Exercises that go easy on the bladder

The high-impact exercise you once loved no longer seems to be a good fit, now that stress incontinence has crept into your life. Maybe you leak urine if you swing your tennis racket with force or do any high-spirited jumping in an aerobics class. The discomfort, hassle, and embarrassment might make you want to give up on your routine. But simple solutions can keep you in action.

Exercise and incontinence

Stress incontinence is characterized by the leakage of small amounts of urine when you do anything that puts pressure on the bladder, whether that's coughing, laughing, or exercising.

The leaks are the result of weakened pelvic floor muscles. These muscles normally help you hold in urine, bowel movements, and gas. "Ideally, the muscles would respond to increased pressure by contracting to prevent leakage. But with stress incontinence, the muscles don't respond properly," says Emily Walsh, a pelvic floor physical therapist at Harvard-affiliated Beth Israel Deaconess Medical Center.

Weak pelvic floor muscles can result from aging, pregnancy, childbirth, certain surgeries, medication side effects, garbled messages between the muscles and the brain, weak abdominal or hip muscles (which work with the pelvic floor muscles), or conditions that cause you to strain the pelvic floor muscles (such as constipation).

Try these exercises

You need aerobic exercise (the kind that works your heart and lungs) for good cardiovascular health. Since high-impact aerobic exercise is demanding on pelvic floor muscles, consider low-impact aerobics with gentler moves.

For example, instead of playing tennis, play pickleball (avoid lunging for the ball or running across the court); instead of going for a run, go for a brisk walk; instead of taking Zumba classes, take ballroom dance lessons.

Other types of low-impact exercise that won't overload pelvic muscles include swimming; cycling; and seated aerobics, boxing, or dance.

Physical therapy

"If your goal is returning to high-impact activity, consider working with a pelvic floor physical therapist. We can tailor treatment to the symptoms you're having and the activities you want to do," Walsh says. Treatment might include any of the following.

Kegel exercises. Your therapist can help you identify your pelvic floor muscles and strengthen them. One way to do this is called a Kegel exercise. All it involves is squeezing like you're trying to stop the flow of urine or hold back gas, holding the contraction for about 10 seconds, relaxing, and repeating.

Abdominal and hip exercises. "By strengthening abdominal and hip muscles, you're also strengthening the pelvic floor, since there's overlap among the muscles," Walsh says. Examples include bridges, planks (see "Move of the month"), and clamshells (lying on your side with your knees bent and raising and lowering only your top knee while keeping your feet together).

Breathing exercises. "A lot of people hold their breath while exercising, but that puts increased pressure on pelvic floor muscles and weakens them," Walsh says. "A helpful cue is exhaling with exertion. Breathe out at the hardest part of the exercise, which will give you more intense contractions of the abdominal and pelvic floor muscles."

Other tips to help

Practicing the following strategies can also help you cope with stress incontinence during exercise.

Prepare for leaks. Wear absorbent "bladder leak" underwear or an absorbent pad. You'll stay comfortable and will be able to keep exercising.

Empty your bladder just before exercising. This is easy to do at home. If you're exercising elsewhere, it helps to locate bathrooms in advance.

Squeeze during exertion. Walsh suggests doing a Kegel-style contraction as you exert yourself with force — as you swing a racket, for example.

Stay hydrated throughout the day. You might be inclined to avoid drinking a lot of fluids, hoping to reduce urine leaks. But that can lead to dehydration, which can cause confusion, fatigue, and falls — problems you always want to avoid, especially during exercise.

Talk to your doctor. If you continue to leak during exercise, consult your doctor about other incontinence treatments, such as medication or surgery.

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