Crossfit and Incontinence.
Updated: Jan 31, 2022
You know the joke that goes "If someone does Crossfit and is vegan, which do they tell you first?", well how funny is that if it goes "If someone does Crossfit and is incontinent, which do they tell you first?". It kind of looses its appeal, doesn't it? Now, lets not get off on the wrong foot. I am not against Crossfit (I value my life) and like any other health professional I encourage physical activity and completely
understand the wide range of benefits it offers the mind, body and soul.
We can't however ignore the fact that Stress Urinary Incontinence (SUI) and Athletic Incontinence (AI) is very prevalent in the Crossfit community among women.
In a study by W. Elks et al in 2020, where they compared the incidence of SUI between women who do Crossfit vs non-Crossfit classes using an online survey it was found that "more than 80% of CrossFit participants reported UI and half of these reported moderate-severe UI, as compared with women who participate in non-CrossFit classes, less than half of whom reported UI with a small minority reporting moderate-severe UI."
L. Wikander et al conducted a survey among Crossfit competitors in 2020 and found that 41.8% of the women suffered UI and 17.7% suffered AI. Of that 17.7% , 9.7% of women were continent before starting Crossfit and remain continent during everyday activities but now experience urinary incontinence during exercise.
Before you burn your Crossfit membership card and run to your nearest yoga class, lets examine this a bit further. Why do so many women that participate in Crossfit suffer from incontinence? Firstly you have to look at the principles of Crossfit. It is a competitive sport that incorporates high impact activities with resistance training and training to fatigue. Unfortunately the this high impact nature and volume of training can lead to pelvic floor muscle fatigue. To put it plainly, the Pelvic Floor becomes overwhelmed by the pressure put on it and can't handle the load anymore.
There is also the issue that the 'core' (including the pelvic floor) muscles become so over trained that they are in a constant state of tone, meaning that a healthy pelvic floor contraction is not possible because the muscle is always tight! The pelvic floor needs to be able to contract fully and relax fully to function properly.
With all this said there are some other considerations that need to be made. One of these are that women who participate in Crossfit tend to be slightly older than women who participate in other classes . In the J.Yang et all study in 2019, the mean age of the Crossfit group was 36.9 and the aerobic group was 29 and as we know age is a predictor of UI. Another factor is the regularity and intensity with which they train compared to other exercise classes
It is clear that further research is required to fully understand the mechanism and impact of Crossfit on the pelvic floor and incidence of incontinence among women, but let me give you some positive points to take away. I think that if Crossfit is approached with more consideration it can be part of a healthy lifestyle routine that does not require weekly incontinence pad purchases.
First of all I would suggest those who are thinking about Crossfit choose wisely. Meaning if you have a history of UI, I would suggest choosing a different sport or at least seeing a Pelvic Health specialist before deciding to join.
I would also suggest being mindful of your pelvic floor when participating in Crossfit activities. Learn how and when to contract and relax your pelvic floor and breath properly during exercises to enable them to work with you. Being aware of the pressure you are putting your body under and knowing when enough is enough is very important. Train to your limits.
Lastly I would suggest that you work as hard on your pelvic floor health as you do the rest of your body. Its a balancing act, if you want your pelvic floor to try and handle the pressure you are putting it under, then you have to give it the tools to do so.
To learn more about pelvic floor health and strengthening visit our page on Incontinence or have a look at our Pelvic Floor Master Class© here:
Elks, Whitney BS∗; Jaramillo-Huff, Ashley MD†; Barnes, K. Lauren MD‡; Petersen, Timothy R. PhD†,§; Komesu, Yuko M. MD‡ The Stress Urinary Incontinence in CrossFit (SUCCeSS) Study, Female Pelvic Medicine & Reconstructive Surgery: February 2020 - Volume 26 - Issue 2 - p 101-106
Lolita Wikander,1Marilynne N Kirshbaum,2 and Daniel E Gahreman. Urinary Incontinence and Women CrossFit Competitors. Int J Womens Health. 2020; 12: 1189–1195.
Jean Yang BS,Julie W. Cheng MD, MAE,Hillary Wagner MD,Everett Lohman DSc,Sang H. Yang PhD,Gene Austin Krishingner BA,Alexandra Trofimova MA,Muhannad Alsyouf MD,Andrea Staack MD, PhD.
The effect of high impact crossfit exercises on stress urinary incontinence in physically active women. Neurology and Neurodynamics: Feb 2019; volume 38- issue 2 - p 749-756