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Why Does Lifting Weights Cause Leakage?

Hi friends! There has been a popular video gaining attention lately on social media of an individual lifting heavy weights and having significant urinary leakage. While it may not have been this severe, this may have happened to you or someone you know, too—even just a few drops. Let’s talk about why this happens, what may be the cause, and how to treat it.

Stress incontinence is the term used for urinary leakage with exercise along with other activities that causes excess pressure on the pelvic floor, like sneezing. Millions of people are affected by urinary incontinence and have feelings of embarrassment, frustration, and fear.

Our core muscles are like a box. There are 4 main groups of muscles that make up all four sides of the box. The abdominal muscles in the front, the back muscles in the back, the diaphragm on the top, and the pelvic floor on the bottom. Activities like lifting weights can often cause a change in the pressure within this box because the muscles are engaging on all sides to provide stability.

With light objects this often isn’t a problem, but as weights get heavier these muscles work a little bit harder. Think of the box like a piston—if all four sides are squeezing in at once it will increase the pressure. This causes the pelvic floor muscles to work harder to keep urine in. If the pelvic floor muscles do not have a good, strong closing pressure you may see leakage.

The heavier the object or weight you are lifting, the more strength we need from the pelvic floor muscles to withstand the pressure and keep pee in.

There are several different factors that can change the pressure without our box. Wearing a weight lifting belt can be beneficial, but dependent upon the belt and how tight you wear it, you may notice your abdominal and back muscles are restricted. This means we may have more pressure going up (towards the diaphragm) and down (towards the pelvic floor). If we have extra pressure being put on those muscles, we may have leakage.

Another common habit with lifting weights is holding our breath. We often hold our breath when doing something heavy. As we hold our breath, our diaphragm maintains constant downward pressure from the top of the box. This means that more pressure is being put on those pelvic floor muscles and they need extra strength to be able to keep urine in.

Other factors that can affect leakage with exercise include hip and core strength and our form with lifting. Weakness in other areas of the body or poor form with the exercise can cause other muscles, like the pelvic floor, to work harder than they were intended to.

So, how do we treat stress incontinence with lifting and exercise? The #1 recommended treatment is pelvic floor therapy! A pelvic floor therapist should perform a thorough evaluation to assess how your entire body is working. They will check the strength and flexibility of your hips, back and abdominals, legs, and the pelvic floor. Depending on what they see, a pelvic floor therapist will develop an individualized treatment plan to address your specific needs. They can help you train the pelvic floor muscles to make them stronger. They can help teach you proper breathing techniques to take extra strain off of the pelvic floor. They can assess your form with lifting heavy weights and help you strengthen any weak muscles like the hip rotators or abductors.

Along with assessing the muscles of your body and how you move, a pelvic floor therapist can also discuss bladder and bowel habits, what you eat and drink, and what you do for exercise to see how it may be impacting your leakage.

You can ask your provider for a referral to a pelvic floor therapist near you, or find one at

Some individuals have found internal supports like a pessary, Poise Impressa, or sponges, to be helpful when exercising. These supports are inserted into the vagina to provide support to the bladder.

To learn more about the pelvic floor muscles, check out these great resources:

For providers, check out our online courses to help your clients. Consider joining our Ambassador Program and most of our courses are included with your membership!

Written by Emily Reul, PT, DPT

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