I recently came across a video online in which several CrossFit athletes were discussing the subject of involuntary urination during a WOD. I then searched for articles online about the subject and found several. Some had really great information and some just offered the standard medical response so I felt compelled to add my two cents.
All of the articles I read attempted to explain why this involuntary urination was happening and the common denominator appears to be pelvic floor weakness. There were also several reasons cited for this weakness including aging, childbirth and lack of strength in that area. My belief is that there are as many different reasons for this condition as there are people who experience it. For this reason, each person’s condition should be assessed individually instead of everyone following the same protocol to try to fix the problem. Here are a couple of articles that had useful information and not just the standard party line: https://pelvicguru.com/2013/06/22/dear-crossfit-and-crossfit-gynecologist-im-appalled-theres-help-for-peeing-during-workouts/ http://breakingmuscle.com/womens-fitness/stop-doing-kegels-real-pelvic-floor-advice-for-women-and-men
The first point I want to make clear is that this “condition” is NOT normal and CAN be reversed without having to take medication or have surgery. There are many doctors and therapists who are unaware of this option however, so they might not be able to confirm this information for you if you ask them about it. Pelvic floor treatment is a specialized modality and isn’t covered specifically in general education settings. I know we never discussed it in massage school and unfortunately it is treated like a taboo subject in many other clinical and social settings. As an RMT in Ontario, I’m not even allowed to treat the pelvic floor internally, which is ridiculous, but that’s a topic for another article.
I attended the Women’s Health seminar as part of my continuing education in the John F. Barnes Approach to Myofascial Release (JFB-MFR) and that is where I learned the importance of treating the pelvic floor. And no, pelvic floor treatment is not only beneficial for women. Men also have problems related to pelvic floor restriction, but usually not as many as women and for our purposes here, I will only be discussing women’s concerns. Men’s concerns will be covered in another article.
Pelvic floor restriction can contribute to a number of problems for women including involuntary urination, painful or irregular periods, fertility problems, miscarriages, endometriosis, cysts, painful intercourse and any other “female issue” you can name. It can also contribute to back pain, neck pain or pain in any other area of the body, which is why a JFB-MFR therapist will treat your entire body to resolve whatever pain you are experiencing.
Now I realize for many women, the thought of having an internal pelvic treatment can range from uncomfortable to downright terrifying but that’s exactly the reason why you need it. And the more afraid of it you are, the more you need it. Emotion plays an enormous part in our pain and restriction patterns and allowing ourselves to feel that pain and express those emotions in a safe and supportive setting will help to release that restriction and relieve that pain like nothing else.
I have frequently seen Kegel exercises being proscribed as a method to help prevent exercise-induced incontinence and while this method can be effective for some women, it can actually make the problem worse for others or not have any effect at all. If your incontinence is the result of weak pelvic floor muscles, then yes, Kegel exercises can help to strengthen the area. Squatting can also help, as long as your body is balanced and you aren’t supporting more of your weight on one leg. However, if your pelvic floor is restricted then the sphincter that controls urination can malfunction and doing strengthening exercises will not help – mostly because a muscle that is restricted cannot fully contract or relax. It would be the same as trying to squat heavier if your quads, glutes or hamstrings were super tight. You aren’t going to get any stronger and you’ll likely end up hurting yourself.
So how can you tell if you need strengthening or release? As I’ve already mentioned, restriction can happen for many reasons. One of the most common is that your pelvis is out of alignment, which means one side is higher or lower or pulled more forward or backward (or a combination of any of these) than the other side. This imbalance will put strain on some of the pelvic floor tissues and slacken others. The longer your pelvis is misaligned, the more problems you are going to have.
Your pelvis is the foundation of the body – if it’s not balanced and solid, the rest of your body has to compensate for that imbalance which can result in problems with your hips, knees, ankles, feet, back, neck and shoulders (or anywhere else!).
So how can these problems be addressed? There are several ways to tell if your pelvis is misaligned. You can stand in front of a mirror or take a picture of yourself and look closely at the height of the top of your pelvic girdle (iliac crests). Is one higher than the other? Take a picture of yourself from the back (it helps to be wearing minimal clothing so you can see your bony landmarks) and look for a difference in position of the dimples in your lower back (PSIS). They should be even. You can take a picture of yourself from the side and see if you have a lot of curve in your lower back, or lay on a hard surface and see if your lower back touches the floor. (It should.) You can also lay face down with a foam roller under your hip bones. If they are uneven, you will feel one on the roller more than the other.
Rebalancing the pelvis is usually a matter of releasing the restricted tissue that is pulling the bones out of position. A chiropractor can adjust the pelvic misalignment but if the soft tissue restriction is not released, the skeleton will just return to its restricted position. By putting sustained, firm but gentle pressure into the restricted tissue, you will cause that tissue to soften and return to its natural state. Soft tissue should be just that – soft. Any area that is hot, hard or tender is an area of restriction and needs some attention before it causes problems elsewhere in the body.
Massage might make you feel better initially, but its effects are very short term because the therapist is just sliding over the problem. Active Release Therapy, Rolfing and Structural Integration are all forms of myofascial release and can be effective to some degree, but they tend to be quite aggressive and don’t apply pressure long enough to create a release that is going to last. Besides, you wouldn’t want aggressive techniques applied in such a sensitive area! I have experienced all these modalities (externally) and have found that JFB-MFR is the most effective method of truly releasing soft tissue restriction, which is why I have chosen to specialize in it.
So if you are experiencing exercise-induced incontinence or incontinence at any time, or any other “female problem”, find a therapist trained in JFB-MFR or a physiotherapist trained in pelvic health and see if a minimally invasive treatment will solve your problem. There are some cases in which surgery or medication might be necessary, but they should be a last resort. Often surgery can create other problems because the procedure will leave scar tissue in the area and that will also need to be released. Your therapist will also be able to give you some self-treatment options to maintain the results you get from treatment.