Pelvic Floor Physiotherapy for Athletes: Leaking, Prolapse, and Performance

A competitive runner came into our Newmarket clinic last spring convinced her bladder was just “one of those things.” She leaked during interval training, every single time she pushed past a 5K pace. She’d stopped drinking water before races and started wearing a pad as a matter of routine. She was 26 years old and had never given birth. This is far more common than most athletes realize, and it’s rarely something you just have to live with.

Leaking Isn’t a Normal Part of Being Fit

There’s a persistent myth that urinary leakage during exercise is the price you pay for being active — something that happens to runners, CrossFitters, and gymnasts the way blisters happen to hikers. It’s common, yes. Normal, no. Research on female athletes has found that urinary incontinence shows up across a wide range of sports, with especially high rates in activities involving repeated impact, like running, gymnastics, and jumping sports. One systematic review looking at pelvic floor dysfunction in athletes found prevalence rates for urinary incontinence ranging from roughly 15% to over 50% depending on the sport (source).

That range is wide because sport matters. Trampoline athletes and gymnasts, who absorb high-impact forces repeatedly through the pelvic floor, tend to report leaking more than swimmers or cyclists. But the underlying issue is the same: the pelvic floor muscles are being asked to manage forces they aren’t coordinating well against.

What’s Actually Happening

The pelvic floor is a group of muscles that sits at the base of your core, working alongside your diaphragm, deep abdominals, and back muscles to manage pressure inside your abdomen. When you land from a box jump or absorb impact on mile 8 of a long run, that system needs to respond instantly and automatically. In athletes with pelvic floor dysfunction, the timing or strength of that response is off — sometimes the muscles are weak, but often they’re actually too tight, or poorly coordinated with breathing and bracing patterns.

This is why simply doing more Kegels rarely fixes the problem, and can occasionally make it worse.

Prolapse Isn’t Just a Postpartum Issue

Pelvic organ prolapse — where the bladder, uterus, or rectum shifts downward and puts pressure on the vaginal wall — gets discussed almost exclusively in the context of childbirth. But athletes without children can experience prolapse symptoms too: a feeling of heaviness, pressure, or “something falling out” during or after heavy lifting, running, or high-impact training. Repetitive high intra-abdominal pressure, the kind generated during heavy squats or deadlifts performed with poor pressure management, can contribute over time.

It doesn’t mean athletes should stop lifting heavy. It means the strategy for managing pressure during those lifts needs attention, and that’s often a coaching and physiotherapy issue rather than a “stop doing the sport” issue.

Performance Is Part of This Conversation Too

Pelvic floor dysfunction isn’t only about symptoms like leaking or heaviness — it affects performance directly. A pelvic floor that isn’t coordinating well with the diaphragm and deep core muscles reduces the efficiency of force transfer through the trunk. Athletes sometimes describe a vague sense of “leakiness” in their core strength, an inability to generate the same power through their midline that they used to. Improving pelvic floor function often improves core stability scores and reported confidence in high-load lifts, not just continence outcomes (source).

What Assessment and Treatment Actually Look Like

A proper evaluation looks at breathing mechanics, how you brace during a squat or a sprint start, hip and core strength, and often includes an internal pelvic floor assessment to check muscle tone, coordination, and strength directly. This isn’t a generic exercise handout situation. Treatment might include:

• Retraining the coordination between breath, brace, and pelvic floor during specific movements (like the exact moment of landing in a jump)
• Downtraining an overly tight pelvic floor before adding strengthening work
• Gradual, sport-specific loading — building back up to running mileage or lifting loads in a structured way
• Addressing hip, glute, and deep abdominal strength that supports pelvic floor function indirectly

For the runner mentioned earlier, treatment involved almost no direct pelvic floor strengthening at first. Her muscles were already overactive and fatiguing early in her runs. We spent the first four weeks on breathing retraining and hip strength, then progressed to interval-specific pressure management drills. She was back to full training loads without leaking by week nine.

When to Get This Looked At

If you’re modifying your training, avoiding certain exercises, or timing your fluid intake around your workouts to manage leaking, that’s a sign worth acting on now rather than later. The same goes for any sense of pelvic pressure or heaviness after training sessions. You can read more about how we assess and treat this on our pelvic floor physiotherapy service page, and our pelvic floor dysfunction condition page covers the broader range of symptoms we see, athletic and otherwise.

Book an assessment before your symptoms start dictating your training plan. Most athletes wait months, sometimes years, before asking about this. There’s no reason to wait that long.