73 Comments

Dear CrossFit and “CrossFit Gynecologist,” I’m Appalled. There’s Help For ‘Peeing’ During Workouts!


What’s the Issue?

Recently, a CrossFit video, entitled, ‘CrossFit – Do You Pee During Workouts?’ was released on YouTube. CrossFit participants were interviewed at the Central East Regional competition.

 “CrossFit is the principal strength and conditioning program for many police academies and tactical operations teams, military special operations units, champion martial artists, and hundreds of other elite and professional athletes worldwide.” CrossFit website

Watch this video to see what the controversy is all about:

Yikes!!

Why am I Shocked About the Video?

  • Any video that starts out with an announcer stating THIS is not going in a good direction: “we’ve seen blood today and now we see urine and that’s what it takes if you want to be the fittest woman on the planet.”
  • A GYNECOLOGIST that participates in CrossFit states in the interview: “We need to invent something to help these women. I’m one of ‘em. Do about 10 double unders, I’m standing in a puddle. It ain’t pretty.” Invent something?? What? There are numerous options available to women (starting with pelvic physical therapy) that have been extensively researched and SHE should know this. 
  • The GYNECOLOGIST states further and emphatically: “Ladies, in my professional opinion, it is okay to pee during double unders.” Let’s set the record straight here. Leakage can definitely happen when doing a jumping maneuver and women shouldn’t feel ashamed. But, there are options for help. One should not just assume they have to wear pads for life and that’s the only option. Why is the GYN advocating this without other options? Ugh!
  • Another women says “…2 kids that does it to ya”. Yes. Childbirth is the leading cause of stress urinary incontinence, but it sounds like she has resigned to the mentality of “that’s the way it is”. There’s help, after you have had 1 kid, 10 kids or 20 years after having kids. 
  • The final mantra that each woman says proudly into the camera is “I pee during workouts”. It’s wonderful to stand in solidarity and bring this topic out. This is something women (and men) should be able to talk about and find solace in knowing they are not alone. BUT, this felt to me like it was a valued, prized quality – If you pee during a CrossFit workout you “put out” and you are super intense. Wrong message! This means their pelvic floors (and other parts of their bodies) are not supported with heavy loads or jumping. This should not be celebrated. There’s help. Yup. There’s help.
  • One woman states at the end: “[peeing is] a correlate of intensity…maybe Heather and I are just going harder than everyone else.” No, no, no! We should not associate urinary leakage as a ‘correlate’ of working harder, better, and stronger. Wrong message! Let’s not make urinary leakage (and potential for increased pelvic organ prolapse) a goal to achieve as a marker of intensity!

The good news:

The video has sparked lots of discussion.  It’s wonderful to bring the topic of urinary (and fecal) leakage into mainstream discussion. Women AND Men can have this. Stress urinary incontinence (SUI) during exercise happens, but we don’t always discuss it. We now have an opportunity to share that there’s help available for this and individuals don’t have to just say “well it’s what I get for having kids” or “my mom had it so I guess I have it now too.”

Quick Facts:

“Urinary incontinence is the unintentional loss of urine. Stress incontinence is prompted by a physical movement or activity — such as coughing, sneezing, running or heavy lifting — that puts pressure (stress) on your bladder.” More info

Statistics:

“Stress urinary incontinence (SUI) has an observed prevalence of between 4% and 35%” (2004)  Article Here

“Stress urinary incontinence is common and affects many women globally. About 50% of women with urinary incontinence report symptoms of stress incontinence” (2011). Abstract here

“Specifically, there are two types of SUI: urethral hypermobility and intrinsic sphincteric deficiency (ISD). In the case of urethral hypermobility, the urethra shifts positions with an increase in abdominal pressure, allowing urine to exit the bladder.”(NAFC)

Stress urinary incontinence is usually associated with weak pelvic floor muscles coupled with too much pressure from above. This can also be complicated by factors such as extra abdominal weight, pelvic organ prolapse, and chronic constipation. However, an individual can also have tight/short pelvic floor muscles (with or without associated pelvic pain). In this case, the pelvic floor muscles aren’t necessarily weak, but they can’t activate properly when a force such as a heavy lift or jump happens (we see this with gymnasts, for example). * There are other factors as well, explained in ‘Take Home Points’. 

The exercise “Double Under” is referenced. It’s essentially an advanced jump rope exercise.

What concerns me about Crossfit? Is it only the pelvic floor and “pee”? No. This video is an example of Crossfit-gone-wrong again. Look at the impact poor lifting has on the body.

Am I bashing CrossFit? No. Many of the power lift moves and fitness components can be performed safely with proper instruction. But, they should only be performed when the individual is ready and strong enough to perform the movements without compensation. Also, not everyone is a candidate for CrossFit and there are many other ways to get in great shape. Am I concerned about Crossfit? YES! Who are the trainers? What is their level of knowledge and education regarding safely instructing and progressing exercises? Is there a mentality that more is always better at the expense of poor form and risk of injury (and embarrassment)?

Images put out for “show” via the news and internet. The leakage is even circled to magnify the effect. Ugh! 

1037235289195727189

images-1

* 6/25/13: Now there are “Pee” and “Poo” shirts promoted by a “Women of CrossFit”  Facebook page. What? Why is this promoted? #Fail.

Screen Shot 2013-06-25 at 7.43.38 PM

So, What Can You Do?

What IF you leak when exercising – Crossfit OR any other exercise?

  • Realize this happens to many people and you’ll likely feel better if you remove feelings of shame, embarrassment, and blame. Seek professional help. This is something you don’t have to just “deal with” or “ignore”. If you need to wear pads or liners, that’s a short-term option, but the ultimate goal is for you to feel empowered get rid of leaking.
  • Always try conservative treatment first (without  immediately seeking medicine or surgery). Pelvic Physical Therapy (Women’s Health Physical Therapy) is one of the best options. We train extensively in helping patients with SUI with a very high success rate. (one of many articles). We use a variety of techniques and approaches (not just Kegels!). There are also nurses and other fitness professionals, specifically trained in exercises to support the pelvic floor.
  • With a conservative approach by a Pelvic Physical Therapist, you will learn if you are, in fact, contracting the right muscles of the pelvic floor and sphincters. We assess much more than the pelvic floor- how’s the whole system functioning? The pelvic floor does not function in isolation. We must consider bowel (such as constipation) and bladder function, strength, length and/or function of the diaphragm, deep back and abdominal muscles, gluteal muscles, breathing, surgical history, fitness level, and much more! We help improve the function of all of the supporting muscles, improve your movement and form for all exercises to decrease stress/excess pressure at the pelvic floor (and all areas), and provide education regarding bowel and bladder habits that can have a major impact on your progress. Sometimes we utilize pelvic floor biofeedback or pelvic floor electrical stimulation, if appropriate.

Take some great advice from my colleagues – pelvic physical therapists (physiotherapists) and other experts in the pelvic field:

Diane Lee’s PDF: Explains the relationship between the pelvic floor, the “core” and the “canister”. READ THIS: Understand Your Back And Pelvic Girdle Pain

Julie Wiebe, PT:  ‘Female Athlete’s Best Kept Secret’

Julie talks about: Training the Pelvic Floor for Fitness, Part 1

Training the Pelvic Floor for Fitness, Part 2

An example of the type of electrical stimulation unit used for stress incontinence (this is discussed with your healthcare professional to see if it is appropriate for use in your case)

Pelvic Floor Biofeedback: Great slide show all about: Pelvic Floor Biofeedback by the Cleveland Clinic (there are all sorts of ways of doing “biofeedback”. This shows external surface EMG, internal sensors, perineometer, and weights.

Pelvic Biofeedback EMG

Pelvic Biofeedback EMG

Here’s another great video introduction regarding biomechanics and the pelvic floor: Aligned and Well “Down There for Women” by Katy Bowman

You see? It’s a lot more than just Kegels!?

Resources:

Want to find a Pelvic/Women’s Physical Therapist? Check out the APTA Section on Women’s Health (we treat men too!) therapist locator

The World Confederation of Physical Therapy – Physical Therapy Organizations around the world. They can connect you to women’s health/pelvic physical therapists.

Society of Urologic Nurses and Associates

National Association for Continence (NAFC)

American Congress of Obstetricians and Gynecologists (ACOG)

National Association of Certified Professional Midwives (NACPM)

* There are also numerous exercise, pilates, and yoga professionals who are very knowledgeable about the pelvic floor.

muscles-of-the-pelvic-floor-diaphragm-levator-ani-coccygeus-pubococcygeus-iliococcygeus

**Admittedly, I don’t participate in CrossFit. I have tried some of the WODs (Workouts of the Day).  I have years of experience in a variety of sports and lifting weights .I’m a physical therapist (specializing in pelvic floor and orthopedics), a personal trainer, and teach internationally on these topics. I used to teach national courses to personal trainers about proper body mechanics, physiology, and kinesiology involved in all forms of exercise. I made a point to include information about the pelvic floor so that trainers were aware.

***This is not an article addressing all forms of incontinence. SUI is one form. Also, I try to stay away from comments such as”you should never pee in your pants”. I think that may promote a form of shaming. How about, “You don’t have to settle…there’s help!”? ~ Tracy

Take Home Points

(if you made it this far):

  • CrossFit might be a great workout for some, but not everyone is ready for it. I have concerns about the instructors. The potential for injury is HUGE! * This can be true of many other forms of exercise too with poor or no instruction.
  • Let’s NOT glorify “peeing” when you lift! This means there are intrinsic weak points that should be addressed. The pressure system and strength are not working and adding weights and or jumps to this is not good.
  • There’s help! Start with conservative treatment. Pelvic Physical (Physio) Therapists are experts at this!
  • Healthcare professionals, particularly gynecologists, should be aware of options available for dealing with stress urinary incontinence. It was appalling to hear the GYN speak as if she was totally unaware of what one can do to stop leakage. She should be the ambassador of change for everyone there!
  • And…even if many people are leaking, let’s not assume that’s a “cool” thing or an intensity goal to achieve. Let’s not glorify a dysfunction. Let’s educate and empower when there’s a solution. This should NOT be “what it takes to be the fittest woman on the planet”.
  • Added 6/25/13- Stress Urinary Leakage (SUI) is NOT just about pelvic floor weakness! This can certainly be one or the only factor, but not always. We must consider the whole “pressure system” of the body (what’s happening with breathing/diaphragm, pressure from poor form, pelvic organ prolapse from above, constipation, hormonal (age-related changes, birth control, progesterone, etc.) and endocrine effects, and genetic/collagen laxity in general. We often see patients who require a multimodal approach with therapy and medicine. It can be common, for example, to see a patient who has pelvic pain with pelvic floor shortening, poor mechanics, history of constipation, childbirth with tearing and weakened pelvic floor,  AND hormonal changes locally or systemic.
  • Added 6/25/13 – The most common myth is that most people can do a “Kegel” (just one part of this larger picture). Statistics show up to 35-50% of women do not know how to perform a pelvic floor contraction (or relaxation or bulging without straining) correctly. The popular magazines tell us to do 600 repetitions of these every day while standing in the grocery store line or while at traffic lights. This does not work if you can’t access the right muscles; and if you are weak, you have to start in a position such as lying on your back and do 30 repetitions a day (not 600!).
  • What if you aren’t leaking, but  currently do lifting or exercises like CrossFit? This is a great opportunity to learn proper biomechanics of exercise and “preventative” execution and form from a qualified professional (orthopedic and pelvic therapists rock at this!). You can learn how to breathe correctly during exercises (oh, what a difference that makes!) and correct weakness or compensatory patterns that could lead to injury or dysfunction in the long-term. The other key elements to learn NOW are: 1. how the pressure system works in the body, 2. how to be aware of your pelvic floor, and 3. how to activate/contract the pelvic floor AND relax it.

537984_10200493929944602_910314352_n

Tracy Sher, MPT, CSCS owns a private physical therapy practice in Orlando, Sher Pelvic Health and Healing. She is an international instructor and faculty member in the area of pelvic physical therapy and is the Founder of Pelvic Guru.  Consider following Pelvic Guru on Facebook too for regular “pelvic” discussions and very regular updates regarding research or articles (and fun stuff too).  

Tracy Sher on Linkedin and @pelvicguru1 on Twitter.

73 comments on “Dear CrossFit and “CrossFit Gynecologist,” I’m Appalled. There’s Help For ‘Peeing’ During Workouts!

  1. Have seen so many clients with pelvic floor dysfunction and incontinence, benefit in receiving Myofascial Release Therapy., you don’t have to live with it!

  2. In 2013, I’m absolutely sure that Myofascial Tissue Release Therapy has to be a part of all treatments of complex conundrums in medicine. Anything that defy logic or modern medicine is in this group from Fibromyalgia, all pain syndrome, neurovascular, neurologic and muscle dyscoordination ie incontinence. That is because modern medicine has left out this vital basic therapy that has been a part of humanity since the beginning.

    MFT is on a spectrum from simple stretching, yoga, Pilates, hands-on manipulations, acupuncture, dry needling to finally Travell trigger point injections.

    The best “Therapy Program” is all inclusive so please don’t discriminate. All of these items have to be put into the pot to simmer and keep the healing process going. Patients have to be proactive in their care. Here are some therapies that can be done at home. Hourly, daily, weekly and monthly.
    Self-Care and hands-on care;
    >Regular physical therapy, massage therapy, sports medicine.
    >Chiropractic medicine.
    >Stretching, yoga and Pilates.
    >Aerobic and any exercise are vital.
    >Vitamins and minerals (Magnesium glycinate)
    >Sleep hygiene.
    >Stress management, Wellness, Mindfulness and forgiveness.
    >Get some Epsoms salts for tub soaking.
    >Get a high quality oral magnesium.
    >Get on the floor or bed and start stretching.
    >Get a foam roller to work on your upper and lower body area.
    >Swimming, Aqua-Therapy and Hot-tub Spa therapy.
    >Rolfing or other hands-on therapy.
    >Review this Youtube self-massage.
    >Use self-trigger point release with your hands or a Thera-cane.
    >Find a PT specialist who can perform “Spray and Stretch.”
    >Professional massage.
    >Find a John F. Barnes myofascial therapist.
    More invasive or minimally invasive care with Myofascial Release Therapy with needles.
    >Acupuncture of the body. (Not just the Ear, Foot or Scalp)
    >Formal Dry Needling
    >Gunn-IMS
    >Prolotherapy (not alone)
    >Botox injections (rare)
    >Travell, MD Trigger Points Injections.

  3. Fabulous article Tracy- so timely with it being the first day of World Continence Awareness week. As shocking as this video is, it has been a catalyst for all us concerned Continence and Women’s Health Physios(Physical Therapists) around the world – otherwise known as the #pelvicmafia to stand up and voice an opinion about:
    1.the negatives of Crossfit
    2.that there’s no safety in numbers- just because all those strong, fit, attractive women (and the GYNAECOLOGIST) are leaking urine doesn’t mean it’s ok and therefore you don’t seek help for it and CHANGE elements of your programme.
    3.most importantly that conservative management of stress urinary incontinence has a high success rate, is without harm and empowers the woman in her management plan.
    Thanks for such a comprehensive article
    Sue Croft
    Pelvic Floor Recovery books are simple self help books available from http://www.pelvicfloorrecovery.com

  4. I’m waiting for the follow up youtube video: “You’re not tough until you have a grade 3 prolapse”.

  5. Awesome and thorough response Tracy- so wonderful! Will share as much as possible- thank so much!

  6. so informative, thanks a lot for sharing all these great information

  7. Really enjoyed the article, seems that it is becoming more acceptable that leaking is ok. Tena Lady adverts with younger and younger models, seem to be validating this, when in fact, there are things you can do and there is help out there

  8. Thank you for this blog post. I talk about this during my Chair/Senior Holy Yoga Training program because so many older adults have this problem. I have always been open with people about this and how to “fix” this problem or at least reduce it for others. I plan to use this in my Chair training along with my Pre-/Post-Natal Training. It is a great resource of information.

  9. I am a physical therapist who has focused my practice on women’s health issues for 12+ years, a private practice owner, CrossFit Level 1 trainer, CrossFit affiliate owner, and active CrossFitter….which means I perform double unders several times per week. I have also treated my own personal urinary incontinence with double unders with all means (and more) mentioned in this article. I was not at all appalled by this video…rather, I was THRILLED that the CF community opened the door for us to have an open discussion and educate!!! Women in our gym talk about this issue on a daily basis but instead of acting ashamed in approaching me about getting help, they are now openly discussing this issue – YAY!!!!
    Tracy, I think you have done an awesome job compiling resources for your readers to get help for leakage with any type of exercise. I love that you encourage readers to try conservative management first – ABSOLUTELY! I plan to reference it often in the treatment of my own patients – thank you for this great, easy-to-read piece!!!
    With that said, I am troubled by a few of your points:
    1) “This is not an article addressing all forms of incontinence. SUI is one form.” I am glad that you mentioned that this article does not address all forms of incontinence. Like the gynecologist in this video, I too experience urinary leakage with double unders…anything above ~10 jumps and I cannot control it!!! It has been incredibly frustrating and I too am working with my gynecologist to come up with a way to manage my own leakage. This management has largely been driven by me up to this point as he suggested surgery years ago! My doctor is also a CrossFitter who not only understands the movement but also understands different management approaches. Remember this video is highly edited – I would hazard to say the physician in the video is not oblivious to conservative management options. We have no idea from the video what her knowledge is…my opinion is that she is giving women permission to not feel ashamed;-) As a PT, however, I realize that my approach cannot solve everyone’s problem…and possibly not my own. Does strengthening the shoulder accessory muscles eliminate the dysfunction caused by a complete rotator cuff tear? No. It may help reduce the symptoms a patient is experiencing (and for some this may be enough) but the underlying problem still exists. I have managed my symptoms successfully with physical therapy alone for many years and progression of the underlying issues has most likely been slowed through conservative management. But I also have not been as active – especially at the level I am now thanks to CF.
    2) “Am I bashing CrossFit? No.” Even though you say you are not bashing CrossFit, I feel that is the intent of the video imbedded in the post. That is the first video that pops up when you do a YouTube search for “CrossFit bad form.” I had such high hopes after you posted Spealler’s video about double unders where he mentions the importance of midline stability!!! You can YouTube anything and help feed the frenzy…there are numerous videos out there of people doing stupid things in ANY sport (or even in their backyard). If you read the comments and even try to research the origins of that video, it is clear it was posted maliciously. As healthcare professionals, we are so careful about the research we reference to make sure the sources are reputable…I really try to challenge myself to apply the same standards to social media sources whenever possible.
    3) “CrossFit might be a great workout for some, but not everyone is ready for it. I have concerns about the instructors. The potential for injury is HUGE!” I believe wholeheartedly in the CF approach and have gained so much personally and physically that I am never looking back. I have employed “fitness professionals” in my clinic for several years – all with varying levels of education/training. The trainer I had with two master’s degrees NEVER watched form as closely as the 10+ CF trainers currently coaching at our affiliate. Sure, “there are many other ways to get in great shape” but I feel this unfairly implies to the public that an entire approach to fitness is careless and unsafe because its participants experience urinary leakage (and aren’t afraid to talk about it). If that were the case, then please mention Zumba and running…how much more harm are we doing by giving people a false sense of being healthy through glorified movement that does not elicit true gains in ALL areas of fitness??? For me, CrossFit is the absolute most effective, comprehensive, and inclusive approach to fitness available. I have attended multiple CrossFit training courses including their Level 1 course, mobility course (which is taught by a physical therapist), and their kids course (which also involved teaching by a physical therapist on how to safely apply CrossFit principles to special populations). CrossFit is absolutely for everyone!!! I am a little disturbed by the lumping of CF instructors into a group to be concerned about. I feel that’s very unfair. The CF affiliate I am associated with is constantly thriving to be better and then pass this info along to our athletes. This includes activating the pelvic floor musculature with lifts (and DUs). This isn’t the case everywhere, but this is true of ANYTHING. There are “professionals” in all fields including yoga, Pilates, personal training, and even physical therapy that we all know should not be calling themselves professionals. The potential for injury is “HUGE” with any idiot who claims to do anything they are not adequately trained to do. Hate to rat out my own profession, but there is a “women’s health physical therapist” down the street from me who is ultrasounding women’s pectorals to address the postural dysfunctions associated with their pelvic floor dysfunction?!?! We have bigger issues than CrossFit!!!
    I am going to assume that the intention of this article overall was good and a call to action to look at this as a HUGE opportunity within a growing and exciting sport!!!
    Just my two cents – I’d love to discuss more:-)

  10. Jessie- I very much value your great input and discussion about this topic. Yes – the intent is a good one.
    The reason I chose to write this article was to make sure the discussion about the video was balanced and the voices of many pelvic/women’s health physical therapists (and other fitness/healthcare professionals) were heard. I also knew this was a GREAT opportunity to share valuable information about treatments for “peeing during exercise”. I chose to focus on conservative management because that is my clinical vantage point. You are absolutely correct – if someone has significant leakage, prolapse, and other concomitant issues, they may require additional treatment (meds, injections, surgery, etc). However, I still firmly believe (and the research supports) that individuals will likely have better outcomes after surgery or other interventions if they had conservative management such as pelvic physical therapy first. As you know, we are teaching patients movement, stability, motor control, and strength “skills” that make a difference in overall function.

    Regarding your specific points:
    1) Thanks for sharing your personal situation. You mentioned you are going to your gynecologist for help with leaking. This goes exactly to my point. Some of my patients are excellent gynecologists. They understand the general idea of conservative management, but until they actually went through my full program (including the modalities listed in the blog article), they didn’t realize the full benefit. The goal here is to share that it’s more than just Kegels and some biofeedback. We are looking at whole system. This can make a difference when returning to starting exercise programs such as CrossFit.

    2 and 3).I’m convinced that there are excellent CrossFit instructors and facilities. I can see how it can be misleading to post a video that is a bad example of CrossFit. However, I saw the original video (with the trainers giving terrible instruction and without music) and it was shocking. My point in showing that was to elucidate that there can be major damage to pressure on the pelvic floor and the entire body when heavy weights are lifted without good form.
    It’s fantastic that your experience has been positive. I’m quite certain those who you instruct are lucky to have you with your background. It’s certainly true that this video could have been of a running group, Zumba class. Etc. I’m not suggesting CrossFit is a problem everywhere. But, there are concerns and it’s good to bring this to light and discuss in this type of respectful forum. I also believe that these issues can be true of any profession. The initial concern was that the video was posted by CrossFit and endorsed on YouTube. This felt like CrossFit was promoting the notion that leaking = sign of amazing intensity and fitness. That’s the shock factor.

    Thanks for your comments and support overall.

  11. Reblogged this on All about the pelvic floor and commented:
    Worth reading this

  12. Such a great article! 1 in 3 women suffer from this, so it’s great to see such a truthful and informative article about this topic. At Knix Wear, we too are tackling this problem head on: we have designed a line of beautiful and seamless high tech fitness underwear called FitKnix – it’s underwear that has a super discreet but absorbant gusset to protect you against leaks during your workout. Check us out: knixwear.com

  13. Thank you knitwear! It’s great that there are options available for individuals to wear. The ultimate goal is to not have to rely on underwear, pads, or outerwear for controlling or hiding the leaking – but rather get help for the source of the issue. However, this is important as well because it can be a good step to decrease embarassment or shame while still having leakage.

  14. We completely agree! Getting to the root of the problem and ultimately curing it is the best path, but we provide some fashionable and discreet support along the way :)

  15. Excellent discussions! Tracy, thanks for being such a great voice and advocate for Pelvic Physical Therapy…there are SOO many women out there that could benefit from PT, we just have to put the conversation out there…there should never be a shortage of patients! YEAH for patient education on this subject!

  16. Ugh… This post, while right in many ways fails to acknowledge that a weak pelvic floor ISN’T always the ONLY cause for SUI. High progesterone levels are often the culprit which this article doesn’t address. So your pelvic floor can be perfectly strong but if you are (typically mid 30′s and beyond) having hormonal fluctuations this can happen. Excessive progesterone may increase urinary incontinence and even counteract the beneficial effects of estrogen in maintaining urinary control. Get your hormone levels checked folks!!

    Batra SC, Iosif CS. Progesterone receptors in the female lower urinary tract. J Urol 1987 Nov;138(5):1301-4

    Caissel J, Ghaddar Y. [Urodynamic study of urinary incontinence appearing in the fifth month of pregnancy and persisting after delivery. The role of progesterone].[Article in French] Ann Urol (Paris) 1984 Sep;18(5):356-60

    Rud T. The effects of estrogens and gestagens on the urethral pressure profile in urinary continent and stress incontinent women. Acta Obstet Gynecol Scand 1980;59(3):265-70

    Miodrag A, Castleden CM, Vallance TR. Sex hormones and the female urinary tract. Drugs 1988 Oct;36(4):491-504

    • Erin- Thanks for sharing additional info! There are definitely other factors that can contribute to urinary leakage – as explained in the article, even shortened/tight pelvic floor muscles can be an issue (this is seen often in younger women who have not had children and are involved in high impact sports – running, gymanstics, etc). Hormones are another; pelvic organ prolapse (increases pressure from above)..and more. To complicate matters even more, (which is why I love my job), you can have ALL of these factors at the same time – shortened AND weak pelvic floor, prolapse, hormonal changes (from age-related to birth control to endocrine..), constipation, poor lifting mechanics…the list goes on! I’m so grateful that we are getting into these discussions! It’s so much more complex than just saying “do a kegel” AND YES…it’s important to address all factors, NOT just the pelvic floor.

  17. I am glad you posted this. I have asked several “experts” on paleo / crossfit / heavy lifting about what considerations need to be made for women with pelvic floor problems, and none of them had anything to say except that they have had clients with these issues who see improvements so there is nothing to worry about. I still don’t know if I should lift heavy, it seems like it’s not worth the risk & I don’t trust the coaches to modify appropriately with the attitude that they have.

  18. I’m glad that there are professionals willing and able to deal with incontinence with multiple modalities. When I suggested my elderly mother ask her doctor about what could be done for hers, she was advised to go on a prescription medication. At that point, she wasn’t even taking a diuretic, and was not diabetic. I have long suspected that she had undiagnosed normal pressure hydrochephalus, with occurs more often in the elderly than doctors think. Being “woman, wobbly, and wet” should lead to further investigation. I suspect that incontinence may be the first symptom, and since the docs consider this normal in the elderly, who will look for a diagnosis?

  19. No joke!! I couldn’t make this up if I wanted tried. There’s a group on Facebook called Women of CrossFit = Strong and they have t-shirts available (and are celebrating them). One reads: “I pood more than you” (with a kettle ball under the legs) and another reads: “Courtesy of Double Unders”, depicting a woman holding a jump rope and a urine puddle directly under her. What!?? Here’s the link if you have Facebook. https://www.facebook.com/photo.php?fbid=478629885558109&set=a.104807052940396.15018.104768352944266&type=1&theater

    • A “pood” is a Russian measurement for weight and it is how CrossFitters refer to the kettlebell weight they are lifting (i.e. women’s weight is usually 1pd and men’s weight is usually 1.5pd). “I pood more than you” is a common joke you hear in a CF gym…and I assure you that NOBODY is referring to fecal incontinence when they say it. This is BASIC CrossFit lingo, nothing more. You will find similar sayings on newborn onesies…and I definitely know those don’t refer to weak pelvic floors!
      I do feel the double under shirt is in poor taste and I would hazard to say that sales are poor on that one. Again, if you find the video and even the FaceBook page referenced to be celebratory, that is one person’s opinion. I follow the same FaceBook page and LOVE the countless stories of women who have changed their lives for the better through CF;-)
      I do see a lot of uneducated, misinformed individuals “celebrating” the fact that they are NOT ALONE and finding freedom in that!!! I have not experienced any of the women in my gym “celebrating” the face that they have incontinence…in fact, they are embarrassed by their leakage. They limit their physical activity because of it and seem overwhelmingly relieved that there is help out there. They are not wanting to advertise their issues, they are wanting to fix them.
      I don’t think for one minute that the women in the original CF video are proud of the fact that they left a puddle. This was simply CrossFit rallying around one of its own at a very recent event leading up to the CrossFit games and saying…we all saw it, we love you, and it’s a problem for many of us. CrossFit is a tight knit community that takes care of its own. The women pictured in the video are the elite of the elite and the video is very tongue in cheek…again, anyone with a BASIC knowledge of the unique CrossFit world would recognize this. I would not be surprised if we saw a follow-up piece by CrossFit at some point addressing the serious side of this issue…CrossFit is constantly looking for ways for its athletes to improve physical prowess and this is no different. AND we have no idea what the background is on each of these ladies in the video – maybe they ARE seeing a highly skilled women’s health PT with an uber comprehensive approach and IT ISN’T WORKING!!! Oi. Please reference my previous comment to understand my qualifications in speaking to this topic…

      • Thank you, Jessie for your thoughts and insight! We can all learn from each other! I’m surprised we haven’t seen more comments from those involved in CrossFit. I also hope this reaches the women (and men) who may benefit from this information (not just PTs and healthcare professionals).

    • FYI: Pood is a standard measurement of weight commonly referenced in a CrossFit workout. It has nothing to do with the issue of urinary leakage.

    • I’m a Crossfitter over the age of 60 … who resisted Crossfit for an entire year because I thought I was too old, I wasn’t athletic enough, I didn’t want to get hurt, and so forth. I’ve been through three natural childbirths and have accepted unwelcome changes in the bladder department … even to the point of not wanting to exercise. I will never forget feeling embarrassed to have to keep going to the bathroom in the middle of my early Crossfit workouts, but realizing NO ONE called attention to it. Everyone just kept encouraging me to do my best. I was taught proper form and watched to ensure I remembered it. I was taught to listen to my own body, the coaches modified movements for me as needed, and I am in the best shape of my life. I also just realized that I don’t have to use the bathroom during workouts nearly as much as I did in the beginning, so perhaps the Crossfit workouts have actually helped in that department! Yes, Crossfit can be intense, but keeping our sense of humor is vital as we come together to get stronger physically and mentally. I also follow Women of Crossfit = Strong. The women who moderate that page and all the women featured on it are celebrating strength, camaraderie, and possibilities. They should not be devalued for appreciating a bit of humor. I realize your profession takes the incontinence issue seriously and I am grateful for the points made in your blog post. I just wish the points could have been made with more generosity towards the Crossfit community, a community I have found to be vitally invested in my health and fitness.

      • Thank you so much for sharing your story. I have learned more about CrossFit and think it can be very wonderful for many people. My biggest mission was to make sure that individuals involved in CrossFit OR any other exercise program understand that if they want help for leaking with exercise it’s available. I was certainly shocked by the video and continue to feel that it was misrepresenting a topic that’ needed a different perspective. However, thanks for sharing your thoughts about generosity. Noted. :)

  20. * This blog reaches over 50+ countries all over the world.
    We are receiving requests for links for how to find pelvic physiotherapists in other countries.
    If you have the information and links, please share them on here. I know there are requests for Canada, India, South Africa, Middle East…etc. thanks! Australia physios just did a fantastic commercial about incontinence. I’ll share that link and request info from them as well.

  21. Thank you, Tracy! And amen. There IS help ladies. Don’t believe those who tell you there is not.

  22. I have just read all the comments and want to say I bought this product called NatraTone overseas and they are just about to launch it in the US online – it is fantastic!
    I had done Pilates and kegels etc. but never actually knew where my pelvic floor muscles were or exactly which muscles to use. This product helped me locate them and with the follow-along DVD (which really is just someone repeating the exercise over and over for 5 minutes) at a follow-along pace, I managed to get in the habit of correctly strengthening my pelvic floor and now do it on a regular basis without the device. Voila! No more leaking! The exercise is simple to do but a little more than the kegel squeeze – they say you need to strengthen your lower abs along with your pelvic floor muscles and learn to breathe properly – that everything works together and is on automatic when you are a ‘normal’ non-leaking person. Well I have become that person again. So kudos to this product! http://www.natratone.com. My friend wants one so we contacted NatraTone and they said they are now FDA Approved and will begin selling online in the US in August/September 2013.

  23. […] Wee Problem with CrossFit Dear CrossFit and “CrossFit Gynecologist,” I’m Appalled! There’s Help For Pe… CrossFit, Your Pelvic Floor and Peeing During […]

  24. Most of these instructors were being “experts” in something else 2 years ago, and the 2 years before that etc…

    Which leads me to a new CrossFit motto

    CrossFit…. ” Change your mind like your underpants”

  25. […] of my colleagues have written blog pieces (and here) in hopes of reaching the CrossFit community to say….peeing on yourself while […]

  26. Actually Jessie, just to clarify, the “double Under” shirt IS one of our best sellers. Maybe, just maybe, our shirts actually opened the door for this topic to be openly discussed amongst women, instead of being something they have to worry about behind closed doors thinking that there is something wrong with them. I know when it first happened to me ( by the way, I am also a Level 1 Crossfit coach ) I was mortified, and thought that I was all alone. Now that the video has been posted, and our t-shirts have been made, more women are talking about it and feeling like they are not alone! I think that as in any situation you can take pieces and parts of things ( for example the video ) and focus on certain points, or you can choose to look at it as a whole. When I first saw the video all I thought was, awesome! These are women that as Crossfit women we look up to, and for them to say “guess what guys, I pee”, makes us feel ok about it. NOT ok about peeing necessarily, but ok that I am not the only one out there with this problem. I just want to say you’re welcome for opening the door for you (pelvic guru) to be able to blog about this, and hopefully increase your business because of our shirts, and Crossfit. Just adds to the list of why Crossfit is loved across the world. If you could also please ask permission in the future to use our photos before linking them to an article we are not in support of, we would greatly appreciate it. Thank you.
    Allison
    Stick it to ‘em tees

    • alisherb- I agree with your sentiments regarding this video opening to door for 1. Showing many people that they are not alone when dealing with leaking and exercise and 2. Allowing for fantastic dialogue (like this) and education to many. There’s DEFINITELY more awareness that many people can get help IF they want. I know that this “issue” is just a minor inconvenience for some (and possibly even laughable). However, for those who secretly wish there was something that could be invented (as the GYN stated), I wanted to share that we, in fact, we do have that invention – pelvic physiotherapy and all of our knowledge and tools (and other associated professions).

      The video is still alarming to me for the reasons I stated. However, I continue to learn great things about CrossFit from my friends and colleagues all over the world. I appreciate hearing the many positive stories.
      I “liked” the Women of CrossFit page and enjoyed seeing the many success stories. I value great discussion and hearing all sides of a story. Thank you!! All the best.

      • @pelvic guru. Perhaps you should have learned more about Crossfit prior to bashing it. You portrayed yourself as knowing what you were talking about when in reality you had no clue of the terminology (pood), the intent of the Crossfit HQ video on YouTube. You judged an entire community from one YouTube video showing poor form. By doing this you look ignorant. I assume you’d complete more thorough research if writing a peer-reviewed article regarding physical therapy. Maybe you should apply those same principles & ethics when “educating” others.

  27. I have read the recent comments from Crossfitters and as I too wrote a fairly damning blog on the issue I would like to clarify the concerns Continence and Pelvic Floor Physios (Physical Therapists) have with this video world wide. You will note that in all my blogs (and I would confidently say with all my colleagues’ blogs) I am extremely encouraging of women’s need and right to exercise. What we are on about is trying to do this exercise in a ‘pelvic floor safe’ fashion.

    Unfortunately I sit in my treatment room with a box of tissues very handy because many women are distraught when they learn they have significant prolapse from exercising incorrectly. Anyone can put on a pad to deal with incontinence, but once they have discovered they have prolapse- often because they can now feel a lump or bulge at the vaginal entrance- then the prolapse is fairly low and unlikely to return to the correct anatomical position.

    I think it is important to take on board the advice that so many Physios have contributed rather than feeling threatened or vilified by it- remember its not so long ago that the Government were handing out cigarettes to soldiers at war unaware of the consequences of that bad habit!

    Most of my dismay is reserved for the Gynaecologist -because as health professionals, we all have a duty of care to do no harm- and for her to endorse so broadly such a form of exercise that for QUITE A LOT OF WOMEN is likely to lead to prolapse eventually is not a good look.

    Also we all wanted to get the message out there that there are many things you can do(which in the Gynae’s 30 second grab she intimated she wished there was something that could be done) to prevent exercise induced urinary leakage. Some of these are: Pelvic floor muscle training; Transversus Abdominis training; Bracing prior to increased intra-abdominal pressure; use of a super tampon in the vagina which acts like a splint to support the bladder (the front wall of the vagina) stopping leaking and helping to prevent prolapse; a Contiform device – a type of pessary to prevent SUI; a ring pessary to support the vaginal walls during heavier exercise are just some.
    A final message for us all: ‘Don’t shoot the messenger’.

    • Fantastic, Sue! Thanks!
      It’s not just the incontinence issue. The pelvic organs take on a lot of pressure with exertion, particularly with the wrong breathing patterns (i.e. holding breath AND without proper pelvic floor and other muscular support -transversus, multifidi muscles, etc).

      We are seeing patients coming in to our clinics with significant pelvic organ prolapse (several forms – uterus, bladder, rectum, vaginal vault, small intestines). I’ll never forget the patient who called 911 Emergency AND me: She had performed a clean and press exercise with the bar above her head. When she got in the shower she noticed something protruding outside of her body [uterine prolapse- grade 4].

      Many patients express that they wish they had access to information about potential ways to prevent prolapse or how to conservatively manage this (i.e. better lifting techniques, better understanding of the pressure systems discussed, pessaries, etc.) when they initially had smaller grades of prolapse issues. Better knowledge can improve outcomes when dealing with incontinence and prolapse. (To be fair – some cases, prolapse may not be prevented – due to a combination of factors such as ligament/supporting structures affected during childbirth, genetic collagen factors, general intra-abdominal pressure, constipation, etc. But, education and treatment can still make a difference in managing prolapse).

      Love the ‘don’t shoot the messenger’ sentiment. We are happy to provide information that can be so valuable.

  28. Whats with the CrossFit marketers organized response. Obvious much ?

    I have been in the Fitness industry for 10 years now. And never made someone pee during a workout. And my participants range from Pro athletes to sufferers of Muscular Dystrophy. What am I doing wrong.

    And do I get more respect if I make them pee blood ?

  29. I like the valuable info you provide in your articles.

    I will bookmark your blog and check again here regularly.
    I’m quite certain I will learn plenty of new stuff right here! Good luck for the next!

  30. Some posts make you smile, other posts leave
    you feeling sad, this particular one makes me think, and that is better than anything else.

  31. […] posted this link about peeing in crossfit a while back, pretty much applies to whatever workout. http://pelvicguru.com/2013/06/22/dea…ring-workouts/ __________________ Ashley Mini Goal 1- 5% […]

  32. […] example of how the overwhelming culture of CrossFit can diminish professional common sense, one gynecologist was quoted dishing this […]

  33. […] example of how the overwhelming culture of CrossFit can diminish professional common sense, one gynecologist was quoted dishing this […]

  34. […] how the overwhelming culture of CrossFit can diminish professional common sense, one gynecologist was quoted dishing this […]

  35. […] example of how the overwhelming culture of CrossFit can diminish professional common sense, one gynecologist was quoted dishing this […]

  36. […] no matter what the cost (there is also a cartoon of Uncle Rhabdo vomiting and there has been recent news about peeing during CrossFit workouts). Here is a quote from a CrossFit participant: “I see pushing my body to […]

  37. […] same goes for issues like peeing during workouts. It seems mainstream media has been talking about the issue a lot in recent times, although when Miranda Oldroyd admitted to it years ago, it wasn’t […]

  38. […] same goes for issues like peeing during workouts. It seems mainstream media has been talking about the issue a lot in recent times, although when Miranda Oldroyd admitted to it years ago, it wasn’t […]

  39. […] example of how the overwhelming culture of CrossFit can diminish professional common sense, one gynecologist was quoted dishing this […]

  40. […] extreme intensity workouts like Cross-Fit are glorifying leaking.  While leaking is common in some circles, it is NEVER normal.  For a doctor to accept leaking or […]

  41. […] classes (oh CrossFit deserves a post of it’s own, but there are already some out there here and here) and maybe even a book club or two (I made my book club read Bonk by Mary Roach–that […]

  42. Oh, hey, look. This was covered a long time ago by K-Star on Mobility WOD: http://www.mobilitywod.com/2012/01/episode-357-baby-mommas-double-unders-bladder-control-and-a-little-bit-of-pee/

    HQ makes a lot of questionable decisions, but there are a lot of really good coaches out there, and they tend to understand technical movement a lot better than all of the PTs that I have shadowed this past year.

    By the way, I ran the platform for an olympic weightlifting meet this past weekend, and one of the visiting lifters, on her last lift, left it all on the platform to stand up out of her clean. She still went for the jerk, and almost got it. It was the toughest thing I saw in a long time, and I told her so at the award ceremony.

  43. […] example of how the overwhelming culture of CrossFit can diminish professional common sense, one gynecologist was quoted dishing this […]

  44. I’d hate to think that women would be dehydrating themselves to keep the pee down to a minimum, but that’s what most women would automatically do if they pee’d the floor during a workout. They’d never have any water with their workout again. And that’s dangerous, too!

  45. […]  http://pelvicguru.com/2013/06/22/dear-crossfit-and-crossfit-gynecologist-im-appalled-theres-help-f… […]

  46. […]  http://pelvicguru.com/2013/06/22/dear-crossfit-and-crossfit-gynecologist-im-appalled-theres-help-f… […]

  47. […] example of how the overwhelming culture of CrossFit can diminish professional common sense, one gynecologist was quoteddishing this […]

Leave a Reply - We want to see your comments!

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Follow

Get every new post delivered to your Inbox.

Join 2,774 other followers

%d bloggers like this: