CrossFit and pelvic floor dysfunction

By Jennifer Watt, PT

​This time of year for Crossfitters is the CrossFit Games season, where it starts with a worldwide event called the CrossFit Open. Hundreds of thousands of people all over the world and of all ages and physical abilities compete in three workouts given across the timespan of three weeks. As someone who has been doing CrossFit since 2018, this will be my fourth CrossFit Open season that I have competed in. CrossFit has become my passion. ​

Now as a pelvic floor physical therapist, I have run into a common situation at my gym. We look up on the white board that has the WOD (workout of the day) and I would see the term “double unders.” Double unders is a form of jump roping where your jump rope must go under you twice. As soon as I see that, I see many of both my female and male buddies head to the bathroom, and in many cases multiple times before the workout starts. 

There is a well known video clip from CrossFit titled “Do You Pee During Workouts?” And when I watched it I got some interesting topics from the CrossFit community. Some say they definitely leak urine during double unders and box jumps. Many basically said it was a part of life as a CrossFitter and simply manage with pads. But is it okay?

As a pelvic floor physical therapist, I would say it is not okay. Peeing when exercising is telling us that there is a problem with our pelvic floor. A normal pelvic floor is simply one that can do all its functions – maintain continence, support the pelvic contents and contribute towards optimal movement during functional tasks. Now there are several reasons why it may not be normal or that there is pelvic floor muscle dysfunction. 

What is pelvic floor dysfunction exactly? Pelvic floor dysfunction is simply where your pelvic floor is not doing its job properly. The pelvic floor is designed to provide support for your pelvic organs, help control intra abdominal pressure, control your urine and bowel movements, and help provide pleasure during sexual intercourse.  One form of dysfunction could be that you have a weak pelvic floor. Common reasons why it is weak are: pregnancy and childbirth, surgery or other medical procedures, posture and behavioral habits, and lack of exercise. Another could be an overactive pelvic floor which is a condition where there may be increased pelvic floor muscle tension at rest, increased voluntary or involuntary contractile activity, or a decreased ability to fully relax the pelvic floor muscles. You could also have a damaged pelvic floor. Your pelvic floor might have been through a lot. Childbirth, cancer and radiotherapy, and other conditions can contribute to tearing, scarring and damage to the pelvic floor muscles. The nerves to the area can be damaged, the muscles themselves can become detached from the pubic bone, scarring from surgery and childbirth can cause asymmetrical contractions.

So what are some things to help? First and foremost, like I said before peeing when working out is NOT normal and should be addressed. Seeing your primary care physician, urologist, gynecologist, and to get a referral for pelvic floor physical therapy. These are health care providers who have taken extensive coursework, some even board certified, on the pelvic floor muscle anatomy and will be able to properly assess your own situation and create a plan specifically for you. Other things to consider, particularly in the realm of CrossFit. Try not to rely on items like lifting belts, braces, wraps, and other means of support. This allows you to really be aware of your physical limitations and hopefully will keep you from moving or lifting something you shouldn’t. Rely on good technique with all movements. Sometimes during these WODs, we push ourselves so much that technique goes out the window. And lastly what ties both the supports and technique is straight ego. Focus and train on your weaknesses and build upon them. If we’re leaking when we hit a certain amount of double unders or box jumps, then make that your target and to slowly build upon that. As I said, leaking during workouts is not normal and one should address it and not let it go.

Pelvic floor symptoms can be the reason that women stop exercising and end up living a more sedentary lifestyle. Don’t let this be you!

Reference used
https://academic.oup.com/ptj/article-abstract/102/3/pzab284/6478875?redirectedFrom=fulltext