“I once heard from a patient that during CrossFit a group of women were lined up doing double-unders all with puddles of pee under them. She told me her CrossFit coach kept yelling at them to keep going and that it’s normal. I’m here to tell you this may be common, but it is definitely not normal and there are treatments available.” –Leah Fulker, PT, DPT, PCES

 

 

High-Intensity Interval Training (HIIT) and CrossFit have revolutionized the fitness world with their dynamic and rigorous workout routines. These high-impact workouts can also pose a challenge for many women in the form of urinary incontinence. Leaking urine during these intense workouts can be embarrassing and uncomfortable. Urinary incontinence during physical activity is unfortunately a common issue that many women face:

• Athletes have a 177% higher risk of urinary incontinence compared to inactive women.
• The Stress Urinary Incontinence in CrossFit (SUCCeSS) Study found more than 80% of CrossFit participants reported bladder leaks and 50% of these reported moderate to severe urinary incontinence.

Despite the risk and prevalence of urinary incontinence with high-intensity exercise, it can be treated effectively.

In this comprehensive guide, we’ll delve into why urinary incontinence occurs during HIIT and CrossFit, and provide actionable strategies, including the use of innovative devices like Flyte, to help you regain control and continue enjoying your workouts without worry.

Understanding Urinary Incontinence in High-Impact Workouts

Types of Urinary Incontinence

1. Stress Urinary Incontinence (SUI):
• This is the most common type of incontinence experienced during high-impact activities. It occurs when the pressure on the bladder increases due to sudden movements, such as jumping, running, coughing, sneezing, laughing, or heavy lifting, causing urine to leak out.
2. Urgency Urinary Incontinence (UUI):
• This type of incontinence is distinguished by a sudden, intense urge to urinate followed by involuntary leakage. It can be triggered by certain activities, though it’s less common in HIIT and CrossFit.
3. Mixed Urinary Incontinence (MUI):
• This is a combination of both stress and urge incontinence. Individuals with mixed incontinence may experience leakage due to physical exertion and a strong urge to urinate.

Why Does It Happen?

Several factors contribute to urinary incontinence during high-impact workouts:

1. Pelvic Floor Weakness:
• The pelvic floor muscles support the bladder and help control urine flow. High-impact exercises put extra pressure on these muscles. If they are weak, do not have proper muscle tone, or fail to engage at the right time, they can fail to support the bladder effectively, leading to leaks.

1. High Intra-Abdominal Pressure:
• HIIT and CrossFit often involve movements that increase intra-abdominal pressure, such as heavy lifting, jumping, and rapid changes in movement. In the SUCCeSS study, the exercises most associated with urinary incontinence were jumping and weightlifting. This pressure can force urine out if the pelvic floor muscles are not strong enough to counteract the pressure and when intra-abdominal pressure is not managed effectively.
2. Impact of Hormones:
• Hormonal changes, especially during pregnancy, postpartum, and menopause, can affect the strength and elasticity of the pelvic floor muscles. Estrogen, which helps keep the tissues of the pelvic floor strong and flexible, decreases during menopause, leading to a higher risk of incontinence. Estrogen and progesterone also rapidly drop after childbirth, another reason to not rush getting back to high-intensity exercise too quickly postpartum to reduce risk of incontinence.
3. Body Alignment and Breathing:
• Poor posture and incorrect breathing techniques during exercise can place additional strain on the pelvic floor, exacerbating the risk of leakage.
4. Too Much Weight or Going Too Fast:
• Bladder leaks during high-intensity workout may be related to increasing exercise dosage too quickly. You may need to reduce weight during weightlifting or slow down during quick movements to first gain control before working back up to increased speed or weight.

Strategies to Prevent Urinary Incontinence During HIIT and CrossFit

Strengthen Your Pelvic Floor

Strengthening the pelvic floor is crucial for preventing urinary incontinence. Here are some effective exercises:

1. Kegel Exercises:
• Identify your pelvic floor muscles as if you were stopping the flow of urine (do not actually do this while urinating) or holding back gas. Contract these muscles for 3-5 seconds, then relax for the same amount of time. Repeat 10 times, three times a day. Over time, increase the duration of each contraction up to 10 seconds.
2. Bridges:
• Lie on your back with your knees bent and feet flat on the floor. Inhale at rest. Exhale and lift your hips towards the ceiling while squeezing your glutes and engaging your pelvic floor. Inhale to lower your hips. Perform 10-15 repetitions.
3. Squats:
• Stand with your feet shoulder-width apart. Inhale to lower your body into a squat as if you were going to sit in a chair, keeping your back straight and your knees behind your toes. Exhale and contract your glutes and pelvic floor as you stand up. Return to the standing position and repeat 10-15 times.
4. Cat/Cow:
• Begin in a hands and knees position. Inhale into cow position with your spine extending, tailbone facing the ceiling, looking up, focusing on letting your sit bones open widely. Exhale into cat position tucking the tailbone under you and imaging your head and tailbone moving towards each other while your spine arches/flexes to the ceiling. Repeat a few times or as needed. 
5. Quadruped Knee Hovers:
• Start in quadruped on all fours. Press your fingertips firmly into the floor. Engage your deep abdominal muscles and pelvic floor, exhale and press the floor away, lift your knees up to hovering. You can also squeeze a ball between your knees. Press the floor away and hold 5-10 sec, 3-5 sets, work up to 30 seconds. 

Improve Your Core Stability

A strong core supports the pelvic floor. Incorporate core strengthening exercises such as:

1. Planks:
   
• Hold a plank position with your body in a straight line from head to heels, engaging your core and pelvic floor muscles. An elbow plank will be harder than elbows straight. Start with 15-30 seconds and gradually increase the duration.
• Looking for an additional challenge? Try a roll out plank with a Swiss ball, then add alternating leg lifts. 
2. Bird Dogs:
• Start on your hands and knees. Imagine balancing a cup of water on the small of your back. Extend your right arm and left leg simultaneously, focusing on reaching long and lengthening, keeping your hips level. Hold for a few seconds, then switch sides. Perform 10-15 repetitions.
3. Bulgarian Squats:
• Also known as a rear foot elevated split squat. Stand about 2 feet away from a knee-level step or bench, with the step or bench behind you. Place one foot on the bench, keep your feet about shoulder width apart. Engage your core, inhale, lean slightly forward and lower down without your knee going in front of your toes, keeping your knee in line with your foot. Exhale while engaging your pelvic floor and pushing through the floor to return to standing.

Practice Proper Breathing Techniques

Proper breathing techniques can reduce intra-abdominal pressure and support the pelvic floor during high-impact activities:

1. Diaphragmatic Breathing:
   
• Breathe deeply into your abdomen; imagine an umbrella opening or a balloon filling in your abdomen, allowing your diaphragm to expand. Your pelvic floor will naturally relax and lengthen. Exhale fully, engaging your pelvic floor and core muscles. Practice this breathing technique to maintain pelvic floor movement and control.
2. Inhale-Exhale Coordination:
• Coordinate your breath with your movements. For instance, exhale during the exertion phase (e.g., lifting, jumping) and inhale during the relaxation phase. This helps to reduce pressure on the pelvic floor.

Incorporate Flyte to Treat Stress Urinary Incontinence

Flyte is an innovative pelvic floor device designed to strengthen the pelvic floor muscles efficiently and effectively, treating bladder leaks. Flyte uses mechanotherapy to promote a healing response in the pelvic floor muscles, restoring strength and bladder control in only 5 minutes a day for six weeks, making it a valuable tool for those experiencing urinary incontinence. Flyte has been demonstrated in two published clinical studies to deliver outcomes very similar to surgery without the risk and downtime associated with surgery.

1. What is Flyte?
• Flyte is a small, non-invasive at-home intravaginal device that delivers mechanotherapy to the pelvic floor muscles. While you are contracting your muscles, Flyte’s mechanotherapy (gentle, targeted vibrations at a specific frequency that triggers a cellular and neuromuscular response) stimulates and strengthens your pelvic floor, helping to improve function and control.

1. How to Use Flyte:
• To use Flyte, simply insert the device into the vagina just like a tampon, ensuring it is positioned comfortably. Flyte will then guide you through a series of pelvic floor contractions and relaxations while delivering mechanotherapy treatment. Each session lasts 5 minutes, and it is recommended to use Flyte daily for a standard treatment time of six weeks for optimal results. In clinical trial, 82% of women were dry in 6 weeks and two years later 77% of them maintained their results and none had surgery!

1. Benefits of Flyte:
• Flyte’s proprietary technology helps engage the pelvic floor muscles more effectively than traditional exercises alone, with surgical-level results. Flyte is also easy to use and can be incorporated into your daily routine without disrupting your schedule. Flyte additionally offers a complimentary Ask a Pelvic Physical Therapist to help answer pelvic health questions and if Flyte is right for you.

Modify Your Workout Routine

If you experience leakage during certain exercises, consider modifying them to reduce the impact on your pelvic floor:

1. Reduce High-Impact Movements:
• Substitute high-impact activities like jumping jacks or box jumps with low-impact alternatives such as step-ups, low squats, lunges and side lunges with variable speed, and alternating step taps with variable speed until you are able to return to high-impact activities without leaks.
2. Adjust Your Load:
• Use lighter weights or decrease the intensity of your exercises to reduce the strain on your pelvic floor.
3. Change Your Posture:
• Pay attention to your posture during exercise. Maintain a neutral spine and avoid excessive arching or tilting of the pelvis. If you notice excessive spine or pelvic movement with a lack of stability and control, adjust the activity, adjust the load, pay attention to your breathing, or ask for help.

Proper Hydration

Avoid bladder irritants such as caffeine, carbonation, alcohol, and acidic foods, especially before your workout. Stay hydrated. Dehydration increases your risk for urgency, frequency, and incontinence. Aim for balanced fluid intake to keep your bladder healthy. Dark colored or amber urine is a sign you are dehydrated. Increase your water intake.

Looking for more details? Check out our blog Sip smarter by learning to manage these 4 bladder irritants.

Use Supportive Gear

Pessaries provide additional support and comfort during workouts:

Pessaries:

• Specialized intravaginal devices designed to apply pressure to the urethra to help reduce leaks during high-impact activities.
• They can be fitted by a urologist, gynecologist, urogynecologist, or pelvic floor physical therapist. There are also over-the-counter ones available (Impressa, Revive, or Uresta).
• While they can provide support and relief while inserted, strengthening the pelvic floor muscles is still necessary to reduce relying on using a pessary full-time. Combining a pessary with pelvic floor exercises or with Flyte can help you manage incontinence during the treatment period (6 weeks for Flyte; 3-6 months for pelvic floor exercises).

Seek Professional Help

If urinary incontinence persists despite your best efforts, it may be beneficial to consult a healthcare professional:

1. Pelvic Floor Physical Therapist:
• A specialized physical therapist can assess your pelvic floor function, evaluate you from a whole-body perspective, and provide personalized exercises, which may include Flyte, and other techniques to strengthen and support your pelvic floor.
• Flyte offers a complimentary Ask a Pelvic Physical Therapist to ask questions about Flyte, guide you through using Flyte, and see if Flyte is right for you. No sales pressure, just answers. Chat with us today.
2. Urologist or Gynecologist:
• Urologists, gynecologists, and urogynecologists are specialists can evaluate underlying causes of incontinence and recommend appropriate treatments, which may include Flyte, pelvic floor physical therapy, medication, lifestyle changes, or, in some severe cases, surgery.

Conclusion

Urinary incontinence during HIIT and CrossFit is a common issue that many individuals face. It is not normal and while it can be frustrating and embarrassing, it is manageable and treatable with the right approach. By strengthening your pelvic floor, using the technology of Flyte, improving core stability, practicing proper breathing techniques, modifying your workout routine, trying a supportive pessary, or seeking professional help, you can significantly reduce or eliminate leakage and enjoy your high-impact workouts with confidence.

Remember, you’re not alone. Many have successfully overcome urinary incontinence during exercise with dedication and the right strategies. Take control of your pelvic health today and continue to pursue your fitness goals without fear or hesitation.

 

 

References

Teixeira, R., Colla, C., Sbruzzi, G., Mallmann, A. and Paiva, L., 2018. Prevalence of urinary incontinence in female athletes: a systematic review with meta-analysis. International Urogynecology Journal, 29(12), pp.1717-1725.

Elks W, Jaramillo-Huff A, Barnes KL, Petersen TR, Komesu YM. The Stress Urinary Incontinence in CrossFit (SUCCeSS) Study. Female Pelvic Med Reconstr Surg. 2020 Feb;26(2):101-106. doi: 10.1097/SPV.0000000000000815. PMID: 31990796.

Oliva-Lozano JM, Muyor JM. Core Muscle Activity During Physical Fitness Exercises: A Systematic Review. Int J Environ Res Public Health. 2020 Jun 16;17(12):4306. doi: 10.3390/ijerph17124306. PMID: 32560185; PMCID: PMC7345922.