May 10, 2015
Double-Unders & Pee: Dealing with Exercise Induced Urinary Incontinence (EIUI)
By Lauryn Lax
May 5, 2016
For some people, seeing those two words on the whiteboard is enough to make them want to pee their pants.
The double-under can be tough to “get”. Even if you have them, there are still days when you are “off”—on those days, the rope marks on your legs and arms are proof of this.
For others, their initial reaction may not be so…relieving, but jumping into double-unders? Now that’s a different story.
The leakage happens.
Some of you know what I’m talking about.
Maybe you don’t completely pull a wet one on yourself, but all that jumping can cause a little…spillage, if you know what I mean.
In fact, it’s a scientific reality, and it has a name: Exercise-induced urinary incontinence (EIUI), also known as stress urinary incontinence (SUI).
In short, EIUI is an involuntary loss of urine during physical exertion.
EIUI occurs during physical activity when intensity and intra-abdominal tension (pressure in your abs) increases. Think about how you feel when bounding during the double-under, or even holding your breath to pick up a one rep-max deadlift, and you’ll start to get the picture.
This type of pressure that is created during exercise is called the ‘Valsalva Maneuver’. Tension from this maneuver presses on the internal organs (including the bladder). When this happens, the neurological and vascular activity in your body is directed to the large muscle groups that are working, which leaves the muscles that control bladder output isolated and unable to perform their duties. This leads to exhibit A of EIUL: Bladder leakage due to the compromised ability of the bladder and urethra to control the exit of urine.
Moral of the story? If you’ve experienced this condition before, you are not alone.
In fact, EIUI is actually twice as likely to occur in women than in men.
At least 25 percent of women of childbearing age and 50 percent of post-menopausal women experience the condition. In addition, 65 percent of pregnant women and about 30 percent of women in their first year after giving birth experience this incontinence (the loss of bladder control).
In 2002, a study in the Scandinavian Journal of Medicine & Science in Sports evaluated the incontinence of elite female trampolinists. Researchers found that 80 percent of the 35 trampolinists (ages 12-22) reported involuntary urinary leakage—but only during trampoline training. The leakage problems started after two and a half years of training and occurred in every single trampolinist above the age of 15.
But why exactly does this happen?
Occasionally, there may be an underlying physiological reason for incontinence that requires the attention of a gynecologist or urologist, but more often than not, it comes down to weak pelvic floor muscles and/or poor urethral sphincter control.
Such issues can come about in a variety of ways: multiple vaginal births or pregnancies, peripheral nerve damage during vaginal delivery, or simply generalized weakness.
A look into the anatomy of the female pelvis reveals a pelvic floor (aka: ‘the basement’) that is comprised of fascia, ligaments and muscles that provide a “hammock” for the bladder and uterus to rest inside. This hammock is also connected to the diaphragm and visceral fascia, which also means, in addition to weaker pelvic floor muscles, that changes in lung volume will increase the amount of pressure placed on these structures.
Add extra heavy breathing + extra pounding + extra exertion and, voila: extra pressure on the bladder.
So how do you fix it?
Just like you work on strengthening your pull-ups, squats and overhead lifts, some focused strength work in the right areas can help to improve your EIUI.
First things first—functional strength and mobility all stem from the core.
From deadlifts and squats to planks and medicine ball twists, to lifting your 3-year-old off the ground or placing your carry-on bag in the overhead bin on an airplane—a strong core will take you places. And whenever we strengthen the muscles around the pelvic floor (such as those of the core), we are helping to strengthen and support the pelvic floor.
Here are a couple of exercises you can add to the end of your workout or do at home. Simply take one to two minutes two to three days per week to strengthen your pelvic floor.
Plank. This isotonic movement (stationary) is a no-brainer. Get into the push-up position, but instead of resting on your hands, rest on your forearms. Maintain a neutral spine, keep those hips from sagging, and hold the position. Aim to hold the position for one minute without breaking. Once you reach that mark, aim for two minutes, then three minutes, then weighted plank holds.
Weighted holds. Pick a moderately heavy weight that you can clean into the front rack position (high elbows!). Hold the weight in that position for 30-45 seconds, then rest 15 seconds. Repeat three times.
Homemade ab-wheel. No need to purchase an ab wheel on the Home Shopping Network for this one! Grab a barbell and put 25 lb. plates on each side. Get on your knees and position the bar slightly away from your body. Roll the weight out until your core gives out and you cannot roll the weight back. On the next roll out, stop two inches before you get to that first point, then return to the starting position. Complete three sets of 15-20 reps, resting as needed. (Note: If you don’t have a barbell or access to one, an ab wheel is perfectly justifiable).
Next up: Your glutes—aka your butt.
The muscles that balance out the forward pull on the sacrum (triangular bone at the base of the spine and at the upper back part of the pelvic cavity) are the glutes. A lack of glute strength makes one more susceptible to a weak (sagging) pelvic floor. A telling sign of a weakened pelvic floor from poor glute and posterior strength is a lack of a lumbar curve (missing the little curve at the small of the back).
In order to toughen up your glutes and help out your pelvic floor, it’s time to focus on engaging your butt. You need to fire those glutes in every squat, deadlift and overhead press. In addition, it’s imperative for you glute strength to squat correctly and hit full depth.
Here are a few key points of performance when it comes to executing a solid squat:
Shin alignment. The more vertical the shin (knee joint over the ankle joint) and the more neutral the pelvis (not tucked), the greater emphasis there is on engaging the glutes. If your knees are consistently in front of the ankle and the your pelvis tucked, your quads will become the dominant muscles in your legs and your glute strength will suffer as a result.
Go deep and get low. You’ve heard it before: Prior to the invention of the toilet, humankind squatted ass-to-grass as an innate functional movement. How low you can go will depend on how well you can maintain that shin alignment, and engage your glutes—as opposed to leaning forward and utilizing the quads.
Squeeeeeze. When driving up from the bottom of the squat, engage the heels and think “fire, fire, fire the glutes”. The more you begin to put your mind into muscle, the more natural the movement pattern will become.