CrossFit Asks "Do You Pee During Workouts?" We've Got Answers

pic courtesy of alustforfitness.blogspot.com

Sooo….this happened. . Female CrossFit athletes happily declaring that they pee during a workout. A Gynecologist offers her medical advice “It’s OK to pee during double-unders!” 

You can even get a t-shirt now in case you want to let folks know who may have missed the viral video. Peeing during a workout was offered as a badge of honor, a sign of intensity.
Many of my colleagues have written blog pieces (and here) in hopes of reaching the CrossFit community to say….peeing on yourself while working out isn’t a good thing, consider other measures proving intensity and your athleticism, please let us help, and it really doesn’t have to be that way. The message: You can workout and not leak. The proof: There ARE women who do CrossFit and other forms of high level fitness that do not leak.
Where’s their video? High fiv-ing their pelvic floors ability to participate in central stability, support movement and maintain continence simultaneously during a box jump?! Let’s celebrate that as normal! Where are they, who are they and what can we learn from their ability to participate at such a high level of fitness and weight training without leaking to help those that do?
The national average is that 1 in 3 women leak. In one study, 291 elite female athletes competing in a variety of sports from basketball to ballet were surveyed regarding their history of urine loss during participation in their sport or day to day activities. 151 reported leakage of some kind. That is 1 in 2. Despite the prevalence, this issue is only recently beginning to be discussed. And now thanks to CrossFit HQ, this issue just went viral.
So while the video has taken some serious heat, it has given huge visibility to an issue that really has needed to come to light for a long time. It is an unprecedented opportunity for us to address this issue not just in CrossFit, but in all fitness pursuits. To broaden the focus of incontinence ideas from little old ladies and postpartum women to include male and female athletes. To broaden our understanding of pelvic floor function, dysfunction, our current treatment options and their efficacy in this population. And we hope…generate some new ideas.
To that end, Antony Lo and I developed a survey to start to gather information from the Crossfit population. We hope it will help us understand how many CrossFitters are having pelvic floor dysfunction, which exercises make their symptoms worse, how they have attempted to manage it either through treatment or behavioral changes and more. Please check it out and give us your feedbackhttps://www.surveymonkey.com/s/FC2VZQB . We need feedback from both those that do and do not leak! We hope this is a first step towards understanding the issues at a greater level, to create better treatment and training approaches,  and to educate athletes, coaches, therapists, and trainers on symptoms to look for, what those symptoms might mean for participants, and how to help.
We have had some early results! Please understand this is raw data, we are still getting feedback so the numbers will change, and we are still trying to understand what the answers are telling us. But there have been some interesting trends emerging that are worthy of note and I wanted to share.
Some numbers so far (percentages are approximate and reflect the percentage of respondents only):
60% of respondents reported leaking urine during exercise (higher than the national average). 13% sought treatment for leaking.
75% reported various joint pains.  65% sought treatment for pain issues.
Comment: This contrast in treatment  seeking reinforces that we know to treat our pain, we know this is a signal that something is wrong. Incontinence  does not get that same attention. Whether that is due to a tragic sense of acceptability among women, lack of education or embarrassment, we cannot know for sure. However, incontinence should be viewed as simply another signal that needs to be considered and addressed the way we would an ache or a pain.

~ Of the 65% that sought help for their joint pains, only 11% were questioned by the treating practitioner if  they had any symptoms of pelvic floor dysfunction.
CommentWe have some work to do to educate rehab and medical pros about the contribution of the pelvic floor to central stability mechanisms that have a role to play in supporting central and peripheral joint mechanics.

60% tried Kegels to address their symptoms. 40% noted symptom relief with Kegels. The other 60% reported either no relief (20%), or they “didn’t know” (40%). 0% reported pain with Kegels.
Comment: While not a glowing endorsement of Kegels in this population, it is  actually a higher success rate than I was expecting. However, it is the “I don’t know”s that are the most striking to me. I am not sure if this speaks to  lack of education, lack of consistency, or lack of ability to know if they are doing it right. But it simply gives me pause.

79% could retain a tampon. 11% had pain with inserting a tampon
CommentTampon retention is higher than I expected as this is a common sign of  pelvic  organ prolapse which is often aggravated with lifting heavy loads. Interesting don’t you think? Those reporting pain with insertion, and pain with sex (7%) may speak to high tight pelvic floors in this crowd, a lower number than I expected.

But I have saved my two favorites for last! 
4% thought that leaking with exercise was normal.
Comment: This is a HUGE contrast to what the viral video would have you believe! This may be the most important number we have revealed so far….the prevailing attitude among those CrossFitters surveyed is PEEING DURING WORKOUTS IS NOT NORMAL! 

80% of respondents said “YES, we would be interested in a program that integrates the pelvic floor into their workouts.”
CommentSo we end on a HUGE high note! Not only does the community recognize this is not normal…they are very open to learning how to integrate the pelvic floor into their workouts. Hallelujah!

So to that 80% out there I offer some early steps to integrating the pelvic floor into programming. You must first understand how the pelvic floor functions, it does a lot more than just squeeze and hold like a Kegel. You also need to know how to find it, particularly the elusive front half that helps stop the leaks. Please check out the Fit Floor video  series Part 1- Part 3 on my website for some ideas to get you startedhttp://bit.ly/127nzp4 .
My partner in crime Antony Lo wrote an excellent piece that had CrossFit specific suggestions to how to change your workout NOW to help.
We also want to get you in touch with a local physical therapy provider in your area for an assessment and suggestions. Check out the following Find a Physio links:
UK: http://www.csp.org.uk (Middle of homepage)
For professionals training and treating athletes there is more info here on how to begin to understand and integrate the pelvic floor as a part of the central stability team. I also offer courses addressing integration of the pelvic floor into programming from rehab to a return to fitness.
80% people, 80%. CrossFitters have spoken…they are ready and willing to change this. 80% of CrossFitters want to star in our video of non-leaking, high performance athletes. Let’s do this!

contributed by Julie Wiebe BSc, MPT

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