The first time it happens it might take you by complete surprise. Maybe it’s when you’re sprinting to finish up a run, or you’re pushing through a squat with a heavy weight racked across your back. Or maybe it’s when you’re powering through a set of jumping jacks, or when you laugh, cough, or sneeze. Before you know it, a little bit (or sometimes a lot!) of pee has come out. Then you find it happening again. And again.

Studies show up to 35% of women experience this type of leakage, known as stress urinary incontinence (SUI). And while it tends to occur with more frequency as you get older and with issues like obesity and smoking, active women tend to experience more than their share of symptoms, in part because of the nature of their workouts. 

“Although it’s more common among women who have had vaginal births, even those who were never pregnant can develop SUI, whether due to a genetic predisposition or from high-impact exercises or coughing or sneezing,” explains Mary Lake Polan, a clinical professor of obstetrics, gynecology, and reproductive sciences at Yale University School of Medicine and a spokesperson for Consortia Health, which specializes in pelvic floor training.

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What’s Happening?

SUI occurs when the pelvic floor muscles, which support your bladder and urethra (the tube that carries urine out of your body), don’t fully do their job. Normally the sphincter muscles around the urethra stay closed even as your bladder fills, but when these muscles weaken, sudden force (like lifting a weight or sneezing) can put pressure on your bladder, causing urine to leak out.

“With daily activities like walking, the muscles that support the urethra area are able to keep things under control,” notes Crystal Liang, D.P.T., a physical therapist with Sloane Stecker Physical Therapy in New York. But when you add the pressure of running (the impact of which can be three to four times your body weight) or jumping (six to 12 times), and there is pelvic floor dysfunction, it’s too much force for your muscles, causing that sudden leakage.

Who’s Affected?

SUI can become more common as we get older. Just like we no longer see the same gains in muscle density, the muscles in our pelvic floor can weaken over time, too. Most women experience an average of 2% of muscle loss a year.

Pregnancy, especially a vaginal delivery, can weaken the pelvic floor muscles so they can’t support the urethra as well. Women who are obese or smoke or who have had pelvic surgery or radiation can also be at risk.

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What Can You Do?

Although some women can recover independently over time, you can minimize your risk factors and cut down on SUI by training the pelvic muscles. “Strengthening this tissue around the bladder will help decrease leakage,” Polan says. As a last resort, there are also surgical procedures to improve closure of the sphincter or add more support to the bladder or urethra, as well as devices that can help control stress incontinence.

Pelvic floor exercise is the recommended first-line treatment for women with SUI. A pelvic floor physical therapist will evaluate strength, coordination, and muscular tone and prescribe appropriate therapy. Since there are different types of incontinence, including stress (coughing, sneezing, jumping), urge (a strong “I gotta go!” feeling), and mixed (both types), therapies vary. “Kegels are just one piece of the puzzle,” Liang says. Other treatments include regaining muscle coordination, urge-suppression techniques, and healthy bladder and bowel habits, including diet and timing voiding intervals.

While Liang recommends that symptomatic individuals consult with a pelvic floor physical therapist before starting rehabilitation techniques, most people can benefit from strengthening the pelvic floor, like any other muscle group. Kegels remain the gold standard of pelvic floor training.

Just as with your strength routine, you can break your Kegels into sets and reps, says Liang. Work up to three sets of 10 reps a day.

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