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Stress urinary incontinence (SUI) — leaking urine during activities like running, jumping, coughing, or lifting — is often thought of as something that only affects women after pregnancy or later in life. But anyone can have stress urinary incontinence for a variety of different reasons. Many young female athletes experience it as well. In fact, research shows that one in every 4 female athletes has experienced urinary leakage related to sports.1
Gymnasts, runners, CrossFit athletes, volleyball players, and weightlifters frequently report leakage during training or competition. Unfortunately, when these athletes seek help, they are often given the same advice: “Just do more Kegels.”
While pelvic floor strengthening exercises can be helpful in certain situations, this blanket recommendation overlooks a critical reality: many athletes with urinary leakage actually have pelvic floors that are already too tight.2
The Pelvic Floor: More Than Just Strength
The pelvic floor is a group of muscles at the base of the pelvis that support the bladder, bowel, and reproductive organs. These muscles must be able to do three key things:
- Contract to maintain continence
- Relax to allow urination and bowel movements
- Coordinate and absorb pressure during movement
In sport, this coordination becomes even more important. Activities like sprinting, jumping, and heavy lifting create rapid increases in intra-abdominal pressure that the pelvic floor must respond to dynamically.
If the muscles are too weak, they may not provide enough support. But if they are too tense or overactive, they may also fail — because muscles that cannot relax properly cannot generate a strong, functional contraction when it counts.
The Overlooked Problem: A Tight Pelvic Floor
Many female athletes live in a constant state of muscular bracing. High training loads, heavy lifting, core overtraining, stress, and postural habits can cause the pelvic floor to become chronically shortened and overactive.
A tight pelvic floor may lead to:
- Urinary leakage with impact
- Difficulty starting urine flow
- Pelvic pain
- Hip or low back tension
- Pain with intercourse
- A feeling of constant pelvic pressure
In these cases, adding more Kegels can actually make symptoms worse.
It’s similar to telling someone with a clenched fist to “squeeze harder” when what they really need is the ability to open their hand and move freely again.
Why Leakage Happens Even When Muscles Are Tight
When muscles stay contracted all the time, they lose their ability to generate force quickly when needed. This is sometimes referred to as a shortened or overactive muscle that lacks functional strength.2
For athletes, that means the pelvic floor may not respond effectively to the sudden load of:
- A box jump
- A heavy clean
- A sprint start
- Landing from a vault or spike
The result can be leakage — not because the muscles are weak, but because they are stuck in the “on” position and cannot coordinate properly.
The Importance of Finding the Root Cause
Pelvic floor dysfunction is rarely caused by just one factor. Leakage in athletes can stem from a variety of contributors, including:
- Pelvic floor overactivity
- Poor breathing mechanics
- Core pressure mismanagement
- Hip and glute weakness
- Training load or fatigue
- Postural patterns
- Previous injury
That’s why a one-size-fits-all exercise prescription rarely works.
Before starting any strengthening program, it’s essential to understand what the pelvic floor is actually doing.
Why Seeing a Pelvic Health Professional Matters
A pelvic health physical therapist can assess the pelvic floor in a way that general exercise programs cannot. This evaluation may include looking at:
- Pelvic floor tone and relaxation ability
- Breathing and diaphragm function
- Core and hip coordination
- Movement patterns during sport-specific tasks
- Pressure management during lifting and impact
For some athletes, treatment may indeed include strengthening. For others, the first step is learning to down-train, relax, and lengthen the pelvic floor before rebuilding strength and coordination.3
The Takeaway
Urinary leakage during sport is common, but it is not normal — and it is not something athletes should simply accept or try to push through.
Just as importantly, the solution is not always to “do more Kegels.”
For many young female athletes, the real issue is a pelvic floor that is working too hard for too long, leaving it unable to perform when it matters most.
The key to effective treatment is not guessing — it’s identifying the root cause and building a plan that restores the pelvic floor’s full range of function: strength, relaxation, and coordination.
If you’re experiencing leakage during exercise, consider working with a pelvic health professional who can help you understand what your body actually needs — and get you back to training with confidence.
Need help? Please reach out to us at Activcore Denver to schedule a session.
REFERENCES
- Joseph C, Srivastava K, Ochuba O, et al. Stress Urinary Incontinence Among Young Nulliparous Female Athletes. Cureus. 2021;13(9):e17986. Published 2021 Sep 15. doi:10.7759/cureus.17986
- Campbell, K.G., Batt, M.E. & Drummond, A. A feasibility study of the physiotherapy management of urinary incontinence in athletic women: trial protocol for the POsITIve study. Pilot Feasibility Stud 6, 103 (2020). https://doi.org/10.1186/s40814-020-00638-6
- Rivalta M, Sighinolfi MC, Micali S, De Stefani S, Torcasio F, Bianchi G. Urinary incontinence and sport: first and preliminary experience with a combined pelvic floor rehabilitation program in three female athletes. Health Care Women Int. 2010;31(5):435-443. doi:10.1080/07399330903324254
Disclaimer: The views expressed in this post are based on the opinion of the author, unless otherwise noted, and should not be taken as personal medical advice. The information provided is intended to help readers make their own informed health and wellness decisions.
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