Peeing While Lifting: Is It Normal?
The videos that always go viral on the ‘gram, filled with hateful, ignorant comments like:
“Just hold it in!”
“That’s disgusting,” and, best of all,
“Women shouldn’t be lifting that much. It’s unnatural.”
Insecure assholes use incontinence episodes to diminish the accomplishments of female athletes, another way that sexism inserts itself into the wavelengths of society- but that’s a larger topic.
Let’s get it straight: peeing during a heavy lift does not invalidate your PR in any way, shape, or form- and is extremely common. It’s not something to be embarrassed or ashamed of, and it’s certainly not voluntary. I promise you that athletes are not actively choosing pee-stained leggings & a visible puddle on their deadlift platform.
It occurs due to many factors: fluid intake, bathroom habits, pelvic floor anatomy, childbirth history, food intake, hormones, etc.
But the question is- is this a concern? Does peeing regularly, involuntarily, during lifts (but also when laughing, sneezing, coughing, etc.) indicate an underlying issue to address?
Everyone’s answer and story will differ- but there are potential ways to mitigate this from happening. Here and there, on an RPE 10 third-attempt deadlift- it may occur- but it does not have to be a part of your everyday gym life. While incontinence should not be a source of guilt and shame, it can feel deeply uncomfortable, annoying and potentially impact other parts of life- and I’m here to tell you that there are things you can do.
(Note: I am NOT a pelvic floor PT- all of this is generalized information. I have done continuing education on this topic from credible PTs, but this is a broad overview, not an individual diagnosis. The Unique Considerations For The Female Barbell Athlete (2*), a Barbell Rehab Course by Dr. Sophia Veiras provided a wealth of knowledge on this topic, and I can’t recommend her enough).
Why does this occur? Pelvic Floor Overview
Let’s outline some basic facts here.
According to Your Pelvic Floor, (1*) with a "normal" bladder, when urine is produced: the bladder muscle "relaxes and stretches to accolade the fluid.” Then, once this fluid reaches a certain threshold, the urge to pee becomes noticeable to the individual, and when appropriate, the bladder contracts & the sphincter muscles relax- to let the urine out. This process coincides with signs from the brain to hold in or let pee out, allowing you to control your release.
What does it mean when urine leaks, but not by choice? While there are a few types of incontinence, the one relevant to lifting is Stress Urinary Incontinence or SUI.
This scenario involves the involuntary excretion of urine that occurs during activities of high-level intra-abdominal pressure (or IAP): including heavy lifting, coughing, sneezing, and laughing: which all increase tension in the core. IAP describes the pressure between the abdominal cavity, influenced by the interaction between these muscles and their surroundings. A higher degree of intra-abdominal pressure places stress on the pelvic floor beyond its capabilities, allowing a release of urine that was not planned or wanted.
While biological males can experience SUI, it’s far less common than in females. The female pelvis is thinner, less dense, and more shallow, with a wider pubic arch: designed to support a) childbearing and b) a less robust body build (2*). The shape and design of our pelvis make it harder to tolerate high levels of stress placed upon it.
Taking it a step further, what is your “pelvic floor”?
Your “pelvic floor” (2*) includes the muscles and connective tissue supporting the bladder, uterus, and bowel, internally located in the pelvic region. Their purposes include stability, support, sexual function, etc. They help with breathing, maintaining posture, and carrying out bodily functions. Like visible muscles, they can be trained- strengthened and weakened, tightened and relaxed, and in the same way that a weak or overly-stressed shoulder can contribute to pain, potential injury, and decreased function-
Weak or overly-stressed pelvic floor muscles can cause issues with bladder and bowel movements, as well as sexual function.
About one in three women experience stress urinary incontinence at some point (2*). This percentage increases further in female lifters, as denoted by this 2021 cross-sectional survey; (3*) In their sample, about 44% of female Powerlifters had experienced leakage in their lifting careers.
When lifting loads above 80%, a Valsalva maneuver is an involuntary action: where one creates a “brace” against the weight, holding their breath and exerting force through their belly- increasing tension in the core (intra-abdominal pressure) to help with force production & efficiency. If the pelvic floor cannot adequately support this increase in pressure (for various reasons), urine can escape.
2. Risk Factors for Stress Urinary Incontinence
To support continence- a few functions must be present (2*):
a) a working nervous and cognitive system (brain damage can influence incontinence),
b) mobility (the ability to move to and control yourself in going to the bathroom), and
c) the expansion and contraction of the bladder (to either hold in or let out urine).
With SUI, that third reason- a flaw in the ability to expand & contract the bladder on command contributes to leakage. In female athletes, the cause is theorized to be either a weak, stretched, or overly stressed pelvic floor: or a combination of all three (2*).
To avoid leakage- the pelvic floor must be strong enough, with an optimal length-tension relationship, to regulate urethral pressure, stability, and support intra-abdominal pressure.
If your pelvic floor is too "tight" or "overly stressed," the bladder and bowel may not empty properly. This condition, according to the Australia Incontinence Organization, (4*) is "less common than a weakened pelvic floor" but can influence incontinence. In this case, these issues will show up during intercourse as well, making it difficult, painful, or impossible. Seek advice from a pelvic floor PT if experiencing this condition.
On the contrary, a few risk factors for a weak pelvic floor include:
Age (pelvic floor muscles weaken as we get older),
Body weight (those with higher body weights report higher levels of SUI)
Childbirth (Especially depending on the delivery method & underlying conditions, pelvic floor muscle damage occurs),
Menopause (the reduction in estrogen weakens all muscles, including the pelvic floor),
Having an ongoing cough (the repeated episodes of high intra-abdominal pressure can increase the risk of urinary incontinence)
(4*).
Essentially, incontinence occurs when the load placed on the pelvic floor exceeds its capacity. This incident may be due to multiple reasons, and there are ways to improve your condition.
3. Pelvic Floor Muscle Training 101
Whether your pelvic floor is weak or tight, training the specific area can help improve symptoms. According to the cross-sectional survey mentioned above, (1*) in female Powerlifters specifically, participants who underwent pelvic floor muscle training (PFMT) "experienced less severe SUI.” This method has been demonstrated to be effective in the literature.
What might PMFT include?
Kegels are a commonly prescribed solution, a conscious contraction of the pelvic floor muscles to improve strength and tone. It can prove difficult for many women to perform one on command, as it’s an invisible area- and one that we often don’t think about. For those with overly tight pelvic floors: this exercise may fail to improve symptoms. However, it can help improve pelvic floor muscle capacity. To do one, think about pulling “up and in” with your pelvic floor, or visualize “sucking up blueberries” through your vagina- try and hold this position for time, increasing as you practice.
Another distinction in PFM techniques is the knack vs. the kegel (2*). The motion is the same, but the kegel is separate time set aside to contract the pelvic floor- whereas the knack is done in anticipation of an incontinence-triggering circumstance- to gain control. This motion can be coincided with lifts, imagining pulling “up and in” on the pelvic floor during the ascent of a squat or a deadlift.
Some advice commonly given to women experiencing incontinence includes simply avoiding the Valsalva, but this is an unrealistic and unhelpful ask. The reality is- it’s an essential component of a heavy lift attempt, not only for efficiency and performance but also- involuntarily- it's not "optional" when going for a PR attempt- and doesn't inherently damage the pelvic floor. The goal is to become resilient and capable of handling intra-abdominal pressure tasks, not run away from them.
Beyond the Valsalva, though, a few aspects can influence your risk factor for incontinence when Powerlifting:
4. Modifying your Lifts to Improve Symptoms:
A) Pelvic Floor Muscle Engagement: Try adding the knack to your lifts- visualizing your pelvic floor during your reps and practicing this technique on warm-up sets,
B) Bracing properly: Focus on creating a 360-degree circle of pressure before you lift. "Bearing down" (as if you were straining through a poop) places additional pressure on the pelvic floor and is unnecessary.
C) Intensity: If you're constantly pushing high-RPE sets, maintaining continence will be highly difficult- among other side effects. Ensure proper recovery, and train in that RPE ~7-8 range most of the time,
D) Technique: A drastic loss in spinal positioning during a lift (spinal flexion after the start of the deadlift, falling forward out of the hole in a squat, etc.) indicates a loss of tension (especially within the core), which can cause incontinence, as denoted by this article (5*).
E) Belts: Belts, of course, increase intra-abdominal pressure, so this can contribute to incontinence. Ensure that your belt is the right fit- you should be able to fit one finger between yourself and the belt when not bracing. At loads below 80-85% or RPEs below 8, it’s probably unnecessary. Training without it can help you practice your natural bracing pattern, technique, and pelvic floor integration, so you can better apply this when wearing it.
F) Diapers/Pads: Wearing one can increase your comfort when experiencing a leakage episode, but you don't want to rely on them forever.
Your first step is to assess those factors, looking for ways to improve and modify them.
Address how much of a concern this is for you. If your leakage is at an extremely high level, impacting you nearly daily, then you'll want to address it immediately and modify lifts further.
If it's slight, here-and-there, relatively infrequent, you may be able to take things slower.
5. Programming Modifications
If, after assessment, leakage continues to be a pressing issue, try temporarily removing the high-intensity/volume lifts that are particularly triggering. Determine where incontinence happens the most frequently: is it a high-rep AMRAP set, singles/doubles at loads above 90%, etc.? You can temporarily taper this down to more sustainable levels, such as:
spreading out your volume across the training week,
breaking it up (instead of 4x4, 4x2-2, for example),
decreasing intensities/percentages, following strict RPEs,
substituting a more tolerable variation: a Goblet squat, High bar, Block pull, etc.
Determine what feels like an accessible starting point- maybe aiming for less frequent and less severe incontinence episodes, training at that intensity for a few weeks before gradually building back up as you address other underlying contributors. We don't want to eradicate these lifts: especially as Powerlifters- but as you work on your pelvic floor & other factors, managing incontinence through programming will be helpful. Then, you can work on increasing your tolerance & capacity to maintain your symptoms- once you return to higher-intensity training.
6. Bathroom Habits & Other Factors To Assess
Beyond pelvic floor tolerance & comorbidities, your diet and bathroom habits can influence whether you’ll pee during a lift. With physical pain being multifactorial, incontinence is also multifactorial- and we must view this holistically- to fully address it.
Fluid intake: Water is highly encouraged in the fitness space, and many also consume supplements such as creatine or stimulants. While none of these are “bad,” and all can support your performance; creatine and caffeine are both diuretics, and when paired with a high water intake? Your bladder may be overflowing.
It’s recommended to drink about half your body weight (in pounds) in ounces of water per day- and try spacing that out rather than front-loading before a training session. Be mindful of how much you’re consuming before you go to lift.
Alcohol, chocolate, and citrus fruits can all irritate the bladder (2*). Consume these foods in moderation, specifically around training sessions.
Bathroom habits: A helpful tool is using a pee tracker to bring awareness to how often, why, and when you’re going. Many of us have been told to go “just in case,” even when the urge isn’t there, which weakens the pelvic floor muscles and can make you pee more often. Generally, it's "regular" to pee every 2-4 hours and only when you actually “have” to go. Try writing down in a journal what time you went to the bathroom, whether you had to go, how much fluid you excreted, and your food/water intake.
On that same note, if you’re worried about peeing before a lift, don’t go simply in anticipation of this occurring. You may trigger that pelvic floor, causing you to pee even more during your set.
Avoid straining or “grinding out” a poop- this can place pressure on the pelvic floor. Healthy bowel movements support incontinence, so if you're regularly constipated, address the root cause of that issue.
Becoming aware of your habits can help you find areas to focus on- to decrease symptoms. Remember, it’s a process, so you may not go from soaked leggings to being completely dry overnight, but continual improvement is something to strive for and a sign of progress.
7. Red Flags to Look For
Knowing when to refer out is essential in navigating this experience.
If you’re noticing blood in your urine,
Incontinence in your lifts more than once per week (even at submaximal loads),
if you have a history of recurring UTIs,
or difficulty urinating,
It’s time to see a specialist.
If after implementing all of the tricks, adaptations, and modifications mentioned above, symptoms do not improve (or you have other concerns), seek a pelvic floor PT.
In the same way that if persistent shoulder, knee, hip, etc. pain goes unmanaged, it will be unlikely to improve (and may be an indicator of underlying issues),
If persistent incontinence is unaddressed, it is unlikely to improve.
Try to find a pelvic health PT versed in lifting- if possible, to avoid the generic advice such as “just don’t go heavy” or “avoid the Valsalva.” You want to find someone who can give you actionable, applicable, and sustainable steps to improve your situation.
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The trickle down your leg as you approach the top of a deadlift- or rise out of the hole in a squat.
It can be a source of embarrassment, discomfort, and even shame for many uterus-having athletes. First and foremost, we must destigmatize this topic. Leakage is not a choice nor an unusual or uncommon occurrence. However, it is not necessarily a forever issue you entirely lack control over. There are many contributing factors, including bathroom habits, food, and fluid consumption: plus age, history, childbirth, weight, etc. Many myths surround this topic, such as one should “avoid the Valsalva” or “just do Kegels”- but the truth is, continual lifting without continual pissing is possible, and the goal is to reduce incontinence in this activity and beyond. Training the pelvic floor is a well-documented solution to improve symptoms. Focus on controlling what you can, substituting or modifying your program as needed, and experiment with some pelvic-floor-focused exercises. If symptoms persist, always speak to a relevant practitioner for information about your unique case.
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References
*Your Pelvic Floor: “Stress Urinary Incontinence.” Your Pelvic Floor, 2 Mar. 2023, www.yourpelvicfloor.org/conditions/stress-urinary-incontinence/.
2. *Barbell Rehab: Veiras, Sophia, PT, DPT. “Unique Considerations for The Female Barbell Athletes.” Barbell Rehab.
3. *Sports Medicine: Wikander, L., Kirshbaum, M.N., Waheed, N. et al. Urinary Incontinence in Competitive Women Powerlifters: A Cross-Sectional Survey. Sports Med - Open 7, 89 (2021). https://doi.org/10.1186/s40798-021-00387-7
4. *Continence Foundation of Australia: “Pelvic Floor Muscles.” Continence Foundation of Australia, www.continence.org.au/about-continence/continence-health/pelvic-floor Accessed 9 Aug. 2023.
5. *Progressive Rehab And Strength: Alter, Dr. Rori. “3 Reasons You Pee When You Powerlift & How to Fix It (Part 2): Mechanical Contributions.” Progressive Rehab & Strength, 19 Nov. 2022, www.progressiverehabandstrength.com/articles/urinary-incontinence-powerlifting-part-2
