And by "some people," I mean me.
Jacques Van Zyl / Stocksy
I thought that I outgrew an uncontrollable bladder at age five but, unfortunately, in recent years I've found that I have not. Within the span of my college track career, I found that during my most intense workouts and races, I'd pee in my shorts/spandex. It wouldn't happen on every ordinary practice run—only on the ones when I exerted my most intense physical effort. But that was often enough to freak me out.
I never even realized that I lost control of my bladder until after I was across the finish line. I was too focused and exerting too much effort at the end of the race to notice. Immediately afterwards, I'd rush to the nearest restroom with a fresh pair of shorts to change into. If my teammates did notice, no one said anything to me about it, probably because it's not exactly necessary or comfortable to tell a 20-something-year-old peer that she peed herself. She knows.
It didn't take me very long after I started having the problem, though, to realize that this was actually an athlete-related thing. A lot of other ladies on my team had the same exact problem. Soon we were swapping post-race pee horror stories and laughing at this unfortunate yet truly comical situation.
"The first time I ever realized I was having bladder issues was during a race," says Audrey Michaelson, a senior division I cross country and track athlete at Loyola University in Chicago. "It was actually one of the best track races of my life. I was racing 800 meters, and, through the first lap, I was feeling strong. I started to kick with 200 meters left. I was flexing all my muscles while sprinting down the final stretch on the track, and I couldn't feel anything. Every time I took a step, I felt like my bladder was releasing and I couldn't hold it in."
It wasn't the last unexpected race leak for Michaelson, either.
"Usually now I get to a point in a race or workout when I'm in overdrive, and it happens again. Actually, it happens a lot now when I'm all-out sprinting," Michaelson says. "Once your bladder contracts, it's hard to stop it."
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After doing a little research, I found out that athletes everywhere—especially female athletes—have been dealing with this problem for quite some time. In a 2001 study in which almost 600 women on the Norwegian national team were surveyed, researchers found a "high prevalence of stress and urge incontinence" that the female elite athletes recalled—in other words, they experienced exercise-induced bladder leakage.
Now that I had a proper term to call the condition I formerly referred to as "unable to control my pee when working out really hard," I wanted to know more about the science behind why this strange occurrence keeps happening to me and other athletes, specifically women. I also wanted to find out if there's is anything I can do to prevent another spontaneous piss-fest the next time I'm going all out in a race or doing pull-ups at the gym.
"The bladder is shaped like a pear, and the sphincter—the muscle that keeps the bladder closed to store urine until it's appropriate to release it—is at the bottom of the pear," says Hillel Marans, a urologist at Mount Sinai in New York. "When you stress the bladder by pushing on it, you're squeezing the top of the bladder."
The sphincter needs to be tight enough because when the muscle is loose, SUI occurs, he tells me. In other words, loose muscles down there ups your chance of unanticipated waterworks. Especially if you're giving it your all on the track that day. "The more stress you place on the body, the more stress you're placing on your pelvic floor," says Mary Plummer, a Milwaukee-based occupational therapist and pelvic muscle dysfunction specialist.
Experts tell me that women are the ones who stress their pelvises the most, which is one of the factors that makes them more prone to SUI. It seems to hit us the hardest, in a large part due to the fact that we're potential babybuckets. After childbirth, by the way, a woman's pelvic muscles will never be the same again.
"When you give birth, you stress all the muscles near your pelvis," Plummer says. "Your nerves are stretched, and, in turn, your muscles have less current going to them. You can build the muscles you have left, but they'll never quite be as strong as they once were."
Another fun thing for me to look forward to: Weakened pelvic muscles are also commonly found in aging women. Women's muscles are affected by estrogen, and their muscle functions start to deteriorate when they are older because they lose that estrogen. "Typically we see SUI in older women who have gone through menopause, but another common group we see SUI in frequently is younger women who are really stressing their body," Marans says.
This explains why my college teammates and I commiserated about bladder leakage not just at the end of hard running workouts, but also when we were lifting weights. Marans tell me men fare a little better in this scenario, though. Since they tend to be more muscular than women, they have more muscle support for their internal organs, which means better bladder control. Men still can lose control, though. "If men have prostate surgery, they no longer have outlet resistance, just like women don't have outlet resistance, and then they're more prone to SUI," Marans says.
You'll fare better in an unexpected bladder rebellion if you work to strengthen your pelvic floor. Women will inevitably internet stumble upon these little vaginal weights that you can stick in like tampons while you're doing your pelvic strengthening exercises. I, for the record, am not recommending those since there isn't any good science behind them. And honestly, they look more than a little suss.
Both men and women can try kegels, on the other hand, which require no foreign objects and have been endorsed by experts. "Kegel exercises are key when strengthening your pelvic floor and preventing SUI," Marans says. "It's all about tightening up the sphincter muscle. In some very severe cases, we do surgery to tighten up the neck of the bladder, but most of the time we teach patients proper strengthening exercises."
Don't rush through these. Squeezing your muscles and holding that position for a second won't do much strengthening. No one wants to have surgery, so if you can combat the problem before surgery is the only option, do it and do it right. A urologist or occupational therapist can brief you on how to do these exercises most effectively.
"Female athletes in particular should definitely be doing regular pelvic exercises," Plummer says. "Women [and men too] who know they have SUI should seek help. If you know you have a problem, you'll want to be able to correct that problem before it gets out of hand. If you don't correct it, pelvic surgery really will be a necessity."
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