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If you leak urine when you run, jump, lift weights, or even do sit ups, you may have stress urinary incontinence. Many active women assume this is just a normal consequence of childbirth or aging. It is common, but it is not something you have to accept.
What Is Happening Inside the Body
Stress urinary incontinence occurs when pressure inside the abdomen increases and the urethra cannot stay closed. Activities like coughing, laughing, or exercising create downward force. If the pelvic floor muscles and connective tissues are weakened or stretched, urine can leak.
Certain types of exercise are more likely to trigger stress incontinence because they repeatedly increase pressure inside the abdomen and push downward on the pelvic floor. High-impact activities like running, jumping, HIIT workouts, CrossFit, trampoline exercise, and plyometrics are common culprits. Heavy weightlifting, especially squats, deadlifts, and overhead presses, can also provoke leakage if core and pelvic floor coordination are not optimized. Even seemingly “core focused” exercises like sit-ups, crunches, and aggressive planks can increase intra-abdominal pressure if you are bearing down instead of properly engaging the deep core.
Common contributing factors include pregnancy, vaginal delivery, chronic constipation, high impact athletics, menopause related tissue changes, and prior pelvic surgery.
Importantly, this is different from overactive bladder. While it is possible to have both conditions at the same time, the distinction with stress incontinence is that leakage happens with movement or pressure, not because of a sudden uncontrollable urge.
What Evaluation Should Include
A proper evaluation for stress urinary incontinence should start with a detailed conversation about your symptoms, when leakage happens, how often it occurs, and how much it affects your daily life. Your provider should review your medical history, childbirth history, prior surgeries, medications, and any pelvic symptoms such as pressure or pain. A pelvic exam is important to assess pelvic floor strength, look for prolapse, evaluate tissue health, and sometimes reproduce leakage with coughing. Most women should have a simple urine test to rule out infection or blood in the urine. In certain cases, additional testing such as a post void residual measurement to see how well the bladder empties, a bladder diary, or urodynamic testing may be recommended, especially if surgery is being considered or if symptoms are not straightforward.
If you are leaking during exercise, ask your provider:
- Is this stress incontinence, overactive bladder, or both?
- Should I have a pelvic exam to assess support and muscle strength?
- Would urodynamic testing help clarify my diagnosis?
- Am I emptying my bladder completely?
A thoughtful evaluation ensures that treatment is tailored to the right diagnosis rather than guessing at the cause.
Treatment Options
There are multiple treatment options for stress urinary incontinence. These include pelvic floor physical therapy, pessaries, urethral bulking and midurethral sling surgery. However, it doesn’t mean you need to try every option before moving forward with surgery.
Treatment is more of an à la carte experience. Every woman can choose what aligns best with her lifestyle, goals, and values. For some, that may mean incorporating pelvic floor exercises into a daily workout routine. For others, it may mean choosing surgery with the goal of not having to think about leakage again.
Workout Tips While Seeking Treatment
While you are exploring treatment options, consider temporarily shifting toward lower-impact movement such as walking, cycling, swimming, elliptical training, Pilates with attention to breath control, barre, or strength training with lighter weights and proper exhale-on-exertion technique. These options allow you to stay active and protect cardiovascular and bone health while minimizing strain on the pelvic floor. The goal is not to stop exercising. It is to modify intelligently while you address the underlying issue.
Leaking during exercise is treatable. With proper diagnosis and individualized treatment, most women can return to the activities they love without fear.
About the Author:
Dr. Alexandra Dubinskaya is a board certified and fellowship trained urogynecologist and pelvic reconstructive surgeon. She is a sexual medicine specialist and the founder of the Los Angeles Institute of Pelvic and Sexual Health. Dr. Dubinskaya is also a Menopause Society certified provider. In her spare time, she is an educational content creator for women’s health on YouTube and social media as @DrUroGyn.
