CrossFit, Your Pelvic Floor and Peeing During Workouts

Pelvic Floor Superior ViewThis post is inspired by the video that CrossFit HQ put out, presumably with good intentions, due to an “event” during the deadlift-box jump event at the Central East Regionals [see video below]. Pelvic floor dysfunction is real and I would never make anyone feel bad if it happens...but it is not “OK” or normal to pee during workouts – it is a sign of Pelvic Floor Dysfunction.

This article hopes to cover the following:

  1. What is Pelvic Floor Dysfunction
  2. What is “normal” and what is not
  3. Things that do NOT help
  4. Things that you can do that will help

Pelvic Floor Dysfunction 

What is Pelvic Floor Dysfunction?

Pelvic floor dysfunction is simply where your pelvic floor is not doing its job properly. The pelvic floor is designed to provide support for your pelvic organs, help control intra abdominal pressure, control your urine and bowel movements, and help provide pleasure during sexual intercourse.

Signs and symptoms of pelvic floor dysfunction:

  • accidentally leaking urine (or faeces) when you exercise, laugh, cough or sneeze
  • needing to get to the toilet in a hurry or not making it there in time
  • constantly needing to go to the toilet
  • finding it difficult to empty your bladder or bowel
  • accidentally losing control of your bladder or bowel
  • accidentally passing wind
  • a prolapse
    • in women, this may be felt as a bulge in the vagina or a feeling of heaviness, discomfort, pulling, dragging or dropping
    • in men, this may be felt as a bulge in the rectum or a feeling of needing to use their bowels but not actually needing to go
    • pain in your pelvic area, or
    • painful sex


There are many possible reasons for pelvic floor dysfunction but I want to break it down to the following reasons and explain them:

  1. You have a weak pelvic floor
  2. You have an overactive but strong pelvic floor but even stronger abdominal, back and diaphragm and glottis (voicebox) muscles – voicebox you ask? It is how you hold your breath – you close off your throat there!
  3. You have an overactive but weak pelvic floor
  4. You have a damaged pelvic floor
  5. You have a medical condition. This is outside the scope of this article. Your doctor is the best person to clear these conditions as the cause of your pelvic floor dysfunction.

Pelvic Floor Prolapse 2The Weak Pelvic Floor:

There are many reasons why your pelvic floor might be weak but the most common ones are:

  • Pregnancy and childbirth
  • Surgery and other medical procedures
  • Posture and Habits
  • Lack of exercise

If you have a weak pelvic floor, then exercises will help! Unfortunately, my experience has been that people are given pelvic floor contractions without being progressed into the high level exercise that CrossFitters are used to...but that doesn’t mean that you can’ just have to work with the right therapists to get you back to what you love doing the most – hard WODs!

Bracing when lifting weights = appropriate Bracing when just standing or sitting only = INAPPROPRIATE!!

Bracing when lifting weights = appropriate
Bracing when just standing or sitting only = INAPPROPRIATE!!

The Overactive Pelvic Floor:

If you have an overactive pelvic floor, then why would you leak? It seems counter-intuitive doesn’t it? The muscles are working...why wouldn’t they prevent leaking? Well, just because it is overactive doesn’t mean it is strong. In this category, an overactive pelvic floor can either be genuinely strong (or at least strong enough) or genuinely weak.

Well, if you have a “strong” pelvic floor AND you exercise a lot AND you still leak, then chances are that you also have a very strong glottis and can make your thorax and abdomen very strong and rigid.

I know this because you leak under load. Basically, if you can build up a lot of intra-abdominal pressure (IAP), that pressure has to be contained. Some people “lose” it and you hear them grunt or scream – that is their glottis letting go – either to breathe or it wasn’t strong enough. Some people get an abdominal or inguinal hernia – they actually tear in their abdomen from the pressure. Still others might get a “slipped” or “herniated” or “bulging” disc. That is because the pressure has gone through the weakest part of their system – the low back. But in you, because you leak, I know that the pressure has overcome your pelvic floor.

In everyday life, you probably don’t leak. You can laugh without an issue, you can sneeze without a worry but when you workout and get tired or if you are lifting heavy weights, then trouble can strike. You probably know how much you can lift without a problem and how much is enough to tip you over the edge. You do everything you think you can to minimize the risk of leaking – going to the toilet just before the WOD starts, you won’t drink water for an hour or 2 before the WOD, you won’t drink during a long WOD (BTW, these are BAD strategies to combat Stress Urinary Incontinence – concentrating urine through dehydration can irritate your bladder and increase your urgency!)

The good news is that your pelvic floor is just need to know how to make it work as part of the whole team that is your body. My friend Julie Wiebe has a nice video on this -

Learning how to coordinate the proper cycles of breathing, activation and relaxation is simply like learning how to snatch – when you first begin, you don’t think it is possible to do everything you need to but then you keep practicing and it slowly comes together...pelvic floor retraining is the same

If you pelvic floor is overactive and weak, then you will have to learn to relax AND strengthen the pelvic floor. It is a combination of the weak pelvic floor retraining and the overactive relaxation/activation/coordination/breathing retraining.

Pelvic Floor ProlapseThe Damaged Pelvic Floor:

Your pelvic floor might have been through a lot. Childbirth, cancer and radiotherapy, and other conditions can contribute to tearing, scarring and damage to the pelvic floor muscles. The nerves to the area can be damaged, the muscles themselves can become detached from the pubic bone, scarring from surgery and childbirth can cause asymmetrical contractions.

If this is the case, then you really need an internal examination to determine the extent of the damage and to see what your options are. The damaged pelvic floor is beyond the scope of this article...please see a pelvic floor physical therapist for assessment and an appropriate treatment plan which may include a surgical consult with a specialist.

Image courtesy of Continence Foundation of Australia

Image courtesy of Continence Foundation of Australia

What is a “normal” pelvic floor?

A normal pelvic floor is simply one that can do all its functions – maintain continence, support the pelvic contents and contribute towards optimal movement during functional tasks.

For the average person, that means you only need to go to the toilet about 6 times during the day and you should be able to get through the night without a toilet trip – of course, this varies based on the amount of fluid you consume, the food you eat and the amount of exercise you have done.

You should be able to squeeze your vagina without “bearing down” – you can test this on your own by using clean hands and inserting 1-2 fingers (yours or your partner’s) into your vagina. When you squeeze, you should be able to generate pressure on the tampon or fingers without squeezing them out of your vagina.

You will be able to cough, laugh, sneeze and jump without fear of leaking. You will be able to feel the urge to go to the toilet but not be overly concerned about dropping everything to go to the toilet NOW!

You won’t feel heaviness in your vagina or feel anything protruding where it should not be. During heavy lifting, you will feel comfortable and will be able to withstand the pressures on your pelvic floor.

What You Can Do To Help

Train "Raw"

Weight Lifting Belts

Avoid if possible - train with better technique

I am a big believer of lifting “raw” – unsupported. I do not like belts, braces, wraps, or supports – not even tape. I accept that my patients will use these things and I understand the place and importance that they have in sport. However, in the ideal world, I would prefer that my athletes train using their weakest link as their limiting factor. That means if your back flexes strains under heavy squats, then you need to keep that weight at a level that your back can cope with until it is strong enough to progress...even though you have the legs for 30kg more. I see a lot of injuries because athletes do not follow this simple rule.

Perfect Technique

Perfect Technique

No Supports - Just Perfect Technique

One of the biggest offenders in contributing to CrossFit-related pelvic floor dysfunction is the weight belt. It is designed to go around your belly and back and is worn by many athletes as a way of support their back. The way that you are taught to use them is to push out against the belt and use it to help support your back and tummy. But when you do that, you generate MASSIVE amounts of intra abdominal pressure which does help your spinal stiffness but at the expense of your pelvic floor. Because it is made of unyielding leather or synthetic materials, the pressure won’t be going through the belt – it will be leaving via your pelvic floor or diaphragm. Pressure on a system always leaves via the weakest point...which is why pressurised containers have a release valve – to control the pressure. The diaphgram is a very strong muscle and rarely does it fail – if it does, you will find it pretty hard to breathe! The back and the abdomen are supported by the belt which only leaves the pelvic floor – the smallest of the muscles – left to hold the massive load of pressure placed upon it.



Check that ego at the door

Ego is another thing that does NOT help. If we ignore the fact that you leak during a WOD, then yes, you are an amazing athlete. But the fact is that you have a technique flaw that is making your weakest link fail. “Work on your weaknesses” is something that we all know and do. If you have trouble in the squat, you work on it – you hit the roller and ball to get more mobility, you practice your squat technique, you turn that weakness into a strength! But why don’t we do that for the pelvic floor? If you actually limited your WODs to the amount of “perfect reps” completed, then you would actually perform better in the long run...and by perfect reps, I mean the amount of reps you can do WITHOUT leaking.

ChecklistThings that you can do that will help.

  1. Contact a physical therapist that understands the pelvic floor...preferably one that can do internal examinations or has a special interest in women’s health. I have a special interest in it and I work with other therapists who do the internal work while I do the whole body assessment and programming back into full function.
  2. Let your limiting factor be your pelvic floor. For example, how many double unders or box jumps can you do before you feel a bit of a leak? I would recommend that you find that out...and then treat it like a strength set. 5 sets at max perfect reps with 2-3mins between sets. If you leak, you end the set there...preferably just before you leak. Keep a journal of your exercises and do them at least 3 times per week. Because the pelvic floor muscles are relatively small, you will fatigue them a lot quicker than your legs – that’s ok! Your pelvic floor just needs to catch up to how awesome the rest of your body is!
  3. Train raw – learn how to coordinate your body into positions of dynamic stability – what that means is that you need to learn how to move and coordinate control of your whole body which includes the pelvic floor. That means getting your posture right, and not blowing out your belly or holding your breath to get the pelvic floor to work.
  4. Be patient – just like it took you ages to get 1 strict pull-up (if you can’t do 1 but you do kipping pull-ups, you are asking for trouble!), so it will take you a while to get your pelvic floor to catch up to the rest of your body...but it can. Be patient.

In another post, I will be putting up some sample exercise programs ranging from those who have quite weak pelvic floors through to those who want to lift heavy and jump...this will be a collaborative effort so please be patient with us!


Julie Wiebe and I have designed a survey to collect some information – if you could please take the 10mins to help us understand how you, your pelvic floor and CrossFit exercises get on. You can take the survey here.


  1. It is not “OK” or normal to pee during workouts. If it happens, please recognise it as a problem that can be helped.
  2. There are many reasons why pelvic floor dysfunction occurs. The best person to talk to is a suitably qualified pelvic floor Physical Therapist and your doctor.
  3. Work with a team of qualified Physical Therapists. I usually ask my patients to see a pelvic floor physical therapist up to a certain point and then I usually take over the strength and conditioning aspect where I integrate it back into heavy lifting, jumping and high level sports. I have written how I work with pelvic floor physios here...
  4. Treat your pelvic floor dysfunction as a weakness to work on. If you can do this well, you will actually get stronger, be able to do more unbroken reps and lift more.
  5. Avoid weight belts...for so many reasons...
  6. Talk to someone. If you don’t know who to talk to, just ask me – comment below, email, facebook, twitter, linkedin – The information is out just have to find the right person for you

I will be at the 2013 CrossFit Games in Carson, California during the Masters week and Games weekend. Say hello to me – I will probably be at the CrossFit Football stand when not watching events.

Some more resources...

Julie Wiebe's Blog -

Australian Physiotherapy Association Post

For basic / general exercise / general public information on your pelvic floor - Continence Foundation of Australia - Helpline 1800 33 00 66

Please leave a comment and let's start this long-overdue discussion

68 Responses

    1. Yoga isn’t for everyone just like CrossFit isn’t for everyone…

      …CrossFit done poorly can cause problems in the same way that yoga done poorly causes problems – I treat both kinds of devotees.

      Both CrossFit and Yoga done properly will help 😉

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  2. Christine Binnendyk

    Reblogged this on Effortless Movement and commented:
    This is a great follow-up to my now infamous queef article. (I attended a training not long ago and 50% of the folks there knew of me from that post alone. Weird.)
    Now, does everyone who occasionally queefs in Pilates or Yoga class have pelvic floor dysfunction? Nope. But if it goes along with other symptoms (see below,) then you might need to find some help from someone who specializes. Who knew? Yes, there are physical therapists and other folks who specialize in PFD.

  3. Leanne

    Now, if only CrossFit had followed up the ‘story’ with this sort of article, they may not have dived so badly in my estimation of them!
    Well done!

    1. Thanks Leanne. It is unfortunate but I bet CrossFit Inc didn’t think the response would be so large and negative.

      Most Pelvic Floor Physical Therapists also tend to approach things differently to how I would. For example, they try to put the facts out there and wait for people to come see them about it to talk about it if they have questions rather than giving people hope that there are ways to get you back to doing what you love doing – of course, there are some conditions which don’t seem to respond to either conservative or surgical care at the moment but they are low in number.

      My next post on this subject will be based on treating your pelvic floor muscles like muscles (well, duh!) and how to train them up.

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  5. Anonymous

    I was advised to hold my breath at the bottom of a squat to prevent curving my torso forward under the weight of the barbell. By the sounds of things this may put extra pressure on the pelvic floor and compensate for weakness rather than build effective core stability. Does that sound about right? Is it advisable to hold your breath while lifting a heavy load to stabilise your torso?

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  7. The lack of symmetrical tension in the pelvic floor has less to do with the actual pelvic floor muscles and much more to do with Pelvis symmetry and the fascial connections w the diaphragm, obterator internus, pectineus, abdominal wall and the fascia iliaca.
    Through proper reinforcement of the proper weak links in the myofascial system, te actual prolapse can be resolved.
    Check out my upcoming blog on an umbilical hernia and how quickly it has been resolved.

    1. Thanks. The myofascial system is just one of 6 systems / causes that I look for in any dysfunction. Being able to sift through all the evidence to make a proper diagnosis is the key.

      Your umbilical hernia story seems interesting. Has it been published in a journal somewhere. I am sure it would be very interesting to the research community.

      Thanks again

      1. If by ‘6 systems’ you are referring to 1. sympathetic ns 2. parasympathetic ns 3. myofascial 4 emotional 5 lymph? 6 muscle? There are some redundancies here.
        Please give me your definition of 6 different systems to obtain the causality?

        I will be publishing the umbilical hernia with Cal State Fullerton. Hopefully soon, but I need more case studies.


        Dr A

        1. Hi.

          1. Psychosocial
          2. Articular
          3. Myofascial
          4. Neural
          5. Visceral / medical causes
          7. Strategies for performance and function

          Look forward to reading the case study. You can get published with just one subject…but it shouldn’t be hard to find umbilical hernias – they are everywhere. If the technique / method works universally, you should have more than one success to report 😉

          Stay in touch 🙂

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    1. Your national association for physical therapy / physiotherapy will have a directory of sorts. Ring some and find out their views on exercise and your pelvic floor. Otherwise use the twitter hashtag #pelvicmafia to find some 😉

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  12. Hi, Antony! I am a physical therapist in the US and LOVE THIS POST!!! I’m a private practice owner, pelvic PT, and CrossFit affiliate owner and I was so frustrated by the response to the video. In reference to pelvic PTs, I could not agree with you more when you say above, “they try to put the facts out there and wait for people to come see them about it to talk about it if they have questions rather than giving people hope that there are ways to get you back to doing what you love doing.” Why would CrossFitters wanting help go to a PT or physio who just attacked or bashed the sport they love?!?! I applaud the responses I’ve seen from both you and Julie Wiebe so thank you. I am scheduled to give informative presentations at 3 local CrossFit boxes starting tomorrow so hopefully I can be a part of the solution!

      1. Done! I’m a Twitter dunce so just FB at this point. I just found your post to PTs and CFers as well so I’ll make sure I get on that feed. For now, I just plan on passing along the information and programs that have worked well for my patients and me personally so mostly anecdotal at this point backed by 12+ years of practice but it will have to do! Excited that I dove into your blog more in depth and looking forward to the ongoing discussion…thanks! My practice and affiliate links are below:

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  19. Max

    In regards to PFD in men, can it cause low libido, tight pelvic muscles and a contracted feeling and look of the genitals?
    How about a loss of sensitivity?
    I did heavy squats with terrible form (leaning forward on balls of feet/all quads/no glutes) and now have tight PFM and those mentioned symptoms.

    1. Hi max. Yes PFD can cause those issues but I am wondering if your squat technique caused an issue that led to the PFD.

      Did you wear a weight belt?

      Did the problem develop gradually or suddenly? There are so many questions that need answers.

      What have other therapists said?

      1. Max

        No weight belt but I held my breath more than I should have.

        I lifted every other day for a month doing squats, Leg Press etc. Not enough posterior chain work. When I did squats I went up a LOT of weight fast. I was on my toes because of bad ankle dorsiflexion and felt it in my quads and low back. I came out with anterior pelvic tilt, forward head posture, tight pelvic floor and more issues that I am working on now with a ROLFer.

        I used to do only upper body then added in RDLs and box squats utilizing my posterior chain and felt muuuuch better but then the next year I screwed up with trying to do back squats with bad form.

        Well other therapists don’t really know. They agree it could be the cause but they’re not sure.

        It’s gotten a better with rolf (not done yet) and myofascial therapy, but I still have sexual issues and terrible cognitive function.

        1. Hi max.

          1. How much is holding your breath a problem? Unless you popped a hernia or burst a blood vessel, or felt your pelvic floor pop, it is usually not because of this. I am not saying it isn’t the case, just saying it isn’t usually the case.

          2. Squats every second day (2-3 times per week) is also not that bad a problem. Olympic lifters lift daily and that includes squats.

          3. “Posterior chain”…it is a funny term. Squats can work them, especially your back but I agree you work your quads more.

          4. Going up in weight fast is also not a problem…but poor technique is. Still, I am not sure if you would get all those things from a month of squatting. Did you have any supervision or anyone teach you how to squat?

          From what you describe, I am wondering if you injured your back and it affected the nerves to your genitals. Not sure how cognitive function is related. Not saying it isn’t, just unsure how it all fits into your picture.

          1. Max

            Not a problem really just was holding my breath during reps.

            I meant I felt pain in my back.
            I would not squat on my heels. I can’t sit back into a squat without falling over. It was all thighs doing the work and I imagine it out a lot of pressure on my pelvic floors.

            Very poor technique. I went up a lot of weight fast. Like 100 pounds in a month always going heavy.

            I imagine the cognitive issues were from neck issues from forward head posture. I’ve read it can impinge on nerves or just cause a huge leak in energy from just holding it up all day. It definitely hurts all day.

  20. Maria

    I am 9 weeks pregnant. I was told by my OB to not do any moves that put pressure on my pelvic floor. Is there a list or resource I can look into that let’s me know what moves I should and shouldn’t be doing?

    1. Hi Maria.

      There are but I don’t agree with some of what they say…

      My guidelines are:

      1. If you so it in real life, then you can do it as exercise…just be careful.
      2. If it is lying down on your back or side, it probably has the least amount of strain on your pelvic floor
      3. If it is sitting or standing but no trunk flexion (bending in the tummy), it has the next most pressure
      4. If it has trunk flexion, it has the most amount of pressure on the pelvic floor
      5. Being overweight/obese/morbidly obese is the biggest risk factor to pressure on the pelvic floor
      6. If you did it before you got pregnant, it probably is ok now but obviously you will need to check with someone who knows.

      A better question is “what do you currently do and why do you have to change it?” – let me know and let’s talk about it 🙂

      1. Maria

        Thanks for helping! I currently CrossFit, so any moves they do in CrossFit, I do. I’ve only been doing CrossFit for 6 months. I am slightly overweight according to my BMI, but not obese or morbidly onese. I pretty much did it all before I got pregnant.

        1. Basically I would say that most things supine (on your back) will be ok-ish.

          Bench press, modified dead bugs, floor press, etc but only for a while. There is a small risk of the baby affecting the inferior vena cava that makes everyone nervous so because I am not your therapist, it is better you check with someone about those moves after about 12-18 weeks. I don’t think a few mins on your back is bad, if you feel uncomfy at all, just don’t do it.

          Things like TTB and sit ups will close the abdominal cavity and cause pressure on the pelvic floor. Lay off them out if respect for the pelvic floor.

          Depending in your squat, Deadlift etc technique, you should still be able to do them to a point.

          Cleans and snatches become a problem once the bump is bigger.

          Play it smart and keep the heart rate and core temp under control.

          Good luck and have fun!

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  23. Peter Carten

    I had a problem lifting weights recently. My friend suggested me to this this blog and told me buy a Weightlifting Belt from The WOD Life super store. Now I don’t find any pain during weightlifting.

  24. Wow, this is such a great article… I have a hypertonic pelvic floor and my abdominals are tight! I am looking for ways to work out during a flare up. Real tough to not activate the core when working out! I REALLY appreciate your suggestions and will post some of them on my website.

  25. Thanks so much for the reply! My PT has assured me that I have no prolapse. I have a tight floor and a strong floor! LOL

    It seems all my pelvic floors muscles are very tight and lots of trigger points. I was away for 2 weeks and unable to work out. (Pain free for those days) I came home and started working out – and bam, my abs are so flared and of course my pelvic area is as well. I was only doing some easy leg type lifts and light arm weights – did not overdue the weight and it was not long workouts, and I stretched!

    I think I need to look at the anatomy of muscles more and see what exercises hit those areas as hard, and will start some of Jill Miller’s rolling methods. If you can think of anything else… would love to know – as I am thinking walking may be my only method of exercise in my future!

    1. At a guess, something is not coordinating properly. You have to sort that out.

      I suspect you are trying to activate too hard.

      Looking at the anatomy won’t tell you how it works. It is all about pressure, response to movements and how your internal organs bounce etc 🙂

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  31. Pari

    Hey Antony,

    I was operated fro inguinal hernia( with mesh) 2 years back and wish to join Crossfit soon. What are the precautions I need to take while lifting. I am worried if I lift heavy weight my hernia might reoccur. Also are there any particular exercises I should avoid.

    1. Hi Pari. 2 years ago shouldn’t be a problem in terms of tissue healing but ASK the surgeon or your local doctor if lifting weights is possible.

      The more important question is to ask if you solved the problem of why you developed the Inguinal Hernia in the first place. I obviously don’t know nearly enough about why it happened to you in the first place to advise you but an Inguinal hernia is usually from a poorly coordinated core that is unable to contain the intraabdominal pressure. This requires a good PT to know how to examine and test for this.

      Crossfit is good for you and carries similar risks of injuries as similar gym based exercises. As with all things, you should consult your doctor or health care professional before commencing any new exercise program.

      Thank you for your question.

  32. Di H

    I have just come across this article via he Australian Crossfitters FB page.

    I’m experiencing this. DU’s and pull-ups are my worst culprits. I guess my problem is holding my breath.

    Symptoms recently worsened as I’m sick and am under intense coughing fits.
    I obviously need to get this looked at, where/who in Melbourne can I see?

      1. Di H

        i had a look at your booking page Anthony, how long an appointment would you suggest I need to go through this? Obviously I won’t be able to have a follow up..

        1. I think an hour should be fine but 90mins is also ok – it depends on the amount of movements we have to go through and what your contributing factors for SUI are. Worst comes to worst, I will teach you more things about how to integrate it into as many crossfit exercises as possible. Since you only have pullups and double unders, maybe just the hour. It is so hard for me to say because I haven’t seen you before.

          Basically I will go through a bunch of questions, assess you, determine the problem/s and go from there. Sometimes the SUI (leaking) is just the symptom of another type of problem or a few different problems…I can’t say which until i assess.

          If it were as simple as teaching you a few exercises, I would just make videos and sell them!!

  33. Jennifer

    Hi, I had a baby 11 months ago & had a good birth but maybe there was some forced pushing at end. I breastfed & went back running at 6-8 weeks post baby unknowlegable about the effect of breastfeeding on the body. I was training for a 10km. I ended up leaking & realising I had no strength in my pelvic floor. I went to my physio in the hospital but all they said was do your pelvic floor exercises, & buy some support shorts. Over the year I became quite depressed as I missed physical exercise & basically had to lay off all impact exercises. I found a better physio who recommended biofeedback which I’m now on my 2nd month, physio says I’m making progress but it feels very slow. My question is what workouts can I do at the moment that won’t set me back but give me a good physical workout. I used to enjoy doing short metcon type workouts at home.

    1. Hi Jennifer. I would be doing you a huge disservice if I tried to advise you.

      The best thing to do is contact a women’s health Physio that knows and understands sport and has a sporting background.

      If you are in Australia, you can look up the APA find a Physio or site for physios.

      If in USA, contact sandy Hilton in Chicago for suggestions around the country.

      Let me know where you are based.

      There are lots of things that can be done.

      I am literally putting the finishing touches on a course that you can do to learn how to do things differently 😉

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