Andrew Siegel MD 6/30/18
Exercise is of vital importance to physical and psychological health, reduces risk for diabetes, cardiovascular disease and cancer, is a great stress reducer and improves muscle strength, endurance, coordination and balance. It is an important factor in maintaining a healthy weight, decreasing body fat, increasing longevity and decreasing mortality. All good!
image above, Creative Commons
Urinary incontinence is an annoying condition that women experience much more commonly than do men. One of the main types is leakage with physical activities and exercise, a.k.a. stress urinary incontinence (SUI). When a woman suffers from SUI it often acts as a barrier to exercising because no one wants to be put in the embarrassing and inconvenient situation of wetting themselves every time they jump, bounce or move vigorously. Some women adapt by modifying the types of exercise that they participate in, while others give up completely on exercising, an omission that can contribute to poor physical and psychological health, a greater risk for medical issues, weight gain, etc.
What physical activities cause leakage?
The most common exercises that provoke SUI are high impact, vertical deceleration activities in which there is repeated contact with a hard surface with both feet simultaneously, e.g. skipping, trampoline, jumping jacks, jumping rope, running and jogging.
Other physical activities that commonly provoke SUI are exercises that combine dynamic abdominal and pelvic movements, e.g., burpees, squats, sit ups and weight bearing exercises, e.g., weighted squats, overhead kettle bell swings, etc. The classic weight lifting style exercises are occasional triggers of SUI.
Activities that cause SUI (in order of those most likely to provoke the SUI)
- Skipping
- Trampoline
- Jumping jacks
- Running
- Jogging
- Box jumps
- Burpees
- Squats
- Sit ups
- Weighted squats
- Kettle bell swings
- Dead lifts
- Push ups
- Wall balls
- Shoulder press
- Clean and jerk
- Snatch
- Bench press
- Rowing
So, what to do?
Many women figure out the means to improve or diminish the problem. Common sense measures include urinating immediately before exercising and if possible taking washroom breaks during the activity (not always possible and inconvenient). Even so, most women do not empty the bladder 100%, so if 1-2 ounces remain after emptying, there is still plenty of urine to potentially leak. Other adaptive measures are fluid restriction (not particularly healthy before vigorous activity, risking dehydration). Wearing a protective pad or incontinence tampon is certainly a way around the problem (although not ideal). Another strategy is to modify one’s exercise program, such as reducing the duration, frequency or intensity of the activity. Avoiding high impact exercises entirely and substituting them with activities that involve less impact is another possibility. However, these are adaptive and coping mechanisms and not real solutions.
There is a better solution
Urologists–particularly those like myself who have expertise in female pelvic medicine–can help manage the condition of stress urinary incontinence. First line treatment is Kegel pelvic floor exercises that—when done properly (as they are often not) with the right program—can often significantly improve the situation.
New video on pelvic floor exercises.
If a concerted effort at a Kegel program fails to sufficiently improve the situation, a 30-minute outpatient procedure called a mid-urethral sling is a highly effective means of treating the exercise incontinence.
Bottom Line: Physical activities most likely to induce urinary leakage are high impact exercises including skipping, trampoline, jumping jacks, jump rope and jogging. Coping mechanisms and adaptive behaviors include fluid restriction (not healthy before exercise), urinating before activities (reasonable), taking breaks from exercise to urinate (inconvenient), pads (ugh), dialing down the intensity of exercising, modifying type of exercise or complete avoidance of exercising (undesirable). If coping and adaptive behaviors are not effective, consider seeing a urologist who focuses on incontinence. The goal of treatment is to be able to return to the physical activities that you enjoy without the fear of urinary leakage.
Excellent resource: Urinary leakage during exercise: problematic activities, adaptive behaviors, and interest in treatment for physically active Canadian women: E Brennand, E Ruiz-Mirazo, S Tang, S Kim-Fine, Int Urogynecol J (2018)29: 497-503
Wishing you the best of health and a happy 4th of July holiday!
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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery. He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.
Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:
MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health
THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health
PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food
These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.
Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx
Our Greatest Wealth Is Health 