Can Women Lift, Run and Jump Without Leaking?

For a long time, the conversation around stress urinary incontinence (SUI) and exercise has focused heavily on what women should avoid.

Don’t run.
Don’t jump.
Don’t lift too heavy.
Protect the pelvic floor.

But what if our goal wasn’t simply to reduce load?

What if we helped women build the capacity to tolerate it?

This is the focus of my presentation for the Continence Foundation of Australia this week - exploring how Exercise Physiologists can work alongside Pelvic Health Physiotherapists, like we do everyday here at Pear - to help women return to the activities that matter to them. This could be playing sports, babysitting grandchildren, running, jumping, skiing you name it!

SUI is not the same in every woman

One of the most important starting points is recognising that SUI is not a single, uniform condition. It actually has LOTS of different mechanisms that could be contributing to leak (SPLASH)

The way we would support, say a young gymnast may be quite different to those in a woman returning to exercise in early postpartum, to someone navigating perimenopause.

In younger athletic women, we might be considering repeated exposure to high ground reaction forces, training volume, fatigue, coordination and the ability of the pelvic floor to respond quickly to changes in pressure.

Postpartum, there may be changes associated with pregnancy and birth, pelvic floor injury, de-conditioning and altered abdominal and pelvic floor function.

During perimenopause and menopause, hormonal changes occur alongside changes in muscle mass, strength, connective tissue and recovery.

Essentially - it’s not one size fits all (when is it ever!)

Instead of ever saying ‘exercise causes leaking, so you should avoid’ - we should as practitioners always be saying ‘your leaking is occurring at this, so how can we increase your capacity to allow you to keep doing it’

Pelvic floor muscle training remains an incredibly important part of SUI management. But continence during exercise requires more than simply having a “strong pelvic floor”.

A woman may demonstrate improvements in pelvic floor muscle strength and still experience leakage when running.

Why?

Because running asks the body to repeatedly create forces, coordinate multiple muscle groups, manage changes in intra-abdominal pressure and respond to ground reaction forces — often while fatigue is accumulating!

This means our assessment and rehabilitation need to extend beyond an isolated measure of pelvic floor strength - we need to consider the demands of the task.

Strength beyond the pelvic floor

If we want to return to demanding physical activity, we also need to prepare the rest of the body for that activity.

That means considering things like our leg strength.

Running, jumping and landing require significant contribution from the calves, quadriceps, hamstrings and hip musculature.

Pessaries can support participation — not represent failure

Pessaries are another SUPER useful tool within continence care - think of them like how we would wear an ankle brace after a sprained ankle to help return to sport, they can help to support our bladder too.

There can still be stigma around their use, but we really hope that we can aid to change this. For the right woman, a pessary may simply be another strategy that enables participation while rehabilitation continues. Our Pelvic Health Physio team are experts in pessary fitting, and seeing what might support you best.

Exercise Physiology can help bridge the gap back to activity

There is often a gap between improving someone's symptoms and actually getting them back to what they want to do.

You might be cleared to return to the gym - but be a bit frightened to lift anything heavy.

Or have minimal leakage in everyday life - but experience symptoms once you hit the third quarter in your netball game.

This is where Exercise Physiology comes in!

Our Pelvic Health Physio’s may assess your pelvic floor function and provide targeted pelvic floor rehabilitation.

Then our Exercise Physiologist can then help integrate those findings into whole-body strength, cardiovascular fitness, impact exposure and sport-specific conditioning.

From pelvic floor exercises to a 10 km run

Our beautiful client Sarah* (name changed, but case study has been approved, thank you kiss!) a 52-year-old woman who loves running!

Following pelvic health physiotherapy, her pelvic floor strength has improved and she experiences minimal leakage. Her goal, however, isn't simply to walk without leaking.

She wants to run!

And run she did!

Over a 10-week program, strengthening legs, practicing running positions and support from our team and in classes - she ran a 10 km funrun without leaking!

The goal isn't to teach women to avoid load.

It's to help them build the capacity to tolerate it.