If you've ever finished a run with a damp patch, crossed your legs before a box jump, or quietly skipped the skipping section of a class, this is for you. Leaking during exercise is one of the most common things I see in clinic, and one of the least talked about. Women tell me they've been managing it with dark tights and a spare pair of undies for years, that they've stopped doing the sprint sessions, and that nobody ever told them it could be treated.
Leaking when you exercise is common. It isn't something you have to put up with, and in most cases it responds very well to the right training, done in the right order.
Why do I leak when I run, jump or lift?
The kind of leaking that happens with impact or effort is called stress urinary incontinence. “Stress” here means mechanical load, not the emotional kind. Every time your foot hits the ground, or you brace to lift something heavy, pressure inside your abdomen spikes. Your pelvic floor muscles, the sling of muscle that supports the bladder, uterus and bowel, are supposed to tighten a fraction of a second before that spike so the urethra stays closed. If the muscles are weak, slow, fatigued, or not coordinated with your breath and your bracing, some urine gets pushed through.
Running is worth looking at on its own, because a 2024 study from Linda McLean's lab at the University of Ottawa measured what a run actually does to the pelvic floor. After a 37-minute treadmill run, the levator hiatus (the opening in the pelvic floor muscles) was larger, the bladder neck had dropped lower, and the levator plate had lengthened. That happened in runners who leak and in runners who don't. The muscles' strength and power, measured with a dynamometer, hadn't changed. So running puts a real, measurable, temporary strain on the supporting tissues, and what separates the women who leak from the women who don't is not simply how strong the muscle is.
That matters because it changes how we treat it. Strength is part of the answer. Timing, endurance, pressure management and load tolerance are the rest of it.
How common is leaking during sport?
More common than most people think, and not only after having babies.
A 2018 systematic review and meta-analysis of female athletes found a pooled prevalence of urinary incontinence of 36 per cent, and athletes had a 177 per cent higher risk of leaking than sedentary women. Kari Bø's classic review of the topic put the range in young women who had never been pregnant at anywhere from zero per cent (golfers) to 80 per cent (elite trampolinists), with the highest rates in high-impact sports like gymnastics, track and field, and some ball sports.
Strength sports are not exempt. A 2025 systematic review of 1,809 female powerlifters and weightlifters found urinary incontinence in 41 to 49 per cent of powerlifters and 37 to 54 per cent of weightlifters. Deadlifts were the lift most associated with leaking (42.5 per cent), followed by squats (36.3 per cent). Age, having had children and body mass index were the main associated factors.
Across the general population, Continence Health Australia reports that almost four in ten Australian women experience incontinence, and one in three women who have had a baby leak afterwards. If you're a runner, a netballer, a lifter or a mum returning to the gym and you leak, you are in a very large and very quiet club.
Is running bad for your pelvic floor?
No. Running is not bad for your pelvic floor, and I don't want anyone reading this to hang up their shoes.
What running does is load the pelvic floor, in the same way it loads your calves and your knees. A pelvic floor that has the strength, endurance and reflex timing to meet that load copes fine. A pelvic floor that doesn't will let you know, usually with leaking, heaviness or a dragging feeling, or pain. Treat that as information, not a verdict. It tells us the load is currently more than the system can manage, and the job is to close that gap from both ends: build the pelvic floor's capacity, and temporarily adjust the load while we do it.
I take the same view here as I do with prolapse. Fear and avoidance cost women far more over a lifetime than a well-managed return to impact. Strong and powerful is the goal.
Does lifting weights weaken your pelvic floor?
Lifting weights doesn't weaken your pelvic floor. Lifting weights with a breath-hold and a big brace, over and over, without ever training the pelvic floor to match it, can overwhelm it. That's a different problem with a different fix.
The lifts most linked to leaking are the ones with the biggest pressure spike: deadlifts and squats, particularly at the heavy end and with a Valsalva (holding your breath to brace). I am not going to tell you to stop deadlifting. Heavy resistance training is one of the best things you can do for your bones, your metabolism and your independence later in life. What I'll do in clinic is look at your breathing strategy, your bracing, how your pelvic floor responds when you load up, and whether the bar is currently heavier than your pelvic floor can match. Then we modify and reintroduce. Sometimes that means an exhale on the hardest part of the lift for a while. Sometimes it means a lighter block while we train the pelvic floor specifically. Sometimes it means changing the position, the tempo or the range. Very rarely does it mean “never”.
What are the signs your pelvic floor isn't coping with exercise?
Leaking is the obvious one, but it isn't the only one. In clinic I ask about all of these:
- Leaking urine, or wind or stool, during or after training, often on the faster efforts, the downhills or the last few kilometres
- A feeling of heaviness, dragging or a bulge in the vagina, especially late in a session or by the evening
- Needing to empty your bladder “just in case” before every run, or planning routes around toilets
- Urgency that arrives out of nowhere mid-session
- Pelvic or perineal pain during or after running
- Lower-back, hip or groin pain that doesn't respond to the usual rehab
- Quietly avoiding jumps, sprints, skipping or the heavy days
If any of those are true for you, that's the point to book a pelvic health physio, not the point to Google “runner's bladder” for another year.
How do I strengthen my pelvic floor for running?
Start with an assessment, because the fix depends on the finding. Some runners have a weak pelvic floor. Others have a pelvic floor that is strong but slow, or one that is already working overtime and needs to learn to relax before it can contract well. Doing hundreds of Kegels when your problem is an overactive pelvic floor makes things worse, not better.
Once we know what we're working with, the plan usually has four parts.
Pelvic floor muscle training. This is the best-evidenced treatment there is for stress incontinence. The 2018 Cochrane review pooled 31 trials across 1,817 women and found that women who did pelvic floor muscle training were eight times more likely to report cure of stress incontinence, and six times more likely to report cure or improvement, than women who did nothing. It's first-line treatment for a reason. The catch is that it has to be done correctly, progressively and for long enough, which is where a physio earns their keep.
The Knack. This is the skill of contracting your pelvic floor a split second before the load arrives: before the cough, the sneeze, the landing. In a study of women with stress incontinence, using the Knack cut cough-related urine loss from a median of 43.2 square centimetres on a paper towel to 6.9, roughly an 84 per cent reduction, and it works from the first day you learn it. For runners we train the same reflex against impact, then let it become automatic.
Endurance and speed. A run is thousands of landings. A pelvic floor that can hold a strong squeeze for ten seconds but can't do quick, repeated contractions for 30 minutes will fatigue and leak at kilometre four. We train both.
Whole-system load management. Your pelvic floor doesn't work alone. Breathing pattern, rib position, glute and hip strength, running cadence and foot-strike all change how much load reaches it. In my experience, small changes to cadence or stride length can take enough load off the pelvic floor to buy you training time while the strength work catches up.
Tools can help once you've been assessed. Weighted kegel balls give the muscle something to hold against and are useful for some women, though they're not right for everyone (I've written about how to use kegel balls safely), and biofeedback trainers are worth it if you find it hard to feel the contraction.
What can I do about leaking right now, while the training takes effect?
Pelvic floor training takes weeks to months to change the muscle. You don't have to stop moving in the meantime, and you don't have to leak through it either.
A support pessary for training days. If you've ever worn a tampon to get through a run, you've already discovered the principle. Contiform is the purpose-built version: a reusable, ARTG-listed silicone pessary that sits inside the vagina and supports the bladder neck. It's designed to help manage stress incontinence symptoms during activity, so a lot of my patients use it for long runs, netball or the heavy days while their training program does its work. It isn't a substitute for the training, but it lets you keep doing the thing you love without planning your route around bathrooms.
A pessary when the problem is support, not strength. Some women leak with impact not because the pelvic floor is weak but because the bladder neck and urethra move too much under load. Remember the Ottawa runners: the bladder neck dropped in every one of them after a 37-minute run. If yours starts from a lower position, or the tissue that normally holds it has been stretched by pregnancy, birth or a prolapse, the urethra can't stay closed no matter how hard the muscle squeezes. Strength training alone won't fix a mobility problem. A pessary gives the bladder neck and the vaginal walls something to rest against, so a normal pelvic floor contraction is enough again. That is why a well-fitted pessary can change things immediately, and why I often prescribe one alongside the training rather than instead of it. If your main symptom is leaking, a bladder-support pessary like Contiform is usually the starting point. If it's heaviness, dragging or a bulge, a prolapse-support pessary (a ring or a cube, fitted by a pelvic health physio or gynaecologist) is the better tool, and plenty of my patients with a prolapse wear one only for training or long days on their feet. Either way, correct fit is essential, so get it assessed rather than guessing a size online.
Compression shorts. SRC Restore shorts provide graduated, medical-grade compression across the pelvis and lower abdomen. Women often tell me they feel more supported through impact, and for anyone returning after a baby they're a sensible bridge back to sport.
Bladder habits. Emptying “just in case” before every session seems logical, but it trains the bladder to signal at smaller volumes and can make urgency worse over time. Emptying once, comfortably, before you start is enough. If urgency is a big part of your picture, bladder retraining is a separate skill and worth learning.
Pads and liners. They are a bridge, not a fix. Use them so you can train, but don't let them turn a treatable problem into a permanent accessory.
Coming back to running after having a baby
If your leaking started after birth, the timing of your return to impact matters. The most widely used guideline, written by Tom Goom, Gráinne Donnelly and Emma Brockwell in 2019, recommends returning to running between three and six months postnatal at the earliest, and only once you can pass a set of readiness tests without pain, heaviness, dragging or leaking:
- Walk for 30 minutes
- Balance on one leg for 10 seconds
- Ten single-leg squats on each side
- Jog on the spot for one minute
- Ten forward bounds
- Ten hops in place on each leg
- The single-leg “running man” (opposite arm and leg, driving through)
The same guideline recommends every postnatal woman be offered a pelvic health assessment from six weeks, and lists leaking, a feeling of pressure or a bulge, ongoing bleeding and musculoskeletal pain as reasons to stop and be assessed before continuing. If you're also managing abdominal separation or wondering whether a belly band or compression garment is the right call, those decisions belong in the same conversation.
When to see a pelvic health physio
See a pelvic health physio if you leak with any exercise, if you feel heaviness or a bulge, if you're avoiding movements you used to enjoy, or if you're returning to sport after a baby or a gynaecological surgery. Bring your training program. A good assessment looks at your pelvic floor, your breathing and bracing, your hips and your running or lifting mechanics, and gives you a plan that gets you back to full training rather than one that tells you to do less forever.
If you're not sure where to start, our weak pelvic floor collection is organised around the problem you're trying to solve, and every product comes with the same clinical context you'd get in my rooms.
References
- Teixeira RV, Colla C, Sbruzzi G, Mallmann A, Paiva LL. Prevalence of urinary incontinence in female athletes: a systematic review with meta-analysis. International Urogynecology Journal. 2018;29(12):1717–1725. doi:10.1007/s00192-018-3651-1
- Bø K. Urinary incontinence, pelvic floor dysfunction, exercise and sport. Sports Medicine. 2004;34(7):451–464. doi:10.2165/00007256-200434070-00004
- Alves ASC, de Araújo MP, Pereira GMV, Brito LGO, Juliato CRT. Influence of powerlifting and weightlifting on female pelvic floor dysfunction: systematic literature review. International Urogynecology Journal. 2025;36(5):955–964. doi:10.1007/s00192-025-06059-4
- Bérubé M-È, McLean L. The acute effects of running on pelvic floor morphology and function in runners with and without running-induced stress urinary incontinence. International Urogynecology Journal. 2024;35(1):127–138. doi:10.1007/s00192-023-05674-3
- Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews. 2018;(10):CD005654. Plain-language summary
- Miller JM, Sampselle C, Ashton-Miller J, Hong GR, DeLancey JO. Clarification and confirmation of the Knack maneuver: the effect of volitional pelvic floor muscle contraction to preempt expected stress incontinence. International Urogynecology Journal. 2008;19(6):773–782. doi:10.1007/s00192-007-0525-3
- Goom T, Donnelly G, Brockwell E. Returning to running postnatal: guidelines for medical, health and fitness professionals managing this population. 2019. Full guideline (PDF)
- Continence Health Australia. Key statistics on incontinence; One in Three Women booklet. continence.org.au
