Pelvic floor dysfunction affects 4.8 million Australians. 1 in 3 women who have had a baby will experience bladder weakness and 1 in 6 men will be affected by bladder weakness in their lifetime. Protecting the pelvic floor across the lifespan is important to help reduce the risk of incontinence, prolapse and bowel dysfunction. Constipation, smoking and chronic coughing, pelvic floor muscle weakness and poor lifting technique are among some of the lifestyle factors that can increase the risk of issues later down the track. However, in recent times, high impact exercise such as Cross-fit and H.I.I.T (high intensity interval training) have hit the media as being associated with bladder weakness and incontinence. A gynaecologist who was filmed in a mini doco on the issue was slammed throughout health circles for suggesting that it was a ‘OK to pee’ during exercise and that bladder leakage is a ‘normal’ part of cross fit.

 

 

The first thing that you need to understand is that these exercise programs are intense, hence the name ‘high intensity interval training’. Double under’s, box jumps and heavy, heavy lifts are among the challenges that women and men put themselves through as part of a regular workout, and they need to do them quickly. The exercises create a huge amount of pressure within the abdomen and the pelvis that the pelvic floor muscles, sphincters and ligaments need to withstand to keep urine inside the bladder. Think about basic physics: if the pressure within the bladder is higher than the pressure outside the bladder that functions to hold\ urine inside the bladder, then leakage will occur. It doesn’t matter how strong your pelvic floor muscles are, if you increase the pressure within the bladder enough the system will eventually fail.

 

“If enough force is applied to a bone it will break. That is a “normal” process to occur. If enough force is generated within the abdomen and the pelvis, the bladder will leak. That is a “normal” process.”

 

Is it ‘OK’ to pee during a workout?

From what we can discover through the research it would seam that pelvic floor changes do occur during a high intensity workout. The organs will descend somewhat and the resting pressure withing the urethra and vagina (that helps create closure) will decrease. In many women these changes do not last long term and we don’t see any changes over (for example) a 2 year period. But it is not every woman! And this again is where it gets hard. How can we possible know if this exercise is safe or not if everyone is slightly different? Well… what we do know is that there is high risk exercise (such as H.I.I.T), and there is low risk exercise (such as Pilates). There are women who are at high risk and there are women who are at low risk. So the answer to our question is basically different for everyone.

 

The thing we need to consider for each individual case is whether the urine leakage is because of the huge pressures they are generating during training (in which case urine leakage is somewhat expected…), or is there a weakness or structural change that needs to be addressed. In other words, the woman is a high risk for pelvic floor damage and the leak point is happening earlier then we would expect for someone without pelvic floor issues. For example, urine leakage during a single cough is different to leakage during a single jump, and that is different again to urine leakage while lifting 150 kg overhead. The pressures are different, so the leak point shouldn’t necessarily occur during all these activities. The really hard part about this is that we have no ‘normal’ values on how much pressure a bladder should be able to withstand during a single activity, different people will generate different pressures based on things like their technique and size. High pressures might be OK, as long as the women is low risk and can withstand those forces!

 

If high risk women perform high risk exercise, will it give them damage in the long term?

Research would suggest that women who leak during exercise are 8-9 x more likely leak later in life. This is possibly due to the impact on the ligaments and connective tissue during high impact exercise and the constant stretching of the pelvic floor structures, reducing their ability to support the pelvic floor and prevent urine leakage. This theory means that leaking during exercise might be a sign that the pelvic floor is not currently strong enough to withstand high forces, such as double under’s and box jumps.

 

Is it wise to continue these exercises even though urine leakage is occurring?

One thing we know for sure is that people who participate in regular exercise, particularly high impact exercise such as cross fit and H.I.I.T experience enormous benefits such as increased bone density, improved cardiovascular fitness and muscle conditioning. Fitness is something we need to encourage for women and to think of ourselves holistically, not as ‘just a pelvic floor’. Pelvic floor physiotherapy is one option that may help you continue to work out safely. Pelvic floor physiotherapy can help you build pelvic floor strength, proper exercise technique and show you ways to protect your pelvic floor while doing high impact exercise. It does not always mean you need to stop the exercise if that is what is important to you.

 

The ‘stop-gap’ device to break the cycle.

Sometimes the pelvic floor needs a rest from supporting the pelvic organs and a break from the stretch and impact of high intensity exercise in order to recover and build strength. If continuing to exercise is important to you, often our physiotherapists will recommend a pessary as a ‘stop-gap’ device in order to break the cycle of damage, weakness and more damage.

 

 

A pessary is a device that is inserted into the vagina that holds up the pelvic organs and supports the ligaments of the pelvic floor. It is often a neat halfway point between conservative therapy such as pelvic floor exercises, and more extreme measures such as surgery.

Our physiotherapists at Calm & Connection Physiotherapy are trained in assessing for and fitting pessaries in women who are experiencing pelvic floor issues and may benefit from some added support. If you think you would like to know more about pessaries, or to discover if they might help you to maintain your active lifestyle, get in touch with our physiotherapists, and start a conversation today.

 

Coming up…

Ever wondered what pelvic floor physio can do for men? We have just updated our information pages on our website see what you think at https://calmandconnection.com.au/physiotherapist-bladder-weakness-mens-health-sale-victoria/. There may be a male in your life that could use some help too?

 

 

Until then…

Be kind to yourself,

 

 

Julia Berger
Physiotherapist