How to Manage Leaks, When a Weak Pelvic Floor Isn't to Blame

But what if you are sure your pelvic floor IS strong already? Perhaps you are confident you’ve exercised sufficiently to look after it, but find yourself still experiencing leaks?

The truth is, leaking pee isn’t always down to pelvic floor weakness. There’s a variety of reasons it can happen, even when that area is strong. Let’s take a look at the reasons we can still be experiencing leaks and urgency - even with a strong pelvic floor. 

1. You’ve undertaken stress and high-impact activities

Leaking while lifting heavy objects, jumping, or running is often linked to stress incontinence. While a weak pelvic floor can play a role, it’s not always the only reason. Even with a strong pelvic floor, the added pressure on your bladder from high-impact activities can overwhelm the system. 

Female weightlifters find that they commonly lose control of their pelvic floor during competitions and training - and far from related to a weak pelvic floor, it’s because of the the increase of pressure on the intra-abdominal muscles. You might find similar when working out with weights, or even picking up a toddler or grandchild can result in leaks. 

What can help: Focussing on engaging your deep core muscles properly, as well as leaning how to breathe through the exertion can reduce the pressure and strain.  

2. You may have urge incontinence or Overactive Bladder (OAB)

Leaking isn’t always about strength, it can be about control. If you find yourself dashing to the loo only to leak before you get there, it could be linked to urge incontinence or overactive bladder (OAB). This happens when the bladder muscles contract too soon, sending you signals to go even when your bladder isn’t full.

There are things that can trigger urge incontinence and OAB. Food and drink, such as caffeine, spicy foods, citrus and tomatoes can affect our bladder. Even sudden changes in temperature (hello, winter!) can irritate the bladder and make these leaks more common.

What can help: Keeping a bladder diary to track patterns and identifying triggers is a good first step. Bladder training and techniques like timed voiding (going to the loo on a schedule) can help regain control, too. 

3. You could be experiencing hormonal fluctuations

Hormones play a huge role in how our bladder and pelvic floor function. During pregnancy, menopause, or even certain points in our cycle, oestrogen levels can dip, and may weaken the tissues around the urethra and bladder. This isn’t about muscle strength but more about the elasticity and support provided by the surrounding structures.

What can help: If you suspect that hormonal changes are playing a role, it’s worth talking to your GP. Vaginal oestrogen creams or other treatments could be an option to strengthen and support these tissues.

4. Your bladder may be sensitive to irritation 

Sometimes the issue isn’t mechanical but chemical. Certain foods and drinks can irritate the bladder lining, making it more reactive. Things like alcohol, citrus, artificial sweeteners, and even fizzy drinks can make leaks worse, regardless of how strong your pelvic floor might be.

What can help: Experiment with reducing or cutting out known irritants to see if it makes a difference. Drinking plenty of water (but not overloading your bladder) can help flush out irritants, too.

5. You could have hypertonic pelvic floor 

Hypertonic pelvic floor occurs when the pelvic muscles are constantly contracting, causing pain and difficulty with urination, passing stools and causing pain during sex. It can also cause leaks - because when the muscles are tightly contracted, they don’t relax as they normally should in order to normally pee. This condition can seriously affect your quality of life. 

What can help: Physical therapy with a a women’s health physiotherapist can help to relax the pelvic floor and help you regain control. 

6. You may have nerve-related Issues

Our pelvic floor, bladder, and brain are all part of the same team. But if the communication between them is disrupted, it can result in leaks. This can happen for several reasons, including childbirth trauma, surgery, or even underlying conditions like multiple sclerosis or diabetes.

What can help: If you suspect a nerve issue, a specialist like a pelvic health physiotherapist or urologist can assess what’s going on and recommend tailored treatments.

6. You may have strained your pelvic floor muscles

Do you experience leaks after sneezing, coughing or even laughing? If so, you’ll know only too well how the pressure applied during these moments can cause us to leak. This can be related to the strain placed upon the pelvic floor throughout the day - often without us even realising. Chronic constipation, in particular, can lead to repetitive straining.

What can help: Addressing constipation by eating fibre-rich foods, staying hydrated, and avoiding unnecessary straining can make a big difference.

7. There could be other factors, too

Sometimes, simple day-to-day habits can have a big impact. A sedentary lifestyle, carrying extra weight, or consistently holding in pee for too long can all add strain to the bladder, even if your pelvic floor is otherwise strong.

What can help: Try making small changes to your lifestyle. Consider ways to stay active, maintain a healthy weight, and ensuring that you respond to your bladder’s call to pee promptly can go a long way.

Speak to your GP, and seek support from a pelvic health physiotherapist

Bladder leaks don’t always mean there’s something wrong with your pelvic floor - but when we keep silent about what we’re experiencing, we can’t know the best way to manage them. 

Speaking to your GP about your symptoms is important, and it’s worth considering either asking for a referral or seeing a private Pelvic Health Physiotherapist who can help you understand how best to manage, and support your pelvic floor to reduce leaks and urgency.