Reasons Why Women Leak Urine (And Why It’s Not Just a “Weak Pelvic Floor”)
If you’ve ever experienced leaking urine when you laugh, sneeze, run, or lift weights, you’re not alone. Many women are told that leaking means they simply have a “weak pelvic floor” and that the only solution is to do more Kegels. Or- that leakage is a normal part of being a Mom. But here’s the truth: urinary leakage isn’t “normal” and it is not always about weakness — Doing endless Kegels may not fix the problem (and sometimes can make it worse).
Urinary leakage can happen for many different reasons. Let’s break down some of the most common contributors based on Doc Roth’s experience:
1. Pelvic Floor Tension (Tight Muscles)
Just like any other muscle group, pelvic floor muscles can become too tight. Tension in the pelvic floor makes it difficult for the muscles to contract and relax effectively, which can lead to leakage. It’s like trying to jump with your knees locked — the movement isn’t functional. And if you add Kegels to an already tight and exhausted system, the symptoms just worsen! This is the most common issue the Doc Roth sees, espeically in athletes and weight lifters. Chances are if your hips, glutes, and core are tight- the pelvic floor is tight too!
2. Poor Abdominal Pressure Management
Our core is like a pressure system. If we hold our breath, brace incorrectly, or push pressure downward into the pelvic floor during daily activities or exercise, that force has to go somewhere — and sometimes it escapes as urine leakage.
3. Lack of Coordination
The pelvic floor is just one part of the core system, working alongside the diaphragm, deep abdominals, and back muscles. If these muscles aren’t well-coordinated, the pelvic floor may not engage or relax when it needs to, leading to accidents. Doc Roth often sees that her patients may not be contracting the right muscles at the right time- leading to increased leakage. The muscles are not weak, they just do not know when to act.
4. Weakness of Urethral Closing Pressure
The urethra (the tube that carries urine out of the body) needs to close firmly to prevent leakage. Sometimes leakage is related to a decrease in that closure strength, which isn’t always about the pelvic floor itself.
5. Pelvic Organ Prolapse
When pelvic organs (such as the bladder or uterus) shift downward, they can place added pressure on the bladder and pelvic floor. This extra load can make it harder to keep urine in, especially during activity.
6. Deep Core Weakness
The pelvic floor doesn’t work alone. Deep abdominal muscles provide essential support. If they’re not activating well, the pelvic floor may struggle to do its job, leading to leakage. This is extremely common postpartum- especially in those who had a C Section. Often times a rigid C Section scar and restricted abdominal muscles prevent us from connecting with our deep core- but Doc Roth can help!
7. Nerve Irritation in the Low Back
The sacral nerves (nerves of the lowest portion of the spine) supply the pelvic floor and bladder. These nerves can become irritated from issues like low back or sacral dysfunction, disc problems, or even chronic tension — This disrupts communication between the brain, bladder, and pelvic floor. This miscommunication can trigger leakage, even if the muscles themselves are strong. The nerves supply our muscles, so irritated nerves cannot conduct the “electricity” to properly power our muscles.
The Bottom Line
Leaking urine is common, but it’s not normal — and it’s not always caused by a “weak” pelvic floor. That’s why a personalized approach is key. A pelvic floor physical therapist can assess whether your leakage is due to tension, coordination, pressure management, prolapse, or another factor, and then guide you with the right strategies for your body.
If you’re tired of worrying about leaking, know that you don’t have to live with it. The first step is understanding the why behind your symptoms — and that’s exactly what I help women uncover every day at The Movement Solution.
