Barbell Medicine Podcast Episode #146: Pelvic Floor Health
Jun 29, 2021
Meryl Alappattu, physical therapist and research professor specializing in pelvic floor dysfunction and female pelvic pain. She breaks down pelvic floor anatomy and function. They cover causes of stress urinary incontinence, why athletes are more affected, fatigue and timing effects, when to keep training, and practical strengthening and coaching strategies.
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What Stress Urinary Incontinence Really Is
- Stress urinary incontinence (SUI) is leakage tied to rises in intra-abdominal pressure and is the most common type in younger women and postpartum individuals.
- Causes include childbirth, pregnancy weight/fetal load, pelvic surgery, age, and female anatomy increasing SUI risk during exertion.
Why Athletes Leak More Than Sedentary Women
- Athletic women report higher SUI rates because sport repeatedly exposes them to large transient intra-abdominal pressures (running, lifting, jumping).
- A review showed ~3.5× increased SUI risk in athletic vs sedentary women, not because exercise is harmful but because exposures are higher.
Leaking Is Not Proof Of Permanent Damage
- Exercise itself likely doesn't permanently damage the pelvic floor but can worsen symptoms if unaddressed; worsening severity (leaking with cough/laugh) signals need for care.
- Decision centers on symptom bother and functional impact, not automatic cessation of activity.