You’re mid-workout. Maybe you’re doing jump rope, running, lifting, or laughing your way through a tough set of squats. And then it happens. A leak.
You move on. Sound familiar?
If so, you’re far from alone. Leaking during exercise, whether it’s a few drops during a jump or a bigger loss during heavy lifting, is one of the most common things I see in my practice. It’s also one of the most normalized problems out there. Women are told it’s just part of being active, part of having kids, or part of getting older. It’s not.
Leaking during exercise is common, but it is not normal, and it’s not something you have to just live with.
Leaking during physical activity is technically called stress urinary incontinence (SUI). The name refers to physical stress placed on your bladder and pelvic floor during activities like:
- Running or jumping
- Lifting weights
- Coughing, sneezing, or laughing
- High-impact cardio
Here’s what’s actually going on underneath: your pelvic floor is a group of muscles that acts like a supportive hammock for your bladder, uterus, and rectum. These muscles also play a key role in controlling continence.
When you exercise, especially with impact or heavy lifting, pressure increases inside your abdomen and pushes down on your pelvic floor. If those muscles aren’t coordinating well, whether because they’re weak, too tight, poorly timed, or not activating in sync with your breath and core, that pressure can overcome their ability to keep things closed. The result? Leaking.
Common Causes
A few things can contribute to this breakdown in coordination:
- Pregnancy and childbirth, which can stretch, weaken, or change the mechanics of the pelvic floor
- Chronic straining, from constipation or improper lifting mechanics
- Poor breathing patterns during exertion, like holding your breath or bearing down instead of exhaling with effort
- Weak or uncoordinated pelvic floor muscles, even in women who have never given birth
- Overly tight pelvic floor muscles, which sounds counterintuitive, but a muscle that’s too tense can be just as dysfunctional as one that’s too weak
This is why leaking isn’t just a “core strength” issue or a “just do kegels” fix. It’s about how your whole system, breath, core, and pelvic floor, works together under pressure.
Because this is a mechanical and neuromuscular issue, it’s also a treatable one. Pelvic floor physical therapy addresses the root cause rather than just managing symptoms. That might include:
- Retraining pelvic floor coordination and timing
- Addressing tightness or restriction, not just building strength
- Teaching proper breathing mechanics during exertion
- Rebuilding a strong, well-coordinated core system
- Gradually reintroducing the specific movements that trigger leaking, so you can get back to your workouts with confidence
If leaking during exercise has become something you plan around, wearing dark leggings, skipping certain exercises, or avoiding workouts altogether, that’s not something you have to accept as your new normal.
Your body is giving you information, and there’s a clear path to addressing it. Pelvic floor PT exists exactly for this reason, and I’d love to help you get back to moving your body without hesitation, worry, or a change of clothes on standby.
Dr. Rachel Atufunwa, PT, DPT