Urine loss during abdominal exercises ?

What causes prolapse or loss of urine while training your abs ?

When the abdominal muscles are used in the correct manner, they contract to make your more flat. Behind these muscles is your abdominal cavity, which is confined by means of the diaphragm (the ‘respiration muscle’) from above, and by the pelvic floor from below (please refer to picture)..

Illustration showing abdominal cavity with pelvic floor, back and diaphragm.


The bladder and the pelvic floor. The effect of abdominal pressure

The abdomen cavity contains several organs of a given size. Contraction of the abdominal muscles causes the pressure in the abdominal cavity to rise. If if you don’t contract your pelvic floor at the same time, this pressure will cause the abdominal contents to be pushed downward. Holding your breath at the same time will increase the abdominal pressure even further. Compare squeezing a tube of toothpaste; without a cap, the contents will be expelled.

Eventually, this may lead to uterine prolapse, hemorrhoids (as with weight lifting !) and/or loss of urine.

When giving instructions for abdominal muscle exercise, often not much attention is directed to the pelvic floor. This ranges from not being mentioned at all (e.g. at abs sessions in the gym) to vague descriptions such as ’to hold your pee in’ or ‘converge your sit bones’ with yoga or Pilates. Respiration is more often mentioned : it is important to expire while increasing your abdominal pressure because it relieves ‘the pressure in the kettle’.

Learning how to use your pelvic floor and abdominal muscles in combination with your respiration may prevent problems such as urinary loss or a uterine prolapse. Abdominal muscle actions and respiratory movements are easy to observe; this is not the case with pelvic floor muscles which are best examined by a pelvic floor physiotherapist.

For instance, after childbirth your pelvic floor is dramatically changed. Power and consistency have decreased and nerve control has altered. Normally, is your pelvic floor will usually contract together with your abdominal muscles but this is not automatically the case after childbirth.

The pelvic floor physiotherapist can examine your pelvic floor muscles and establish their function. This allows her to guide the process in which you will learn how to train your pelvic floor and subsequently how to make the connection between pelvic floor and abdominal musculature. This skill will be then be applicable for you in daily life and doing sports.

(The pelvic floor muscles constitute the movable floor of the pelvis. Indeed, you can hold your pee with it, but also for instance close off your vagina, draw up your testicles, or prevent passing wind. Contraction or relaxation of your pelvic floor is externally invisible because it is located between your legs and buttocks. It is, in essence, your crotch.)


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