Commentary: Leaking While Lifting? (Part 1)

Perhaps you’re reading this article because you’re a female powerlifter who has experienced some sort of leaking while lifting. You could also be a coach reading this article to help address this issue for your female athletes. This article is targeted at the lay powerlifter, so medical jargon and expressions will be toned down. Even so, there are still some terms that I hope everyone will have a chance to learn to increase their knowledge in this area.

It is always helpful to have a disclaimer before proceeding. I am a student physiotherapist, not yet trained as a women’s physiotherapist. Most of my understanding about the pelvic floor comes from research and inference from available literature. Feel free to contact us at enso.powerlifting@gmail.com if you have further questions. 

What is the pelvic floor?

The pelvic floor is a hammock-shaped structure comprising muscles, ligaments and tissue. This structure is located at the bottom of your hip to support the organs sitting within your hip bones. These organs include your bladder, womb and bowel; they are also termed as pelvic organs. The pelvic organs exit the body through your urethra (you can’t really find this when you look down), vagina (vulva is the part you see) and rectum (anus is the part you see), and are surrounded by the pelvic floor muscles.

Figure 1: Diagram of pelvic floor and hammock. (Photo credits: www.burrelleducation.com)

What is the function of the pelvic floor?

At rest, the pelvic floor muscles (i.e. levator ani) together with the urethral and anal sphincter muscles, which are composed of predominantly type 1 striated muscle fibres, maintain a constant muscle tone (constant muscle contraction) to keep the bladder and bowel exits closed. This is one of the main reasons why we don’t walk around leaking pee and poop everywhere.

Thus, the pelvic floor helps you to control your need to pee, hold your pee when you are coughing or jumping, hold your fart/poop in public, force your pee/shit out when you are in a hurry (not ideal, please stop doing this, I’m watching you) and reach sexual arousal/orgasm.
Figure 2: Diagram of intra-abdominal cavity. (Photo credits: www.burrelleducation.com)
 These activities, particularly coughing and jumping, puts additional physical stress on the pelvic floor and its innate muscle tone is not enough to counter the forces pushing down. This physical stress is the result of the increased intra-abdominal pressure (IAP) generated during these activities. Hence, the pelvic floor is often co-activated in anticipation of and during these activities as a form of reflex action. Some people may be able to contract the pelvic floor muscles voluntarily during these activities to further counter the increases in IAP.

Why is it bad to force your pee/shit out when you are in a hurry?

This action is called “straining”. When you strain, you are directly applying pressure on your bladder and bowel to excrete your pee and poo. When this has been practiced for prolonged periods, one would grow accustomed to the sensation and strain when asked to contract the pelvic floor. Also, given the amount of practice straining, these women would be prone to strain at times of high IAP and experience leakage.

An advice I would give regarding this is to fully relax when you have to go. Also, do not disrupt the urine stream like how most instructions to contract the pelvic floor are given. This may disrupt the fine neurological balance to complete urinating.

So how should I contract the pelvic floor?

Let’s first try locating the pelvic floor in you. If you take your hand and slide it down from your belly button, you’ll reach a bony point, this is your pubic symphysis (sim-firh-sis). Then, slide your finger down your butt crack and you’ll feel your tailbone, this is your coccyx (kok-six). For the third and fourth points, sit on a hard surface and lean your body slightly sideways. You will feel the bones underneath your butt cheeks, which are your ischial (Eee-sh-iel) tuberosities. These are the four points that your pelvic floor attaches like a hammock horizontally to support your pelvic organs.

You’ll need to focus on directing your efforts down south. You can do this by sitting on a chair with a back rest or lying down on the floor with your knees bent. Relax in that position by closing your eyes and concentrating on the region by paying attention to the blood flow, temperature and the feeling of clothes against your skin. Bringing your attention to the vagina, think of closing the entrance of the vagina and lifting it up. You shouldn’t be feeling as if your stomach is pushing down onto your pelvic floor and the glutes, quads, hamstrings and abs should remain relaxed.
 Several analogies/cues for pelvic floor contraction include imagining that you are:
  • Sucking a blueberry into your vagina
  • Bringing your anus closer to your vagina
  • Plucking a tissue with your vagina
  • Trying to stop your fart in public

For more information, please visit thepelvicfloorproject.com.

What next?

Stay tuned for our next article(s) on what happens when the pelvic floor does not function properly, what is urinary incontinence (UI) and how to manage it!

Further questions? Feel free to contact us at enso.powerlifting@gmail.com. You may also contact the writer of the original article, Aleen Tan, over here.

This article and commentary first appeared on ENSO Powerlifting, on May 18, 2020.

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