Leaking When You Run or Skip? More Pelvic Floor Exercises May Not Be The Answer...

You’re halfway through a run, pick up the pace…and there it is.

Or perhaps you’re completely fine through squats, deadlifts and burpees, but as soon as the skipping rope comes out and you start double unders, you leak.

The obvious conclusion is:

“My pelvic floor must be weak.”

But emerging research suggests the story is much more interesting than that.

In fact, some women who leak during running have been shown to have pelvic floor muscles that perform just as well as—or in some measures better than—the pelvic floors of women who don’t leak.

So if simply getting stronger isn’t always the answer, what is?

First: leakage during exercise is common, but it isn't something you just have to accept

Stress urinary incontinence (SUI) is leakage associated with increases in pressure or impact—think coughing, jumping, running, lifting or skipping.

High-impact exercise is a particularly common trigger.

A systematic review of women participating in CrossFit reported urinary incontinence in approximately 44.5% of participants, with stress incontinence the most commonly reported type. Jumping exercises are consistently among the activities most likely to provoke leakage.

One study found 75% of female athletes reported stress urinary incontinence during skipping, most commonly during double and triple unders.

Running is another common culprit, with research reporting stress urinary incontinence in a substantial proportion of female runners.

But here's where things get interesting.

Women who leak when they run don't necessarily have weaker pelvic floors

One study compared female runners who leaked with runners who didn’t. Surprisingly, the women who leaked didn’t have weaker pelvic floor muscles.

In fact, in some tests, their pelvic floor muscles were actually stronger and quicker to respond.

The difference seemed to be less about muscle strength and more about support. The women who leaked appeared to have less support around the bladder and urethra.

In other words:

You can have a strong pelvic floor and still leak.

This is important because it changes the way we think about leakage during exercise. If your pelvic floor is already strong, simply doing more and more pelvic floor squeezes may not address the reason you're leaking.

So what happens when we run?

Every time your foot hits the ground when you run, your body has to absorb that impact—including your pelvic floor.

Research using ultrasound has shown that after running, the bladder can temporarily sit a little lower and the opening within the pelvic floor muscles can become slightly wider.

Interestingly, the pelvic floor muscles themselves don't necessarily become weaker.

So staying dry while you run isn't simply about:

“How hard can I squeeze my pelvic floor?”

It is also about how well your bladder and urethra are supported when you repeatedly hit the ground, how your pelvic floor responds to that load, and how effectively the rest of your body absorbs the impact of running.

That's why treating exercise-related leakage may involve much more than pelvic floor strengthening.

Your running technique may matter too

This is one of the most interesting recent developments.

A 2025 biomechanics study compared runners with and without stress urinary incontinence. The researchers found no difference in pelvic floor muscle function between the two groups.

What they did find were differences in the way forces were absorbed through the body.

Women with leakage showed reduced shock attenuation between the tibia and femur, lower energy absorption at the ankle and greater energy absorption at the hip.

The researchers proposed that inefficient impact absorption through the kinetic chain may expose the pelvis to different demands during running.

This is one reason pelvic floor physiotherapy for runners shouldn't stop at prescribing another set of pelvic floor squeezes.

We may also look at things like running mechanics, cadence, impact absorption, lower-limb function, breathing and pressure strategies, fatigue, training volume and how symptoms change across a session.

For skipping and double unders, we can similarly assess how you manage repeated impacts, fatigue, breathing and pressure—and whether changing the volume, technique or progression of the exercise changes your leakage.

Does that mean pelvic floor exercises are pointless?

Definitely not.

Pelvic floor muscle training remains an evidence-based treatment for stress urinary incontinence, including in exercising women.

A systematic review of conservative treatments for exercise-induced urinary incontinence found evidence supporting pelvic floor muscle training, although the authors highlighted that the overall evidence base in athletic women remains relatively small.

The takeaway?

Pelvic floor rehabilitation matters—but rehabilitation needs to be individualised.

For one woman, strength may genuinely be the missing piece.

For another, it might be coordination, timing or relaxation.

And for someone else, the pelvic floor might already be strong, and treatment needs to focus more heavily on support, technique and load management.

Sometimes we need to change the load—not stop the exercise

Our goal as pelvic floor physiotherapists isn't automatically to tell you to stop running, skipping or lifting.

Quite the opposite.

We want to work out how we can help you keep doing the exercise you love without leaking.

That might mean temporarily changing running volume or intensity, adjusting the number of double unders performed in a session, introducing strategic recovery between high-impact sets, modifying technique, or gradually building the pelvic floor's capacity to tolerate repeated loading.

We can then progressively increase the challenge as your symptoms improve.

And sometimes we can provide a little extra mechanical support.

Enter the continence pessary

A continence pessary is a small, removable device worn inside the vagina.

While many people associate pessaries with pelvic organ prolapse, certain pessaries are specifically designed to help manage stress urinary incontinence.

Rather than making your pelvic floor muscles stronger, a continence pessary provides mechanical support around the urethra and bladder neck, helping them remain supported when pressure and impact increase.

Think of it a little like putting on supportive shoes for a run.

The shoes aren't strengthening your calf muscles while you're wearing them—they're providing additional support so that your body can manage the task more effectively.

A continence pessary can play a similar role for the bladder and urethra.

Why we love pessaries for exercise-related leakage

For the right person, one of the biggest advantages is that a pessary can be used only when you need it.

You may choose to insert it before your Saturday morning run, CrossFit session, netball game or skipping workout, then remove it afterwards.

There's no medication and no surgery, and when appropriately fitted, many women can learn to insert and remove their pessary themselves.

Clinical guidelines recognise continence pessaries and other vaginal support devices as a conservative treatment option for stress urinary incontinence.

While we shouldn't promise that a pessary will completely eliminate leakage for every runner, it can be a very useful, low-risk option to trial.

The bottom line

If you leak when you run or do double unders, don't assume your pelvic floor is simply weak.

Recent research is showing us that women with exercise-related leakage may have perfectly good—and sometimes particularly strong and fast—pelvic floor muscle contractions.

Continence during high-impact exercise is more complex. It involves pelvic floor muscle function, passive support of the bladder and urethra, impact absorption, technique, fatigue and the amount of load your body is being asked to tolerate.

You don't necessarily need to stop running. And the answer isn't always “do more Kegels.”

A pelvic floor physiotherapist can help identify what's contributing to your leakage and build a plan around the activities you actually want to do—whether that's running 5 km, getting back to netball or finally getting through a set of double unders without worrying about your bladder.

If exercise-related leakage is getting in the way of your training, book an appointment with the Female Focus Physiotherapy team to find out what options might work for you.

By Erin Cuskelly

Appointments: Monday-Saturday | Book

Enquiries: info@femalefocusphysiotherapy.com

Call: 0400373415

References

Bérubé M-E et al. Differences in pelvic floor muscle morphology and function between female runners with and without running-induced stress urinary incontinence. Journal of Strength and Conditioning Research.

Bérubé M-E et al. The acute effects of running on pelvic floor morphology and function in runners with and without running-induced stress urinary incontinence.

Bérubé M-E et al. Is pelvic floor loading in female runners associated with post-run changes in pelvic floor morphometry or function? BJU International. 2025.

Campos NC et al. Inefficient impact absorption and reduced shock attenuation in female runners with stress urinary incontinence. Journal of Biomechanics. 2025.

Forner LB et al. Conservative interventions for female exercise-induced urinary incontinence: a systematic review. 2024.

Pelvic floor muscle training in female functional fitness exercisers: an assessor-blinded randomised controlled trial. 2024.

Wikander L et al. Prevalence of urinary incontinence in female CrossFit athletes: a systematic review with meta-analysis.

Urinary incontinence among competitive rope-skipping athletes: a cross-sectional study.