# Why is incontinence during sport still a big taboo
There is a topic that troubles hundreds of thousands of active people, yet it is almost never discussed. If you have ever experienced urinary leakage during running, jumping, or intense exercise, you are not alone - and you are certainly not an exception. Incontinence during sport is a phenomenon that affects both women and men across all age groups, yet it remains one of the greatest taboos in the modern fitness world. While topics like nutritional supplements, recovery, or proper squat technique are openly discussed, most people quietly pass over this subject, shrouded in shame that has no justification whatsoever.
According to data from the International Continence Society (ICS), approximately 200 million people worldwide suffer from some form of urinary incontinence. Experts estimate that the actual number is even higher, as a large proportion of those affected never report their condition to a doctor or mention it in everyday conversation. And sport is one of the most common situations in which the problem manifests itself - an innocent jump during aerobics, a sprint at the end of a race, or a simple cough after an intense workout can cause an unpleasant surprise.
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Why does it actually happen?
To understand the problem, it is helpful to know what happens in the body during physical exertion. The pelvic floor is a group of muscles and ligaments that form a kind of hammock at the bottom of the pelvis. These muscles hold the bladder, uterus, and intestines in place and regulate the flow of urine. With every jump, cough, or sudden movement, intra-abdominal pressure rises sharply - and if the pelvic floor is not strong enough or coordinated enough to manage this pressure, urinary leakage occurs. Medically, this condition is called stress incontinence, where the word "stress" does not refer to psychological pressure, but to physical exertion.
Women who have given birth are most commonly affected, because pregnancy and childbirth significantly weaken the pelvic floor. According to a study published in the British Journal of Sports Medicine, up to 41% of women who exercise regularly report experiencing urinary leakage during physical activity. Surprisingly high numbers also apply to elite female athletes - gymnasts, track and field athletes, or CrossFit competitors - who, by general assumption, should have a pelvic floor in perfect condition. The opposite may in fact be true: intense and repeated physical exertion without conscious pelvic floor strengthening can worsen the situation.
Men are not an exception either, although male incontinence is discussed even less. In men, the most common cause is prostate surgery, but chronic cough, obesity, or simply age also play a role. The male fitness world is particularly closed off to this topic - admitting such a problem in a gym changing room would be unthinkable for many men, and that is precisely why many of them reduce their sporting activities or stop exercising altogether, rather than seeking help.
Imagine a forty-year-old mother of two who, after years of sedentary work, decides to take up running again. She buys new shoes, downloads a training plan app, and enthusiastically heads out for her first session. But after a few hundred metres, she discovers that every footstrike causes a small but uncomfortable urinary leak. The shame and frustration are immediate. Instead of acknowledging the problem and seeking a solution, she starts putting off running and eventually gives it up entirely - without even mentioning it to her gynaecologist at her next appointment. This scenario is not exceptional. It is the everyday reality of thousands of people.
The taboo surrounding this topic has very concrete consequences. People restrict their movement, avoid social sporting activities, and live in constant fear of an embarrassing situation. Paradoxically, regular exercise - performed correctly - is one of the most effective ways to improve or completely eliminate incontinence. Inactivity only deepens the problem, as weakened muscles without training continue to deteriorate.
How to deal with incontinence during sport?
The good news is that stress incontinence is in most cases highly treatable, without surgery or medication. The key is targeted pelvic floor strengthening, known among specialists as Kegel exercises - named after American gynaecologist Arnold Kegel, who described them in the 1950s. The principle is simple: conscious contraction and relaxation of the pelvic floor muscles, repeated regularly, gradually restores their strength and coordination.
But how do you perform a Kegel correctly? Simply put, it involves contracting the muscles as if you were trying to stop the flow of urine - holding this contraction for several seconds, then releasing. It sounds simple, but according to physiotherapists specialising in the pelvic floor, up to a third of people perform this exercise incorrectly, for example by contracting their gluteal muscles instead of the pelvic floor, or by holding their breath. This is why at least an initial consultation with a physiotherapist specialising in urogynaecology is ideal - they can use biofeedback to verify that the exercises are being performed correctly.
In addition to classic Kegel exercises, there are a whole range of approaches that can help. Pilates and yoga focused on the pelvic floor are increasingly popular methods for connecting body awareness with strengthening the deep stabilising system. Hypopressive exercise - a technique that combines specific breathing with postural positions - has been attracting the attention of specialists in recent years as a complement to traditional pelvic floor rehabilitation methods.
As physiotherapist and author of books on the pelvic floor Katy Bowman once said: "The pelvic floor is not an isolated problem - it is a reflection of how the whole body functions and moves." This perspective reminds us that incontinence during sport is not merely a localised muscular problem, but part of a broader picture of movement patterns, posture, and overall fitness.
An important part of approaching incontinence is also choosing the right sports equipment. The market offers absorbent sports underwear and pads designed specifically for physical activity - they are thin, discreet, and allow people to continue moving without worry. This is not a surrender to the problem, but a practical solution that gives people the freedom to move without fear while they work on long-term improvement. Just as a diabetic uses insulin while also adjusting their lifestyle, here too it is about combining an immediate solution with long-term work on the underlying cause.
Lifestyle changes also play a significant role. Being overweight considerably increases intra-abdominal pressure, and even modest weight loss can bring visible improvement. Smoking causes chronic coughing, which places long-term strain on the pelvic floor. Excessive consumption of caffeine and alcohol irritates the bladder and impairs its control. These changes may not sound revolutionary - but their combination with targeted pelvic floor exercises can produce results faster than most people would expect.
How sport itself is performed also plays a crucial role. Certain activities place more strain on the pelvic floor than others. Trampolining, CrossFit, heavy weightlifting, and intense aerobics are among the disciplines with the highest risk of urinary leakage. This does not mean they need to be abandoned entirely - but it is sensible to start gradually, pay attention to breathing technique (exhaling during peak exertion significantly reduces intra-abdominal pressure), and consult a physiotherapist about a training plan if incontinence is significant.
Swimming and cycling, on the other hand, are activities that place almost no strain on the pelvic floor and are a suitable starting point for those who want to remain active during rehabilitation. Walking - especially brisk walking in nature - is another excellent compromise between movement and sparing the pelvic floor.
The psychological dimension of the whole topic must not be overlooked. Shame and silence around incontinence during sport mean that people delay visiting a doctor by an average of six to seven years from the first symptoms - as stated in research published in the specialist journal Neurourology and Urodynamics. Six to seven years of living with a limitation that could be addressed. Six to seven years of giving up movement that brings joy and health. This is precisely why breaking the taboo around this topic is itself a therapeutic step - because the first condition for a solution is acknowledging that the problem exists.
Fortunately, the situation is slowly changing. A growing number of sports influencers and competitors are choosing to speak publicly about their experiences with incontinence. British Olympic athletes and other elite sportswomen are helping to bring the topic into mainstream media. In the Czech Republic, physiotherapists specialising in the pelvic floor are beginning to offer specialist courses and workshops, and awareness is gradually reaching prenatal and postnatal programmes in maternity hospitals.
Nevertheless, there is still much ground to cover. Incontinence during sport should be part of standard care - so that it is discussed at gynaecological check-ups, with general practitioners, and in urologists' offices, before the patient themselves finds the courage to raise the issue. Just as naturally as back or knee pain after sport is discussed, the pelvic floor should be discussed too - because it is a set of muscles like any other, requiring care, training, and attention.
Movement is one of the fundamental pillars of a healthy lifestyle. It would be a tragedy to let it be undermined by a problem that has a solution - simply because we are afraid to talk about it.
