 at 5:39 pm #

    Wow, and I thought it was just old age! (hahaha)… I’ve been dealing with this issue for about year, thank you so much for the tips and video. Definitely trying this!

  80. Marjorie
    December 11, 2013 at 5:40 pm #

    Great article! I’ve had this problem at the gym and at random other times as well and I haven’t had kids! I’ll ask for a PT referral next time I see my primary…. Wonder how to find a women’s health specialist?

    • December 11, 2013 at 8:56 pm #

      Marjorie,
      See the link in the article to find a women’s health physical therapist near you.

  81. December 11, 2013 at 5:41 pm #

    Thanks so much, Ann, but such an informative article. I can’t wait to share this with the girls (and guys) at my gym. It’s a common joke that the women will race to the bathroom before DU’s and many of us keep sanitary pads in our workout bags for DU days. :-/

    I can’t wait to try the exercises.

  82. December 11, 2013 at 5:45 pm #

    Can exercise alone help all women with weak pelvic floor muscles? I have had 7 vaginal births and my pelvic floor is very weak.

    • December 11, 2013 at 8:58 pm #

      Kristen,
      Excellent question. As I discussed in the article, there are several different reasons for incontinence. Sometimes it is weakness, but sometimes it is tightness. The only way to tell what’s going on with you is to have an evaluation with a women’s health specialist. See the link in the article to find one near you.

  83. Jana
    December 11, 2013 at 5:48 pm #

    I did dribble a bit years ago at an aerobic class but don’t any more. I think I’m in better shape now. I still want to PREVENT this from happening in my future! Thanks. Jana

  84. Carrie Botts
    December 11, 2013 at 5:53 pm #

    I definitely have issues when doing double unders and dead lifts. I’d love to win the squatty potty!

  85. Raylene
    December 11, 2013 at 6:01 pm #

    Really great article. Can’t wait to try the squats exercise and see if that helps. Kegel exercises don’t seem to do the trick. Just had my second baby and it’s really bad. Yoga isn’t too much of an issue but any type of cardio is no good. And don’t get me started on sneezing!

  86. Alyssa
    December 11, 2013 at 6:02 pm #

    Thank you for this information! It is nice to know that this is common and that there are solutions out there!

  87. Britiney
    December 11, 2013 at 6:02 pm #

    Great info! Thanks for sharing!

  88. Theresa Kennedy
    December 11, 2013 at 6:08 pm #

    I’ve never heard of pelvic floor strain or the squatter potty but think it would be useful. Asthma coughing, bronchial, abrupt cold weather exasperate my condition. Some exercises work but not all. Thanks.

  89. Margaret
    December 11, 2013 at 6:12 pm #

    I just found this article via Whole 9 and couldn’t stop reading it. I just had my first appointment with the nurse practitioner in an office with Urogynecologists. Lots of tests being run and lots of confusion on my part. Your article really helped me understand a few things I was confused about. Thank you!

    Being a private person, it’s hard for me to talk about this.

    I was told yesterday after my second mammogram in two weeks, I need a biopsy…this is all very overwhelming.

    I would love to win your generous gift.

    • December 11, 2013 at 9:00 pm #

      Margaret,
      Try not to be overwhelmed. Just take it one step at a time. I’m glad the article helped clarify some things for you. See what the Urogyn says and if necessary, follow up with a physical therapist for an evaluation. Wishing you all the best,
      Ann

  90. Laura McLaughlin
    December 11, 2013 at 6:16 pm #

    I can’t wait to try some of these exercises, This is the first time I see some hope for my problem. Thank you!

  91. Alyssa
    December 11, 2013 at 6:23 pm #

    Awesome article!! I can’t wait to hear if I win the squatty potty 🙂

  92. Gabrielle
    December 11, 2013 at 6:25 pm #

    Thank you so much for this article! I developed this problem with double unders and never asked for help because I just assumed it was my age and pregnancy history. Ive had 2 9# babies, 17months apart and one (my first) caused a 4th degree tear. I will do the research to find a qualified PT in my area but, hope to do the legwork on the phone versus trial and error. I can’t afford to Miss that much work. My step daughter also sufers and she has cystic fibrosis. She doesn’t exercise much bbut I feel like w/an eval they could give her a strengthening program that would improve. Right now I am considered the evil step mother with my dietary restrictions (whole foods) and extreme exercise programs (crossfit). I bet my rec to seek help from a PT will go over like a ton of bricks. I’ll try anyway. Maybe if I can improve my own issues, that will convince her.

    I’d never heard of the squatty potty.wouldn’t 2 stools w/non slip serve same purpose? This warrants further research! Thank you again!…

    • December 11, 2013 at 9:03 pm #

      Gabrielle,
      Yes, do a bit of research to find the right person in your area. And, there is a connection between Cystic Fibrosis and incontinence. I’m not sure if you saw that Julie responded to you below, so I’m copying/pasting here:

      For Gabrielle, sorry to insert here, but I didn’t want to miss the chance to connect.

      I have a special interest in the Cystic Fibrosis community for this exact issue. There is actually a lot of overlap of issues between the uber fit female and teen/adult females with CF. I am sincerely working toward developing programs for this community, by any chance are you in the Los Angeles/So Cal area. I am hoping to actively seek out patients with CF in the New Year to start to understand their needs in this regard and tailor programs. Would you contact me off the forum if you are interested, or know of anyone in the LA are that might be. This offer/request is open to anyone who may know someone in the LA area. Thanks…sorry to interject.

      Thanks! Julie Wiebe, PT julie@juliewiebept.com

  93. Linda
    December 11, 2013 at 6:41 pm #

    Love this article! I thought it was just normal to leak after having kids. Just yesterday, my doctor mentioned that there is a way to fix this problem. I will have to look into it more. THanks!

  94. December 11, 2013 at 7:01 pm #

    Wow! It is nice to know that I am not the only one who has this problem. All along I wondered how I got this way and what to do about it.

    I love your advice, simple and clear. I am starting the squats today, and will schedule an appointment in the morning.

    Thanks to the Whole9 for sharing this great article!

  95. Julia
    December 11, 2013 at 7:02 pm #

    Thank you for this information! All the women in my family struggle with this and learned to expect it.

  96. Seanan
    December 11, 2013 at 7:03 pm #

    Every Mom I know pees themselves when they sneeze. Keels obviously aren’t quite enough!

  97. Lori
    December 11, 2013 at 7:05 pm #

    All the moms at my gym have this issue. For me, it’s run to the bathroom before jumping rope or sometimes, running. I figured it was par for the course post three vaginal deliveries and an episiotomy. The assumption is perma-leaking in old age too (Depends for sure). Kegels are never something I’ve done, but the idea that squatting and strengthening my core can help is intriguing to me. I have a very strong core, or so I’ve always thought, but this makes sense to me–a whole body driven therapy, not just a spot focused remedy.

    Question– how much does morning coffee affect leakage? If I were to jump rope later in the day, I don’t believe I’d have the issue. What do you recommend in terms of diet that may help the leaking switch?

    Thanks much for a wonderful article!

    • December 11, 2013 at 9:07 pm #

      Lori,
      Caffeine is both a diuretic and a bladder stimulant, so it’s possible that it may be playing a part in the issue for you. Have you tried going caffeine free for a period of time? (I know, no fun – trust me, I’m now 6 weeks into caffeine free for other reasons!). I think it’s worth a try, along with talking to your gyn/PT if it persists.
      Ann

  98. December 11, 2013 at 7:09 pm #

    When I moved and started at a new gym I swear every single female said this. They always pee’d a little during DUs, or heavy lifting, etc. They were actually MORE surprised to hear that I did NOT, nor had I ever pee’d in a workout. I think things like this need to get out there a lot more, because I never thought it was normal, and neither should others.

  99. JessieRae
    December 11, 2013 at 7:10 pm #

    I’m so sharing this link so my Facebook friends can be informed. Thanks bunches!

  100. Catherine
    December 11, 2013 at 7:11 pm #

    I just brought this issue up at a single parent meeting I am part of. Most of the women laughed nervously as I brought up the slightly-peeing-my-pants incidents that happen throughout the day. I brought it up because we were discussing dating as a single parent and one of my biggest concerns, besides the usual things regarding my children, is sex with a, what I thought was, a weak bladder. I suppose the same movements with sex happen with exercise? It’s a bit embarrassing to bring up, but I figure if I don’t talk about it, I’ll be alone and peeing my pants forever. My first step will be to visit a gynecologist and find myself a squatty potty, a DIY one since I’m not financially in a position to buy one just now. I really appreciate this article and the blog itself! What a great find!

  101. Holly
    December 11, 2013 at 7:15 pm #

    This is great information and I would love to win too! 🙂

  102. Tara O
    December 11, 2013 at 7:40 pm #

    Thanks again for another wonderful article. Well peed, I mean, played.

  103. Lori
    December 11, 2013 at 7:47 pm #

    Thank you for this important post and the video. Do you know of insurance would cover some form of therapy like your services? It would be great to not leak during runs or jump roping.

    • December 11, 2013 at 9:08 pm #

      Lori,
      It depends on your specific insurance plan, but most insurances cover physical therapy. I would recommend calling your insurance company to find out what your PT benefits are.
      Ann

  104. Debra in TX
    December 11, 2013 at 7:50 pm #

    Great info! I definitely have SUI issues when running, particularly with sprints. I have always blamed the scourge of unwanted episiotomies, but I am glad to see that other things may also be contributing. I wonder if you have any tips on finding a mindful doctor with whom to discuss SUI.

    Thank you for the article (and the opportunity to win). 🙂

    • December 11, 2013 at 9:10 pm #

      Debra,
      Please see the link provided in the article for the Section on Women’s Health.

  105. Michelle
    December 11, 2013 at 7:54 pm #

    Great article as this is so often labeled as “normal.”

  106. Tanya CI
    December 11, 2013 at 7:54 pm #

    Timely article as I just had a baby and have been wondering what things will be like post recovery. At least I know now where to head for help if I need it.

  107. Megan
    December 11, 2013 at 7:56 pm #

    Hi Ann,

    I am currently 1.5 weeks post partum and I am having significant leaking. Anytime I get up from sitting, walk around or go up/down stairs I leak a lot. At what point should I ask my gyn. For a referral for a women’s health pt?

    Thanks, Megan

    • December 11, 2013 at 9:14 pm #

      Hi Megan,
      It is not uncommon for women to experience leakage just after giving birth, especially if it was a long labor with a lot of pushing, or if you had an episiotomy. I would recommend giving your doctor a call to discuss it, and see if he/she would like you to come in sooner than the 6 week check up. It may be that you need an assessment and some teaching to retrain the muscles. The only way to know what is causing the issue is to have the OB/GYN or a PT do an evaluation if it continues.
      Ann

  108. Nicole
    December 11, 2013 at 8:05 pm #

    This is me 100%! I will deifnitely start the conversation with me gyno. Thank you so much for sharing the information!

  109. December 11, 2013 at 8:07 pm #

    We super-women tend to keep our problems to ourselves. I am sure this article will be a god- send to so many who never knew they were not alone! Thank you for this.

  110. December 11, 2013 at 8:12 pm #

    I loved this article so much, I just published a blog post about it: http://francesstrata.wordpress.com/! Does that count as a submission? I suuure hope so. My bf won his own Squatty Potty in another giveaway, and I want one too! I have to beg him to bring his when he stays over…haha!

  111. Jessica
    December 11, 2013 at 8:15 pm #

    I’ve wanted a squatty potty forever!

  112. Liz
    December 11, 2013 at 8:19 pm #

    Thank you. Great post. I have a question – I experience incontinence only with something like box jumps or jump roping. I also am now in the third trimester of my third pregnancy (and yes, I’m currently taking a break form all types of jumping!). I’ve been trying to squat regularly but wonder if there is any point in seeking out a PT at this point or if I should just wait. I am definitely going to discuss with my midwife at the next visit too.

    • December 11, 2013 at 9:16 pm #

      I think it is definitely worth discussing with your midwife. She may be able to give you feedback about whether you are contracting your pelvic floor correctly by doing an exam. Then she can help you feel exactly what you should be doing to keep the pelvic floor strong throughout your pregnancy. I wouldn’t wait 😉

  113. December 11, 2013 at 8:27 pm #

    This is a great article and gives me as an ATC lots to think about 🙂 I am 36 weeks pregnant and have to pee all the time.. But haven’t had too many accidents. I was ok after my first but I’m curious to see how I do at the gym after #2. Thanks for posting this!

  114. Ellerye
    December 11, 2013 at 8:29 pm #

    I just made an appt this week for this very thing. I’m so tired of not being able to do jumping jacks or jumping rope due to leaking, and not just a little bit. Feel more prepared to address it now! Thanks!

  115. Lindsay lester
    December 11, 2013 at 8:32 pm #

    Fascinating info. Thanks for the article and the giveaway!!

  116. Victoria Morgan
    December 11, 2013 at 8:35 pm #

    This article was very enlightening,,,and I hope I win the squat pot 😉

  117. December 11, 2013 at 8:42 pm #

    For Gabrielle, sorry to insert here, but I didn’t want to miss the chance to connect.

    I have a special interest in the Cystic Fibrosis community for this exact issue. There is actually a lot of overlap of issues between the uber fit female and teen/adult females with CF. I am sincerely working toward developing programs for this community, by any chance are you in the Los Angeles/So Cal area. I am hoping to actively seek out patients with CF in the New Year to start to understand their needs in this regard and tailor programs. Would you contact me off the forum if you are interested, or know of anyone in the LA are that might be. This offer/request is open to anyone who may know someone in the LA area. Thanks…sorry to interject.

    Thanks! Julie Wiebe, PT julie@juliewiebept.com

  118. Lisa
    December 11, 2013 at 8:42 pm #

    Great article. I was told by the gyn to try PT, but all they wanted to teach was kegels. After reading Aligned and Well blog about No More Kegals, I have been working hard on building that glute/squatting ability. Would love to win the squatty potty! Husband unemployed so can’t afford to buy one or afford PT IF I could find someone around here that knows this info!
    Thanks again for the video

    • December 11, 2013 at 9:20 pm #

      Lisa,
      That’s unfortunate that the PT you worked with didn’t incorporate treatment for the whole system. We have to retrain the pelvic floor to function in everyday movements to get the strength and timing of the contractions right. If you have health insurance, PT may be covered for you. If not, I recommend watching some of Julie Wiebe’s videos on You Tube – she does an excellent job of explaining these issues and showing different techniques for treatment.
      Best,
      Ann

  119. Tara
    December 11, 2013 at 8:49 pm #

    I don’t have this problem yet… But I am 35 and pretty sure it WILL happen sooner or later as my mom has these issues. So I’m looking for ways to just prevent it and stay strong. 🙂 Great read.. Thanks!

  120. Julie
    December 11, 2013 at 9:07 pm #

    My sisters and I all laugh about it and thought it was just because we are getting older. I’m going for forward this article to them and some other ladies that have mentioned this problem. That’s why I don’t like doubleunders!

  121. Ann
    December 11, 2013 at 9:09 pm #

    Great article – such an important topic! I will be sharing this with my gym – they thankfully take this issue very seriously!

  122. Ann
    December 11, 2013 at 9:14 pm #

    I submitted too soon … I do have a question. I’m actually very interested in this area of research in young men (specifically military with a history of carrying heavy loads over an extended period of time). Ann, do you have any recommendations for literature to read that focuses on this problem in young men?

    Thanks!

    • December 12, 2013 at 8:19 am #

      Ann,
      That’s a great question – I have treated men with these issues, one was military and was injured picking up a very heavy weight in training. I don’t have specific articles, but you could search Pub Med and see what you find. Also, Sandy Hilton is a great resource, and she just taught a course on treating pelvic issues in men. Here’s her website: http://entropy-physio.com/

  123. Jennifer
    December 11, 2013 at 9:16 pm #

    Great post, very informative! And I would love to try out the squatty potty!

  124. Michelle E
    December 11, 2013 at 9:29 pm #

    I really want one of these. My friends and family will officially give me the title of crazy crunchy!

  125. December 11, 2013 at 9:39 pm #

    I’m thankful for honest talk about this. I was told by a uro-gyno to try physical therapy, but I was afraid it would be too invasive. It’s not a life-altering problem, but I’m only 35 and fear being a pee-pee pants when I get older. I think I’m going to make a phone call now.

  126. Peggy
    December 11, 2013 at 9:43 pm #

    This has been a very informative article. I never imagined that squats could help with this problem. I only recently learned about the squatty potty, and it does make good sense. Thank you for this information and a chance to win one.

  127. Joanne P
    December 11, 2013 at 9:46 pm #

    So glad to see that I am not alone! I have been living with this since I was about 39 years old, and now I am 46 and do not have any children. I am so tired of wearing a pad every day, just in case. It doesn’t have to be hard exercise to cause me to leak- just walking to the car can make it happen! I find when i do a fast walk for exercise, it seems to cause leaking issues and it is so frustrating that I don’t want to even exercise anymore. I have been asking my dr’s about this for years and they always ask if you are doing the Kegal exercises. I am to the point that I have been considering surgery, but will look into the physio therapist route. Thanks for the encouragement to look at other options.

    • December 12, 2013 at 8:22 am #

      Joanne,
      Yes, please see a physical therapist first before considering surgery. There are many different types of treatment (including but not limited to exercises for the pelvic floor). A qualified therapist will be able to assess you and provide insight into treatment options.

  128. Jenn Johnston
    December 11, 2013 at 9:59 pm #

    Thank you for this article! Aside from the pee part, it really hits home! I could kegel all day…no difference. I had never heard of a squatty potty! Perfect!

  129. December 11, 2013 at 10:29 pm #

    This is a great article and thank you for the giveaway! I am a PT and work in a PT/training facility. Our restroom has an elevated seat for our patients with post operative hip precautions. Every time I see a client run into the restroom during box jumps it makes me cringe because I know either their feet are dangling from that toilet, or they are hovering above it and their PFM cannot fully relax! My initiative is to put a sign and a stool in there, now if I could just come up with some fun graphics…or maybe I will win a Squatty Potty!!

    • December 12, 2013 at 8:23 am #

      Diana,
      If you don’t win the Squatty Potty, you may consider convincing the clinic to buy one! Please share the article!

  130. December 11, 2013 at 10:29 pm #

    Thank you so much for this article. You are a god send to me. I am going to begin the suggested exercise immediately. Thank you, thank you, thank you.

  131. Sue
    December 11, 2013 at 10:29 pm #

    Thanks for publishing this article and starting the dialog. I am a PTA in WA and all my PT’s (8 of them) we teach pelvic floor exercises to all patients beginning core exercises! I’ve been intrigued by the squatty potty myself but have yet to try one. Maybe this will give me the opportunity!

  132. Jennifer
    December 11, 2013 at 10:45 pm #

    I would love to own a squatty potty!

  133. Kira Boyd
    December 11, 2013 at 10:52 pm #

    Thank you for this article! As a fellow Physical Therapist specializing in orthopedics, sports medicine, and women’s health (including pelvic rehab!) I am always excited to see this topic get the attention it deserves. There is still such a big need to educate women and men (and even our MD and PT colleagues!) that treatment is so much more specialized than just prescribing “Kegels”, Working with a qualified Pelvic Rehab Physical Therapist can make all the difference.

  134. Charlene
    December 11, 2013 at 11:01 pm #

    Thank you so much for this article! It is wonderful to hear this topic addressed in such an open, helpful way.
    I used to have a consistent problem with urination during heavy deadlifts and occasionally heavy squats, but then my husband started giving me vinpocetine, which is a vasodilator. I have no idea why that would help, but it seems to. I have not had problems in this area for a couple of years now.
    I read on Dr. Mercola’s site (Mercola.com) that squatting is a more natural position for going to the bathroom, so I usually put my feet up on the edge of the tub. Not truly squatting, I realize, but it helps.

  135. Sarah
    December 11, 2013 at 11:14 pm #

    Great info! Thanks for sharing! I’ve been wanting a squatty potty! 🙂

  136. Leslie Cruickshank
    December 11, 2013 at 11:18 pm #

    Great article! I miss jumping on the trampoline 🙁

  137. jennifer
    December 12, 2013 at 1:00 am #

    I have been searching for a product like this and had NO clue where to start. This is something that would help SO much! Thank you for the information!!

  138. Anna B.
    December 12, 2013 at 1:20 am #

    Thanks so much for this post! It is comforting knowing that I’m not the only one who deals with this issue. I like to run, but I always feel like I need to plan my hydration for fear that I’m going to leak! Sadly, this has even stopped me from running outdoors (and instead running at the gym) for fear that I won’t be able to find a bathroom in time. I’ve heard about the squatty potty and would LOVE to try one!

  139. Kendra Storm
    December 12, 2013 at 1:39 am #

    Wow! I have had 3 laparascopies due to endometriosis and returning scar tissue. I suffer from knee and hip pain along with incontinence, but had no idea they could all be related. I’ve been looking for a product like the squatty potty after using something similar after getting a colonic.

  140. Krystal
    December 12, 2013 at 1:42 am #

    I had urodynamic testing done in my OB’s office 6 months after having my baby. The test results showed that I had an incompetent bladder ( no kidding, I had to have a test to tell me that?). My ob suggested surgery after I have my last child. Do you think seeing a pt would also benefit me? I guess I just want to be sure since I have this diagnosis (having had the test) that one of the causes listed in the article could be causing my bladder to be incompetent. It would be so awesome to correct this with daily exercises. I would love to work on my doubleunders and to box jumps again! Thanks for the article.

  141. Krystal
    December 12, 2013 at 1:44 am #

    I should also add the test showed prolapsed bladder.

    • December 12, 2013 at 8:26 am #

      Krystal,
      I would definitely recommend an evaluation with a physical therapist who specializes in pelvic health. PT can help with even a prolapsed bladder (POP). It is always best to try the least invasive treatments before surgery. I really encourage you to find a therapist in your area.
      Ann

  142. Diana Van Pelt
    December 12, 2013 at 2:15 am #

    Thank you for this article! This is something always off my radar until it’s an issue. I have been trying to remember to do more Kegels, but not being an athletic person, I’m not very consistent with it. I had no idea that knee and hip problems could be connected to pelvic floor issues. I definitely intend now to find a functional medicine provider or PT to address this issue with. This is all so timely, as I was just looking online last week at the Squatty Potty, wondering if I really needed it, thinking it was only helpful for bowels. Now that I understand how it can help the bladder as well, I would love to try one! I also want to learn what exercises to do for core and pelvic floor strengthening. 🙂

  143. Alisha
    December 12, 2013 at 3:16 am #

    Interesting, helpful post!
    I’d love a squatty potty!!

  144. December 12, 2013 at 5:02 am #

    Thank you for the info! Super helpful!

  145. Jenny
    December 12, 2013 at 7:10 am #

    Thanks so much for talking about this out in the open!

  146. Kimba
    December 12, 2013 at 7:58 am #

    Thanks so much! This is great information!

  147. Amy
    December 12, 2013 at 8:27 am #

    Is it better to start these pelvic exercises while pregnant or should you wait until after the baby to start?

  148. December 12, 2013 at 8:31 am #

    Thanks to everyone who has left a comment. I’m truly overwhelmed by the stories you are all sharing. Please don’t feel like you’re alone in this any more. You can see by the almost 200 comments that this is a very common issue and that most treatable conditions go untreated because either the patient doesn’t know there is help available or the physician isn’t up to date on treatment, or women are afraid to speak to anyone about it. For those of you who have tried working with a physical therapist and didn’t find it helpful, I encourage you to try again – in every industry there are people who excel at what they do and people who don’t. You wouldn’t say “I tried taking my car to a mechanic, but it didn’t work!” You would find a new mechanic! Please persevere and find an outstanding physical therapist to work with. Thank you all for being so open and honest, and thanks to Jen for hosting the discussion.
    Ann

  149. Jacqui
    December 12, 2013 at 9:17 am #

    Thanksf or the great informative article…..

  150. December 12, 2013 at 9:51 am #

    Great Information Ann! I’m sharing with my readers and my staff! Never heard of a squatty potty so thanks for that. Pelvic floor disorders are so undertreated. There are only a few specialists here in the Boston area, and they are booked out at least 6 mo – 1 year. As a neuromuscular therapist, I can treat extrinsic muscles and always find weak gluteals to be a primary cause of dysfunction. Looking forward to more, and sign me up to attend the Anthony & Ann east coast education tour as mentioned in the above thread! Katie

    • December 12, 2013 at 10:09 am #

      Katie,
      So good to hear from you! Do you know Jessica Mc Kinney, PT? She’s in Boston, and she’s fantastic. If she’s totally booked, I’m sure she could refer your clients to another therapist.
      http://www.marathonphysicaltherapy.com/
      We need to catch up soon!
      Ann

  151. December 12, 2013 at 10:14 am #

    Why do we suffer in silence? This is why women’s health issues don’t get the attention that they should, women won’t talk or feel shame. I’m so pleased to come across this post. I have recently started to have this issue and I also have a pfd involving bowel movements. One of the things I do is to tip my trash can over and put my feet on that! Haha, as you can see, a Squatty Potty is just what I need.

    • Danielle
      December 12, 2013 at 11:04 am #

      OK your comment made me laugh. I do the same thing with my trash can!!!

  152. Accala Kessler
    December 12, 2013 at 10:18 am #

    Thank you for this article. I have been in pelvic floor PT for just over a year and its made a big difference. What is exciting to me about your post is that I’m not going to be ‘stuck’ with just pilates and yoga forever. There is a way to safely move back into crossfit-type exercise. That’s so wonderful! Thank you for bringing this topic out. You are right that so many of us have issues and so few of us talk about it. Or, if we do talk about it, its just to commisserate about something we thing we just have to live with.

  153. Allyson
    December 12, 2013 at 11:03 am #

    Thanks for this article. I always run to the bathroom when I start my jumping jacks, but usually only at the beginning of my work out. Subsequent jumps are generally without incontinence. I think I’m in the hypertonic camp (no babies), because while reading this article, I tried relaxing the pelvic floor just while sitting in my chair, and I find it very difficult. Almost like I can do it while I concentrate, but I don’t quite have the coordination yet.

    I’m wondering, could this contribute to not enjoying sex? Sex doesn’t hurt or feel bad, it just doesn’t feel as good as it used to, almost like some of the nerves in my vagina are numb. (Everything at the OBGYN is normal, and once I have health insurance next month, I will seek out a physical therapist to work with!)

    Thanks!

    • December 13, 2013 at 1:24 pm #

      Allyson,
      I would recommend working with a women’s health physical therapist. There are different causes for not only pain but also loss of sensation in the pelvic floor. A thorough evaluation should help to figure out the cause. Nerves can be injured or compressed which can alter sensation, and an evaluation/treatment can help you to relax the muscles.
      Ann

  154. ToniY
    December 12, 2013 at 11:07 am #

    Thank you for addressing this. I’ve dealt with this for so many years and it’s a relief to know how to get help and what to ask for.

  155. Shelley
    December 12, 2013 at 11:17 am #

    Do you think there could be a connection between this problem and gluten intolerance?

  156. rachel
    December 12, 2013 at 11:58 am #

    thanks to this article by ann, i have finally made an appointment with a PT (one that she recommended!) to deal with this. i so look forward to double unders without peeing myself! someday…

  157. Cheryl
    December 13, 2013 at 12:11 am #

    I found this very interesting. But I am worried that there might be no help for me. Due to bad knees I have not been able to squat for many years. Just that alone has been very frustrating to me since it interferes with so many activities I’ve done all my life. But the incontinence on top of that is just really the pits.

    • December 13, 2013 at 1:26 pm #

      Cheryl,
      The exercises mentioned in the article are only some of the ways to address pelvic floor dysfunction. Treatment can be done in many different positions (laying down, sitting, etc) and sometimes what is needed is manual treatment, not exercise. Please follow up with someone near you who can fully evaluate you.
      Ann

  158. Stephanie
    December 13, 2013 at 7:03 am #

    Was there a winner chosen yesterday? I am really excited to find out if I won! 🙂

  159. Gina
    December 13, 2013 at 11:51 am #

    I didn’t read through all the posts here and you may have answered this already, but I only leak when I wear a tampon. Should I seek help?

  160. December 16, 2013 at 11:34 pm #

    Great article and inspiring comments! I am a NJ based pelvic floor PT, will put the article on my Facebook page and also print it out for my patients to read it in the office. The biggest problem is that there are so many men and women who still are not aware that SUI during work outs is not “normal”, and they don’t seek treatment. Even a bigger issue is that there are so many doctors who are not aware of the pelvic floor PT treatment options, and they don’t stir their patients in the right direction.
    We should educate our patients that there is a Direct Access to get a PT treatment in most states, so they don’t need to see a doctor if they need physical therapy for any condition. If a physical therapist feels that a patient needs an MD consult, they will refer a patient to an appropriate specialist.
    Thank you so much again for spreading the word!

  161. Petra
    December 24, 2013 at 5:44 am #

    This is a great article! For more information along the same lines, I highly recommend checking out Katy Bowman’s work – either her blog at http://www.katysays.com or else a great discussion of her work here: http://mamasweat.blogspot.com/2010/05/pelvic-floor-party-kegels-are-not.html

  162. January 1, 2014 at 8:19 pm #

    Ann!

    You are the BEST! Great job educating and doing your best to help! Thank you to you and Jen. for discussing what surely must be a difficult and at times embarrassing issue for many!

    Many kudos!

    Brian Patrick Murphy, Manimal “Minister of Belief”

    • January 2, 2014 at 12:08 pm #

      Brian,

      You are the best! Thanks for connecting me with The Baby Guy NYC, and thanks for changing the lives of all those you train!

      Ann

  163. Jacquelyn
    January 2, 2014 at 11:28 am #

    I fit into the episiotomy category, and am pregnant again, and pee everytime I sneeze… any tips to help a lady out?

    • January 2, 2014 at 12:10 pm #

      Jacquelyn,
      I highly recommend that you see a pelvic floor physical therapist now for an evaluation and treatment. There are things you can do now during your pregnancy to set you up for success during and after delivery.
      Ann

  164. Madison K.
    March 5, 2014 at 11:24 pm #

    I am so happy to know that this is a common problem. I just experienced this today for the first time. I am 17, have never had children, and it still happened. It was embarrassing even though no one knew but myself. We have to do jump roping for a class I am in at school and it shocked me when I found out that my shorts were wet. (Good thing I was wearing black shorts!) maybe these exercises will help to where I can do this class without embarrassment.

  165. Bayley
    March 19, 2014 at 10:50 am #

    I am 48, perimenopausal, and have birthed 6 children. I’ve leaked a little for several years, but in October, it got much worse and I pissed my pants for a WHOLE 5K race! Needless to say, it was a bad race for me and very discouraging. I now wear a Poise pad every day that I will run or workout. I had a race Monday at 6:30 pm and stopped drinking at 12:00 noon, so I wouldn’t pee myself during the race. I also bought a skort to wear over my running tights, just in case. By the end of the race, I was fairly foaming at the mouth, so know I should have hydrated some in the afternoon. This article gives me hope that I can get this better under control. I don’t want to stop running.

  166. Pam
    March 19, 2014 at 8:34 pm #

    Check out Kim Anami’s course called Vaginal Kung Fu. Many a lady, including myself, have eliminated SUI with this course.

    • MPW
      April 15, 2014 at 4:20 pm #

      Pam,

      I thought about Kim’s course but find the price to be insanely high at about $500 — how was your experience with it? what did you get out of the course that you wouldnt have been able to through home practice, books, youtube etc?

      thanks
      MPW

  167. emily
    April 22, 2014 at 4:54 pm #

    I never had issues and suddenly in the last few months all of the points above fit (can’t jump rope, run, jumping jacks, etc. without leaking (and yes – an extra trip to the bathroom during the workout). Will read more on SUI and ask my gyno when I’m in next month. Thanks!

  168. Amanda
    June 8, 2014 at 11:08 pm #

    It kinda drives me nuts when people constantly say go to a physio therapist. I have seen 4 different ones in my city, including one that specializes in this issue, to no avail. It is extremely frustrating. They charge me a ton and mostly just have me try to kegels. They do not work for me. The only time I have made any progress is when I started a flute exercising regime on my own. Generally all health professionals seem to have a dismissive line like “do kegels” as this is some miracle cure. If it was that easy, there wouldn’t be so many women suffering. It is obviously a complicated issue, for which there is easy cure.

    • July 13, 2014 at 6:35 pm #

      Amanda,
      Sorry to hear that. If the only thing that the physical therapists have had you do is kegels, then I’m afraid you haven’t had very thorough treatment. Have you had an internal exam? An ultrasound for diagnostic and training purposes (using the ultrasound as a sort of biofeedback)? Have the PT’s helped you incorporate the pelvic floor relaxation and contraction with functional movments? Where are you located? Maybe I can find someone who can help you.
      Ann

  169. Deb
    July 11, 2014 at 4:00 pm #

    Thank you!! I am not a terribly active gal; at 37, I have had two kids (in two years), and I am just hating, hating, hating my body these days. I know that’s not *good,* and I am doing everything I can to work on it. My mother had pelvic floor issues, and she has had TWO surgeries to deal with it. My gyn just says kegels kegels kegels. 🙁 I ordered some luna beads to try to help, but I am just not certain of their efficacy — where are the studies?? I want to get back to being active, but I can’t even walk fast without leaking (forget jogging, or jump-rope, which I used to do a lot in my 20s). This is a fascinating article. I think I will see a physical therapist, and then make some decisions.

  170. Bella Kavalerchik
    July 11, 2014 at 6:21 pm #

    I am a PT specializing in Pelvic Floor issues. I am surprised, Amanda, that PT didn’t help you. Although, I myself did see pts who saw other Pelvic Floor PTs before me without much improvement. It turned out that their treatment wasn’t specific enough for patient’s condition and/or body type. There are many variations of pelvic floor strengthening exercises, and I am convinced that every individual problem has an individualised solution to it. Sometimes PT heeds to be creative to be able to problem solve.
    Where are you located? i may know some good PTs in your area to recommend.

  171. July 18, 2014 at 9:45 am #

    I’m so happy others have issues similar to mine! I’ve tried everything and still leak a little when I run or play tennis. Finally I decided to try all the underwear/workout gear out there that says they’re “leak resistant.” I found Knix Wear and am a convict. I’ve tried them ALL and these are the only ones that actually keep me feeling fresh after a vigorous workout. I don’t work for their company but I probably should since I tell everyone how great they are LOL! Worth it, trust me.

  172. Denise
    August 19, 2014 at 2:57 pm #

    I am post menopausal and not given birth. I have had a little SUI with very heavy lifting or sneezing on a full bladder. This past year the issue escalated. I leak (with any urge or warning) when I do an exercise walk. I do not leak other times including general walking or bodyflow type exercise or gardening, etc. I am also in better shape now that years ago. The urogyny suggested vagifem which may help a little. Any ideas what the cause may be?

  173. jwoolman
    October 14, 2014 at 6:50 pm #

    Someone mentioned getting her husband on board before getting a Squatty Potty. No need. It just fits around the base of the toilet for convenient storage and in that position, someone can just sit on the toilet with no interference. You pull it out in front of you to use it. It’s very light, so you could also easily stash it in a closet etc. if the occasion demanded. Or you have a fussy person in the house…

    Also you could do a DUI trial by getting something that is 7″ high and sturdy. Maybe make a couple of wood blocks, hammer pieces together if needed. Just make them long enough to comfortably plant your feet on. You can check out the squattypotty site for dimensions of the device. It has outlines of feet on top showing the proper position. Or you could just hammer together a platform with the right dimensions to set your feet. The Squatty Potty is just a convenient implementation of the idea. I experimented a little with cartons before getting it but soon saw the advantage of just paying the $25 … But if you have the right stuff lying around, your DYI may work a lot better than mine.

  174. April
    October 16, 2014 at 11:10 am #

    Thank you so much. I will add these squats to my pre-workout.

  175. M
    November 12, 2014 at 7:53 pm #

    I came to this great article because the other day I washed my yoga mat. I have been doing a 100 burpee a day challenge, and suddenly had to do them on the bare wood floor. All of a sudden, I began to leak. I have been doing burpees for years and although I leak when I run or do jumping jacks or sneeze or cough, I have not, until now, leaked when I do burpees. I was pretty bummed and wondered if maybe doing so many burpees has worsened my condition. However, my yoga mat is now dry and I did my burpees on it yesterday and today and no more leaking. I wonder why? It’s cushy, it’s a bit more slippery than the wood floor (you’d think it would be the opposite, but it’s not), but for some reason, no leaking. I just thought some ladies might like to know that in case they want to make sure they do their burpees on yoga mats from now on. It’s one of those thick natural ones in case that makes a difference.

    • January 10, 2015 at 9:58 am #

      Hi M,
      I’m not sure what the difference might have been with and without the mat…yet, given that you are experiencing leaking, doing 100 consecutive burpees probably isn’t the best workout for you right now. I would highly recommend that you see a women’s health/pelvic health physical therapist for a full evaluation. Any leakage is a sign that the whole system isn’t working well, and you may need some treatment.
      Best,
      Ann

  176. Sydney
    January 22, 2015 at 4:30 pm #

    I am a younger teenager, 14 and a half and I have been doing cheer and gymnastics my whole life. I love it and everything but whenever we are tumbling, I always tend to pee a little!! It is extremely obnoxious because I always have to go to the bathroom and am always trying to be discrete about checking if I peed some. Can anybody please help? I would really appreciate it!!

  177. January 25, 2015 at 9:43 am #

    Hi Sydney,
    Thanks for reaching out with your question. It is actually fairly common for women and teens to have this issue with gymnastics. Please talk with your mom, and have her look into finding a women’s health physical therapist near you. Help is available to prevent this from continuing to be an issue for you.
    Ann

  178. Ard
    February 5, 2015 at 10:56 am #

    Question about the exercise technique you show in the video (and apologies if you’ve answered already): I am most definitely not as flexible as you, and while I can squat and hold the position comfortably for quite a while, my heels are up. Should I still squat, or is this more damaging than good? And if still squat is the answer, which do you recommend: hold onto something to allow me to put my heels down, do it heels up, or squat on a block as you show? Thank you so much for the help.

  179. February 6, 2015 at 10:54 am #

    Hi, love your site. Great info. BUT….in your video there is an awful lot of background noise (sounds like people are actually talking!) and echoing. Very hard to understand what you are saying. Keep up the great work! Women need you!

    • February 6, 2015 at 11:46 am #

      Sorry about that — I’ll have to ask her to mic up next time.:) Ann is great!

  180. Raine
    February 6, 2015 at 3:49 pm #

    Im 21 and this happens to me when I do skipping exercises. Do you think these excersises will work for me? I went to a Doctor about it and she told me it was all in my head.

    • February 12, 2015 at 9:02 am #

      Raine,
      As I have recommended above, I think that an evaluation with a pelvic floor physical therapist is the best way to address this issue. A thorough evaluation will determine the root cause of the issue and then your therapist can work with you to develop a personalized treatment program. I’m sorry that your doctor was not supportive – it may be time to find a new doctor who listens to your concerns and partners with you to find a solution.

  181. Amanda O
    March 8, 2015 at 4:25 pm #

    What are your thoughts on catheterization due to epidural? I was given the option for indwelling (left in) or straight cath a few times. I opted for straight cath, but after delivery went to the bathroom and emptied my bladder like no other. Stress incontinence is now a daily issue 20 months later. .. Should I seek treatment now? Thinking about having another baby soon, or should I wait until after that? Thank you in advance!

  182. March 8, 2015 at 5:44 pm #

    Hi Amanda,
    Sorry to hear that you’re struggling with this. Use of a catheter can cause issues for some women in the postpartum period. My advice is to see a Women’s Health Physical Therapist for an evaluation now – don’t wait. You want to go into your next pregnancy able to coordinate your breathing and pelvic floor, to minimize the issues you have during and after this pregnancy.
    Ann

  183. Sarah
    March 10, 2015 at 9:45 am #

    Fistulas, pessaries, and PT. I was sent to the urologist because of incontinence, pain, and recurring infections. The guy didnt mention that i have extra holes, didnt seem to think that was a problem, and wouldnt offer any support for peeing when running (lots of my friends have pessary and I thought that might be a n immideiate solution for dribbling urine while I run). He thought i should just do more sit ups not physical therapy because the said that woulndt do anything. I am confused by all this as I feel like doing squats and the exercises here have helped me, so wouldnt PT help more? Now in my last labor it was noted that i do have extra holes and oddly enough with me working on exercises I dont have as bad incontinence. Any work you have done with women with fistulas that help with SUI, too or is that something I need to find a better urologist for?

    • March 11, 2015 at 8:35 am #

      Sarah,

      I am so sorry to hear that you have been getting the run around. Sit ups are one of the worst things you can do to address these issues. My friend, Jessica Mc Kinney does a lot of work with healing fistulas and incontinence both in the US and in other countries. You can read more about what she does here: http://www.sharemayflowers.org/Mission_and_Founder.htm
      Please check out the information, and maybe she can help you find a Women’s Health PT near you that can help.
      Ann

  184. Mel
    March 20, 2015 at 12:33 pm #

    I started seeing a PT that helps with pelvic issues. She sticks this machine thing in me and i have to squeeze around it. This send information to the computer that tells her how “strong” the squeeze is. Then she sends me home with kegel exercises to do through the week (lying down, squeeze and hold, squeeze, etc.). Suppose to work up to doing them standing up. So my question is what do you think of this? I’ve been barefoot shoe wearing, calf stretching, walking, Katy Bowman reading for over a year now. Peeing while jumping wasn’t getting better. But with the PT things are getting better and a lot faster than Katy’s suggestions. I just think it’s discouraging to tell people these things can’t work. They do. And faster. So i’m having a hard time understanding the problem (i’m saying this kindly! really want to understand)

    • March 22, 2015 at 11:00 am #

      Hi Mel,

      I’m glad to hear that you are experiencing success by working with a physical therapist. I always recommend an evaluation with a Women’s Health PT as the first step in the rehab process for pelvic floor issues. Every woman is unique, and the issues affecting pelvic pain and incontinence are also unique. I am glad that you found the right match, and hope you continue to experience success.
      Ann

  185. March 30, 2015 at 2:26 am #

    Jen,

    I had incontinence from coughing sneezing jumping
    or running. It was mild and I rarely used pads. I had
    it fixed with a urethral sling which made me very I’ll & in
    pain. It had to be excised and unfortunately now have
    to wear pads 24/7 and have leakage just from slowly walkin
    just standing if my bladder starts to fill. Any ideas! It’s
    extremely life limiting.

  186. April 13, 2015 at 11:48 pm #

    What an excellent article and so wonderful to see how well received it was. It is so great to see pelvic great Tracy Scher and so many other pelvic PT’s able to share ideas and dialogue, and have it reach the mainstream! As a certified pelvic PT myself I am consistently saddened by how many times women sit on incontinence for years because they feel embarrassed or have been told by friends or heaven forbid other health care practitioners that it is how things go. On the other hand, the men I see in my clinic have often only experienced urinary incontinence for 1 week following various procedures before they are in their physician’s office demanding that something be done about the incontinence wherein they are swiftly sent to my office. I hope that early detection and proper referral will continue to gain traction, and that women will feel comfortable seeking treatment for this highly treatable condition.
    Thanks ladies for the excellent article!
    Amanda Olson, DPT, PRPC

  187. Lindsay
    April 15, 2015 at 7:59 pm #

    I’m comforted know I’m not alone, but I have no idea how to relax or lift my pelvic floor. I feel like I have no control or no way to access these muscles. I recently bought aqua flex and no results have been seen. I’m going to try this and see if it makes a difference. Here’s to hoping!!!

    • April 16, 2015 at 7:52 am #

      Lindsay,
      I would really recommend that you meet with a physical therapist who specializes in pelvic floor dysfunction/women’s health. A thorough evaluation will determine whether or not you are able to coordinate the pelvic floor contraction and follow up care will focus on retraining the system.
      Ann

  188. Therese
    May 20, 2015 at 11:52 am #

    How do you feel about weighted cones?

  189. Kate
    November 12, 2015 at 9:56 pm #

    After two kids and approaching two years of weight loss & now adding routine fitness, I’ve joined the cross fit world. I love it but get nervous when I see WODs with any jumping; ropes, jacks, boxes… I go to the bathroom and yet still proceed to just “lose” more! Is there a good way to locate a physical therapist in the twin cities metro area? NW of Minneapolis to be exact.
    So happy I’m not alone in dealing with this, but thankful to know it is not something that has to be permanent!

  190. January 17, 2016 at 8:50 pm #

    I just saw this article, thanks to a friend who shared it on Facebook. This is so very helpful, for several of my clients as well as for myself. I fall into the hypertonic pelvic floor category and it’s caused me a lot of problems over the last few years. (no incontinence but lots of pain) It’s even prevented me from doing heavy deadlifts and 1 leg deadlifts because of the pain in my hips! I’ve seen a pelvic floor PT with no long term relief. Stretching my adductors has helped a little bit, but I will definitely incorporate the squatting drill you show here. I’m also going to look at getting a squatty potty. If those things did not work, do you have any other recommendations? Thank you!

  191. Jade
    January 19, 2016 at 2:39 am #

    Hi there I just wanted to let you know that this is not just an issue for women who have had kids. I’m 24 and have never been pregnant. When I do jumping jacks I leak if I drank a normal amount of fluid that day. I found this site because I knew it wasn’t normal and was happy to find I can go to a physical therapist. I just thought I’d mention that it’s not just women who have had kids!

  192. Laura
    January 19, 2016 at 2:16 pm #

    Jade,

    A qualified women’s health PT is a great idea for you. I hope you can find one and that her treatment helps to correct the issue. I recommend being very careful about any surgery involving a mesh product (if anyone suggests this as an option for you) as this has caused long term problems for some people, but the problems are often not even discussed beforehand. And the problems are minimized, if talked about at all.

    Laura

  193. Jacqueline
    February 1, 2016 at 7:51 pm #

    This happens to me everyday. I am 12 and I am in the school’s athletics. Just by walking I leak, whenever I go to athletics and workout, I leak. It began approximately 2 years ago. It is something that really bothers me, I can’t do something simple like doing a squat or running without leaking a bit.

  194. Amber
    April 10, 2016 at 9:32 am #

    Wow! I’ve been struggling with this since I was in high school. I’ve never had children or an abortion either. I was so embarrassed and could never really do anything active. Is it common for a girl that age to have SUI? Thank you so much for this article.

  195. Agnieszka
    August 4, 2016 at 3:19 pm #

    Hello

    The original post is very old, so I’m guessing nobody reads it anymore, but I will try anyway. I have had incontinence problems since I gave birth to my child, and by (semi) regular exercising of my pelvic floor I managed to stop incontinence while sneezing, coughing, lifting etc. But I still have problems while dancing or training for a longer period of time. Is it because my pelvic floor is still too weak, or is it because I am supposed to flex the muscles while training? And if so, how? I find it very difficult to flex it while moving, and it seems almost impossible to flex it throughout the exercise, so what is the right approach?

    Thanks in advance for any help.

    Agnieszka

  196. Holly N.
    September 16, 2016 at 3:26 pm #

    The link is not working for me, perhaps it’s expired. I found the search section on the website, too, and it did not pull up any results. Any chance you can help? Thank you!

  197. September 27, 2016 at 11:32 pm #

    Hello Bret, thank you for sharing this article. Do you think there could be a relation between this problem and gluten intolerance?

  198. Jen
    October 26, 2016 at 5:15 am #

    I am so pleased to read this article. I have had 2 kids vaginally (both episiotomies- horrendous) and I leak a lot when I skip or do double unders. I am ok squatting and deadlifting but always wear a pad just in case. I can do kegels no problem and can hold my stream of urine for quite long. I am going to try the deep squat inhale/ exhale thing. If it doesn’t improve I will go to the gynaecologist. I am only 38, its mortifying!

  199. Carol
    January 15, 2017 at 2:46 am #

    I am in the UK, think I fall into the overactive but weak category and am a powerlifter. I have been to the doctor and asked for referrals but they tell me to stop lifting heavy instead (missing the point of powerlifting 😂) will be trying out the things listed here as self help is all I got.

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