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Why You Still Leak Urine Even Though You’re Pilates Queen

So you do your pilates every week, maybe multiple days per week. You know you have a solid and strong core.Your back and hip pain went away when you started doing pilates.

These are amazing things but guess what. Typically people who do pilates have really great activation of the Transverse Abdominis muscle and also can control and coordinate the glutes.

However, what I see time and time again is that people who do Pilates have very tight and shortened pelvic floors. What this means is that the pelvic floor doesn’t relax and elongate. So if you walk around with this muscle also working and in a contracted state.

Last week I got to have a conversation with a really close friend of mine who owns a PT practice and a huge pilates studio. She is the master of all cores. She is what you would think of as optimal health. But guess what, the last 3 times we have been together she has mentioned how she needs my help because she is leaking urine and can’t feel herself doing a kegel. This has now been going on for over three years!!!!!! She confided that even during our meeting she peed a bit when she coughed. She has stress urinary incontinence and NO she has not had kids.

I have so many things to say about this. And I am going to share all the advice and reasons why this could be happening to her. But first let me give you a back story.

Three years ago she went through a divorce, navigating a business through covid, fell on her tail bone which finally started feeling better after about 1 year of consistent PT and through all of this she has maintained a strong dedication to her pilates exercise practice.

First, let’s go back to common patterns that show up in people who do pilates:

1. Tight Pelvic Floor Muscle
2. Shortened Pelvic Floor Muscle
3. Decreased Range of Movement of the Pelvic Floor Muscle
4. Changes in the Pelvic Floor Muscle tissue after being tight for so long, including the quality of the muscle turning into a beef jerky like texture
5. Decreased blood flow in the Pelvic Floor muscle

So this pattern of tightness is not conducive to a healthy pelvic floor. A strong, healthy, coordinated pelvic floor can do three things:

1. Contract
2. Relax
3. Bugle or over stretch

When we consistently overtrain the contraction like in Pilates we have to make sure to relax these muscles. But often these muscles are really hard to connect to and to therefore control the relaxation. Some studios will train the relaxation which is fabulous. My suggestion is to go home and stick your finger right inside the vagina and see if you can feel yourself go through all of these movements.

Pilates in my opinion is one of the BEST exercises you can do for core strength and feeling supple as you age. But it is absolutely imperative that you learn how to relax these muscles and because most people are so tight, honestly getting pelvic work done to stretch these muscles is very beneficial. This will help you strengthen the pelvic floor, you read that right, OVERSTRETCHING THE PELVIC FLOOR is the KEY to strengthening the pelvic floor. This helps you work in a new range of motions when you’re doing your pilates or core strengthening of your choice.

So let’s get back to the possible issues my super fit pilates queen friend was experiencing. The reasons that she is having incontinence (I can tell you without even evaluating her pelvic floor, as I have done this so many times and the patterns don’t change)

1. She hasn’t spent adequate time relaxing and “downtraining” her pelvic floor to open and over stretch with ease, instead she has spent tons of time tightening and contracting.

2. She fell on her tailbone, when this happens, your tailbone goes into what we call a counter-nutated position, meaning the tip of your tailbone points towards your anus and vagina more aggressively. This causes reactive spasms of the pelvic floor further tightening the pelvic floor muscles. Yes she had some external massage and manual therapy to the tailbone, but to help correct the position, oftentimes intra-vaginal muscle releases are required to allow the tail bone to relax back into its normal position. Sometimes it takes intra-rectal (placing a finger in the anus and pulling the tailbone back into the correct position. She never had any internal manual pelvic balancing or therapy done.

3. She got divorced. The pelvic floor muscles hold and store emotion. When a stressful experience or event takes place, we tend to jump into a sympathetic nervous system response and our muscles tighten and they are ready to fight! Well oftentimes with the pelvic floor, these muscles forget to relax or need more conscious instruction to relax. When you go through chronic stress and all the emotions that come with divorce, your body tends to hold this stress in the pelvic floor muscles and don’t let go.

We have now established where the tightness has come from. But now, let me tell you what happens when you have very tight pelvic floor muscles. When you jump, cough or sneeze, because these muscles are already fully contracted, they can not contract any further to seal off the urethra, where the pee comes out. So therefore, the increase in pressure, with a cough or sneeze, causes some or lots of urine to sneak out.

Another thing that we see in clinic, is that chronic tightness often leads to a condition called pelvic organ prolapse. When this tightness persists, the bladder often falls below the pelvic floor, the muscles have constricted so much that the bladder (anterior wall of the vagina), tends to sneak down below the third layer of the pelvic floor muscles. This then increases the urinary incontinence and inability to control holding your pee.

It is honestly a quite simple fix. Make space for the bladder to go back into place by relaxing every single tight muscle, ligament and fascia within the pelvic floor. Then learn how to make sure you know how to keep these muscles relaxed and then train and coordinate them to contract and relax during your normal movements in life and especially in your preferred exercise or fitness class like Pilates.

So there you have it!

Reach out today to get your Pelvic Wellness Check and make sure your muscles and core are as strong as humanly possible, so you don’t end up leaking urine or worse, end up with a pelvic organ prolapse. There is so much prevention that we can do! Don’t settle for the bladder meds that your doctor prescribes you, it won’t change what’s happening in your vagina and by the time you reach your 60’s or 70’s you’ll still have these issues and the drugs may no longer work.

Want to learn more listen to this podcast “What you don’t know about your vagina”


Allison Feldt

Body Motion Physical Therapy

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