Active living

Managing Bladder Leaks During Exercise

As a Women’s Health Physiotherapist, I very seldom advise my clients to avoid exercise because of iincontinence. Why? Two reasons. First, urinary incontinence is extremely common. If every woman who experienced bladder leaks stopped exercising, we would be facing a serious public health crisis, with other aspects of our health quietly declining in the background. Second, and more importantly, there is so much more we can do to actually help.

By Sarah Percy, Women’s Health Physiotherapist & Founder, Female Physio Co.

Why Does Urinary Incontinence Happen During Exercise?

The type of leaking that occurs during physical activity is called stress urinary incontinence (SUI) and despite the name, it has nothing to do with emotional stress. “Stress” here refers to physical load.

When you run, jump, lift, cough, or sneeze, intra-abdominal pressure rises rapidly. Under normal circumstances, the pelvic floor muscles and urethral sphincter respond reflexively, contracting just ahead of that pressure spike to maintain continence. When this system is disrupted (whether due to weakness, poor timing, fatigue, or structural change) leakage occurs.

Think of the pelvic floor as a hammock of muscles at the base of the pelvis, supporting the bladder, uterus, small intestine, and bowel. When these muscles are weakened, overstretched, poorly coordinated, or simply fatigued, they cannot provide adequate support under load.

It is worth noting, however, that SUI is not always about strength alone. Contributing factors include poor pressure management across the diaphragm, deep abdominals, and pelvic floor particularly when breath-holding or over-bracing during heavy lifts. An overactive or persistently tight pelvic floor can also be at fault; constantly gripped muscles fatigue quickly and often fail to generate an effective contraction when it is actually needed. Postpartum tissue and nerve changes, declining oestrogen levels (which reduce tissue elasticity and urethral closure pressure), and returning to exercise too soon (and without proper clearance) after having a baby are all recognised contributors. Pelvic organ prolapse where the bladder, uterus, or bowel descends into the vaginal canal can further compromise continence by altering the angle of the urethra and disrupting pressure management. In many cases, leaking during exercise is less about being “weak” and more about coordination, load management, and tissue readiness.

Who Is At Greater Risk?

Whilst urinary incontinence can affect both women and men, certain groups are at a higher risk.

  • Women who have been pregnant or given birth¹,²: Pregnancy places enormous load on the pelvic floor for nine months. Vaginal birth can stretch or injure pelvic floor muscles and nerves, and even caesarean birth is not entirely protective, as pregnancy itself is a major contributing factor.
  • Perimenopausal and postmenopausal women²: Declining oestrogen levels cause changes in the urethral and pelvic floor tissues, reducing their elasticity and strength. This is one of the reasons bladder leaks become more common as women age.
  • Women with a history of heavy lifting or high-impact sport³,⁴: Decades of high intra-abdominal pressure from repetitive impact or heavy loads can gradually wear down pelvic floor function.
  • Women with a high BMI⁵: Increased abdominal load places ongoing pressure on the bladder and pelvic floor.
  • Women with chronic cough or constipation⁶: Both conditions repeatedly strain the pelvic floor, reducing its reserve capacity.
  • Elite athletes³,⁴: Counterintuitively, high-level female athletes have some of the highest rates of stress urinary incontinence. The sheer volume and intensity of training, often without dedicated pelvic floor rehabilitation, takes its toll.  

Which Exercises Carry the Highest Risk?

The higher the impact and the greater the intra-abdominal pressure generated, the harder your pelvic floor must work. Higher-risk activities include:

  • Running and jogging - the repetitive impact of ground contact creates consistent spikes in bladder pressure
  • Jumping and plyometric exercises - box jumps, burpees, jumping jacks, skipping
  • Heavy resistance training - maximal deadlifts, squats, overhead pressing
  • HIIT workouts - particularly those combining running, jumping, and heavy loads
  • CrossFit-style training - double-unders and kettlebell swings are particularly notorious
  • High-intensity group exercise classes

Lower-risk activities include swimming, cycling, yoga, Pilates, and walking. Key is building pelvic floor capacity alongside the exercise you love.

Now, this doesn’t mean you should avoid any of these exercises. It simply means you may have to adapt you training temporarily whilst you’re working with a Women’s Health Physiotherapist, or utilise some external support (like a vaginal pessary) during these exercises. 

Practical Strategies to Reduce Urinary Incontinence

The good news is that stress urinary incontinence is highly treatable and in many cases, fully reversible with the right approach. Here are the evidence-based strategies I recommend as a Women’s Health Physiotherapist.

Pelvic Floor Muscle Training

This is the gold-standard treatment and in many cases, with a well-structured pelvic floor exercise program, can completely cure your incontinence. In some cases, SUI can be caused by overactive muscles, so it’s important to be assessed by a Women’s Health Physiotherapist first to ensure you don’t make your symptoms worse.

How To Do It Correctly:

  • Sit, stand, or lie in a comfortable position. Breathe normally throughout, don’t hold your breath.
  • Imagine you are trying to stop yourself from passing wind and urine at the same time. You should feel a lifting and squeezing sensation inside the pelvis.
  • Contract and lift these muscles, hold for 3–10 seconds, then release completely. The release is just as important as the contraction.
  • Rest for an equal amount of time between contractions.
  • Aim for 3 sets of 10 repetitions, twice daily. This is assuming you need to work on strengthening and not relaxation.
  • Progress the hold time and number of repetitions gradually over weeks.

The Knack: Your Secret Weapon for Exercise

The “knack” is a simple but highly effective technique where you perform a deliberate pelvic floor contraction immediately before and during any activity that increases intra-abdominal pressure. It essentially gives your pelvic floor a head start against the pressure spike.

In practice, this means: just before you begin a jump, a sprint, or a heavy lift, brace your pelvic floor, squeeze and lift, and maintain that contraction through the effort. Research by Miller et al.⁷ demonstrated up to a 98% reduction in urine loss during coughing when women used the knack, and the technique is equally applicable to exercise.

Over time, with consistent practice, this contraction becomes more automatic and reflexive. The goal is always to retrain the nervous system so the pelvic floor responds instinctively, but in the early stages, the knack is a valuable conscious strategy.

Pessaries for Bladder Support

A continence pessary is a small, removable silicone device that sits inside the vagina and provides gentle support to the urethra, bladder, bowel and uterus, reducing leakage during activity.

Pessaries are a safe and highly effective option. They do not replace pelvic floor training but can be used alongside it to maintain your activity levels while you build pelvic floor strength.

Bladder Habits and Lifestyle Adjustments

  • Bladder training: Avoid “just in case” toileting before exercise. Going to the toilet more frequently than necessary trains the bladder to signal urgency at lower volumes. Aim to urinate every 3-4 hours throughout the day.
  • Fluid intake: Stay well hydrated - dehydration concentrates the urine and irritates the bladder lining, making leaks more likely.
  • Reduce bladder irritants: Caffeine, alcohol, carbonated drinks, and spicy foods can irritate the bladder and worsen symptoms. Consider reducing these, particularly around exercise sessions.
  • Bowel health: Constipation and straining at the toilet significantly worsen pelvic floor problems. Prioritise fibre, hydration, and a good toileting position: feet on a small stool, leaning forward slightly.

Continence Pads

Using a continence pad during exercise is not a sign of giving up or giving in. It is a smart, practical, dignified solution that allows you to continue doing the things that matter to your health, while you work on your pelvic floor in the background.

MoliCare continence pads are designed specifically for bladder leaks, they are very different from menstrual products. They feature rapid absorbency technology that draws fluid away from the skin quickly, neutralises odours, and offers a discreet profile that fits comfortably under activewear.

Continence pads can eliminate the anxiety around leakage during exercise, and that reduction in anxiety itself often reduces urgency and frequency.

The goal is always to use pads as a support alongside rehabilitation, not as a permanent substitute for treatment. But during the weeks and months that you are building pelvic floor strength, there is absolutely no reason to sit on the sidelines.

Staying Active For Longevity

Staying active is critically important for women, and bladder leaks should never prevent participation in exercise. Regular physical activity supports bone density, helping slow postmenopausal bone loss and reduce the risk of osteoporosis and fractures, which carry serious health consequences. Exercise also protects cardiovascular health by improving blood pressure, cholesterol, weight management, and reducing the risk of type 2 diabetes.

Beyond physical benefits, activity promotes mental health, reducing depression, anxiety, and stress, while supporting cognitive function and lowering dementia risk. Resistance and weight-bearing exercises help preserve muscle mass, maintain metabolism, protect joints, and ensure functional independence, allowing women to move confidently and maintain daily activities well into older age.

Ultimately, staying active safeguards long-term health, wellbeing, and independence.

The goal is not to avoid all exercise that challenges the pelvic floor. Progressive loading of the pelvic floor gradually increasing the demands we place on it, and this is how we build its capacity. Women who remain completely sedentary do not protect their pelvic floor; they simply have a weaker one.

Bladder leaks during exercise are common, treatable and manageable. You deserve to run, jump, lift and sweat without fear or embarrassment.

References

  1. Wang, Y., Li, X., Zhang, L., & Chen, Y. (2021). Risk factors for postpartum stress urinary incontinence: A systematic review and meta-analysis. International Urogynecology Journal, 32(7), 1651–1665. https://pubmed.ncbi.nlm.nih.gov/32638282
  2. Fritel, X., Ringa, V., & Chautard, M. (2012). Female urinary incontinence, from pregnancy to menopause: A review of epidemiological and pathophysiological findings. Acta Obstetricia et Gynecologica Scandinavica, 91(6), 557–567. https://pubmed.ncbi.nlm.nih.gov/22497363
  3. Pires, E., Silva, D., & Oliveira, R. (2020). Prevalence of urinary incontinence in high-impact sport athletes: A systematic review and meta-analysis. International Urogynecology Journal, 31(8), 1577–1588. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7386138
  4. Almousa, S., & Van Loon, L. (2019). Urinary incontinence in female athletes: A systematic review. International Urogynecology Journal, 30(12), 2017–2030. https://pubmed.ncbi.nlm.nih.gov/29552736
  5. Lamerton, A., Møller, L., & Burgio, K. (2018). Overweight and obesity as major, modifiable risk factors for urinary incontinence in young to mid-aged women: A systematic review and meta-analysis. Obesity Reviews, 19(10), 1445–1456. https://pubmed.ncbi.nlm.nih.gov/30230164
  6. Oshani, T., Perera, A., & Fernando, S. (2013). Risk factors for stress urinary incontinence: A cross-sectional study. BMC Women’s Health, 13, 32. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4094634
  7. Miller, J. M., Ashton-Miller, J. A., & DeLancey, J. O. L. (1998). A pelvic muscle precontraction can reduce cough-related urine loss in selected women with mild stress urinary incontinence. Journal of the American Geriatrics Society, 46(7), 870–874. https://doi.org/10.1111/j.1532-5415.1998.tb02721.x