CrossFit and Incontinence: Expected or Undesired?

Emily Bickers, PT

DECEMBER 18, 2018


Olympic liftingCrossFit is a booming exercise program that is comprised of gymnastic movements, Olympic lifting, and aerobic exercises. It was originally developed for training police, military personnel, and other tactical operation teams. Since its origin CrossFit has grown worldwide. With that growth more and more women have joined the CrossFit culture with a 1:1 ratio of male to female athletes. CrossFit claims it is suitable for every individual regardless of gender, age, or experience. The programs are scaled by weight and intensity to accommodate all individuals.

With the increase in number of female athletes there has been more chatter about the female athlete and the pelvic floor. Largely this is due to the prevalence of women who experience stress incontinence during their workouts. Stress incontinence is defined as the involuntary loss of urine during physical activity, coughing, sneezing, or laughing. Many people consider this to be a positive correlation of the intensity of the workout. Can you imagine! Making it a goal to “pee” your pants? How does this sound normal in any situation?

Losing urine involuntarily means that you are not continent of your bladder. No matter how intense or strenuous the workout may be, involuntary loss of urine should never be a goal!

Pelvic Diaphragm of Female

Let’s step back and look at the anatomy of the pelvic floor. The pelvic floor is made up of muscle, ligaments, and the endopelvic fascia. The fascia is the tissue that holds the pelvic organs (bladder, urethra, uterus) in place. The muscles are referred to at the levator ani muscles that make up the pelvic floor, otherwise known as the basement. It forms the shape of a hammock that supports the pelvic organs. These structures not only aid in maintaining the pelvic organ anatomy but aid in postural support and respiration. The fascia, muscles, and ligaments coordinate with the diaphragm to maintain intra-abdominal pressure. This is the primary concept to understand when it comes to maintaining continence during workouts.

When the intra-abdominal pressure is increased, during double unders or heavy squats, the pressure inside the abdomen must be coordinated between these structures. When the pressure increases inside the abdomen, pressure increases on these structures. If there is a breakdown in one component one may become incontinent.

Pelvic Floor LiftsClinically, I have seen many of these cases with my CrossFitters. Primary complaints are incontinence during double unders, heavy squats, or running. They admit to poor bladder habits such as voiding before and after each workout. Yet, still demonstrate incontinence during their workout. Many admit to skipping workouts if they know those movements are part of the programming! Or, just wearing incontinence undergarments during their workouts and accepting it as normal. Let me reiterate, the involuntary loss of urine with any activity is not normal.

What may contribute to a breakdown of these structures? One may quickly jump to parity (pregnancies), thinking that the more vaginal deliveries one has had the more likely one is to be incontinent. This does not always ring true. There are nulliparous women (women who have never had any children – around 20%) who are incontinent. So, what is the deal? The most common cause is poor regulation of the intra-abdominal pressure. With the heavy lifting or quick jumping movements the intra-abdominal pressure is too great for the pelvic floor to resist against, causing one to become incontinent. Another cause could be due to improper activation of the pelvic floor muscles. 80% of individuals perform pelvic floor contractions incorrectly!

The good news is how we strengthen our muscles during CrossFit is the same way we can train the pelvic floor. If you are incontinent you need to be evaluated by a pelvic physical therapist. Find a physical therapist who specializes in the pelvic floor and who is willing to work with your coaches. If we scale your workouts to promote function the incontinence will improve. The key is knowing when or how to scale. Having that relationship with your physical therapist is the best option to obtain the best results.

Stress incontinence is not a badge of honor or something we should strive for. It is something that should be addressed because over time things may only progressively worsen. Awareness of pelvic floor muscle training is something that is growing within the CrossFit industry. There are many resources available within the CrossFit community as well as other health care professionals. Do not hesitate to ask. I am sure you are not the only one, and who knows, maybe with strengthening of the pelvic floor you can reach a new PR!


References

CrossFit Journal Online

Bo, K and Borgen, JS. 2001. Prevalence of stress and urge urinary incontinence in elite athletes and controls.
Med Sci Sports Ex, 33(11), 1797-1802

Diane, Lee. 2009. The Pelvic Girdle: An integration of clinical expertise and research, 4e.

Herschorn, S. 2004. Female pelvic floor anatomy: the pelvic floor, supporting structures, and pelvic organs.
Rev Urol, 6(5), S2-S10.

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