What If Leaking Is a Threshold, Not a Failure?
Why leaks during movement, urgency or impact may be less about weakness and more about timing, pressure, fear and whole-body load sharing.
A woman running along a country lane
For years, women have been told a very simple story about leaking urine during activies, like walking, jumping or running.
“If you leak, your pelvic floor is weak.”
And if your pelvic floor is perceived to be weak, the answer from most quarters is usually:
“Do more squeezes.” Some of my clients have ended up being given over 100 squeezes a day!
But what if that story is just too small?
What if leaking during running, jumping, coughing, sneezing, lifting or walking downhill is not always a sign that your pelvic floor is weak or damaged?
What if, sometimes, leaking is the body showing us that it has reached its current training limit?
This is a hypothesis put forward in a recent training course by Monika Leitner that I was completely enthralled by, because she put forward ideas that have been my thinking and chatting about for a while.
But while mine are thoughts and ideas I have in my head based on observations of the women I see. Hers are based in science and research with numbers and measurable outcomes.
She hypothesised that we shouldn’t necessarily see all leaking as failure. Or a complete disaster, But instead as very useful feedback. A clear signal that the system has run out of options at that particular speed, load, fatigue level, bladder state or point in your cycle.
Because your pelvic floor does not live in isolation. It is influenced by all the systems around it. It is part of a whole-body system involving your breath, ribs, feet, hips, pelvis, abdominal wall, nervous system, bladder, fascia, timing, posture and proprioception.
And when that system cannot organise quickly enough, the pelvic floor often gets the blame.
But it may not be the pelvic floor that has failed.
It may be the strategy.
Is leaking bad for your pelvic floor?
Leaking is not something we want to ignore.
It is not something you simply “push through”, especially if it is new, worsening, associated with urgency, pain, blood in the urine, recurrent infections, difficulty emptying, or a sudden change in bladder control.
But leaking also does not automatically mean you are damaging yourself. This has been a bit of a paradigm shift for me because I always saw leaking as an indicator that we had pushed an exercise too far. But the research says otherwise.
It does not automatically mean your pelvic floor is getting worse.
And it does not mean running, jumping, lifting or impact are forever off the table.
It may mean that the demand of the task is currently greater than your body’s ability to manage pressure, timing and load.
That is very different.
A stop sign says:
“Never do this again.”
A threshold sign says:
“This is currently more than your system can organise well.”
And that gives us something to work with. This I have said forever, but I would still always stop at the point of leaking, working with the body until we increased the limit and load without any.
What do we mean by “load limit”?
When I say someone has reached their load limit, I do not mean one single muscle has failed.
I mean the continence system has run out of options at that moment.
That might be because of the intensity or speed of the exercise.
It might be because of fatigue.
It might be because the bladder is fuller than usual.
It might be because the nervous system is on alert.
It might be because the body is premenstrual and tissues feel more sensitive.
It might be because the ribs are stiff, the breath is held, the hips are not sharing load, or the feet are not absorbing impact well.
It might be because the pelvic floor is trying to respond, but the information coming from the rest of the body is unclear, late or poorly organised.
So the question is not simply:
“Is the pelvic floor strong enough?”
The better question is:
“What part of the system stopped sharing load?”
Your pelvic floor is not passive
This is where the research becomes really interesting.
Monika Leitner and colleagues have explored pelvic floor muscle activity during running and impact. Their work suggests that running does not simply squash the pelvic floor passively as we may naturally assume it does. The pelvic floor appears to show activity before heel strike and reflex activity after heel strike.
That means the pelvic floor is not just waiting for impact and then trying to catch everything.
It is preparing.
It is anticipating.
It is listening before your foot even hits the ground.
This is important because running happens quickly. By the time you consciously think, “I need to squeeze,” the moment has already passed.
Continence during movement is not just voluntary.
It is predictive.
It is reflexive.
It is rhythmic.
It is whole-body.
This is why I am much more interested in how the body prepares for load than whether someone can perform a perfect pelvic floor squeeze lying on their back. because so many of my clients are told they squeeze perfectly, that their pelvic floors are ‘strong’ and yet they still leak.
A voluntary squeeze is one skill.
Running and other impact and associated activities like walking, jumping and climbing stairs are another world entirely.
Continence is predictive, not just reactive
Your body is constantly predicting what is about to happen.
Before your foot lands, your nervous system is already gathering information from your eyes, vestibular system, hips, feet, pelvis, spine and previous steps.
It knows impact is coming.
It begins to organise.
The foot prepares to meet the ground.
The hip prepares to rotate and transfer load.
The pelvic floor prepares to respond.
The diaphragm prepares to manage pressure.
The abdominal wall prepares to recoil.
This is why I often think of the body as a series of diaphragms.
The breathing diaphragm sits under the ribs.
The pelvic floor forms another responsive diaphragm within the pelvis.
And the arch of the foot can be thought of as the lowest diaphragm — not identical anatomically, but functionally similar in the way it senses, yields and recoils against the ground.
When these diaphragms communicate well, the body has options.
The foot can yield and spring.
The pelvis can organise around the femur heads.
The ribs can widen and recoil.
The breath can stay available.
The pelvic floor can lengthen, respond and recover.
But when one part becomes rigid, delayed or poorly informed, the pressure does not disappear.
It gets passed somewhere else.
Often, that “somewhere else” is the pelvic floor.
A fearful body does not run or move the same way as a trusting body
This is another important piece.
If a woman is afraid of running, jumping or other impact activities, afraid of leaking, afraid of heaviness, afraid of symptoms getting worse, afraid of embarrassing herself, the her body will not organise itself in the same way as it would if she felt safe and confident.
Fear changes movement.
It changes breath.
It changes footfall.
It changes tone.
It changes timing.
A fearful body may perform with more bracing and less spring. The jaw may clench. The ribs may stiffen. The breath may become shallow or held. The abdominal wall may grip. The pelvic floor may tighten in anticipation. The stride may shorten. The feet may land more heavily. The eyes may drop. The arms may become rigid. The body may move with more “brake” than bounce.
So instead of: receive, yield, recoil, spring
the body may move more like: brace, protect, impact, leak
This matters loads because leaking can become a loop.
A woman leaks once during an activity.
Then she becomes afraid of leaking again.
The next time she experiences that movement pattern, the body braces before the first step has even landed.
That bracing can reduce rib movement, interrupt breath, alter pressure management, stiffen the pelvic floor and make the whole system less responsive.
Then she leaks again.
And the brain says:
“See, I told you? Movement like this is unsafe.”
But the problem may not be the acrivity itself.
It may be the protective strategy the body has chosen around it.
This is why confidence is not just emotional.
Confidence is also biomechanical.
A body that feels safe often moves with more rhythm, more breath, more elasticity and better load sharing.
So when I work with women who are fearful of movement, I am not just trying to build fitness. I am trying to help the body experience impact activities as safe again.
Not by forcing it.
Not by pushing through.
But by giving the nervous system small, successful experiences of impact, breath, rhythm and recovery.
Why might someone leak at the start of a run, but not at the end?
This is a really interesting pattern.
If someone leaks at the start of a run but not later, it may suggest the issue is not simply weakness or fatigue.
If it were purely fatigue, we might expect leaking to appear later as the run goes on.
But early leaking may tell us something different.
It may suggest the body has not yet found its rhythm.
At the beginning of the run, the nervous system may still be scanning for threat.
The person may be thinking:
“Will I leak?”
“Will I be okay?”
“Can I trust my body?”
That alone can change the way the body moves.
The breath may be higher.
The jaw may be tighter.
The pelvic floor may be gripping.
The foot may not yet be sensing the ground well.
The hip may not yet be rotating smoothly.
The ribs may not yet be moving freely.
The pelvic floor may either be too slow to respond or too held to respond well.
Then, as the run continues, something changes.
The breath settles.
The rhythm arrives.
The arms swing.
The feet find the floor.
The hips begin to share load.
The nervous system realises:
“I am doing this.”
The pelvic floor may then stop gripping and start responding.
So the early leak may not mean:
“I cannot run.”
It may mean:
“My body had not entered the run yet.”
This gives us a very practical training idea.
Some women need a better run-entry strategy.
They may need to arrive into running before asking the body to run.
That could include walking first, softening the jaw, feeling the feet, letting the ribs move, doing tiny rebounds, adding short walk-run intervals, or beginning at a pace that feels almost too easy.
The first few minutes may be the nervous system warming up, not just the muscles.
The surface matters too
The surface under the body also changes the message the pelvic floor receives.
This is something Monika Leitner has spoken about in relation to impact, running and jumping. If the pelvic floor is responding to load before and after heel strike, then the quality of the surface matters because the nervous system is constantly reading what is coming from the ground.
A hard, unyielding surface gives the body a different message from a softer, more elastic surface.
A trampoline that yields more will not create the same experience as a trampoline that gives very little. Even within trampolines, the construction may matter. For example, a trampoline with firmer metal supports may produce a less yielding response than one with more flexible plastic supports. If the surface gives less, the body may have to absorb more.
This does not mean one surface is always “good” and another is always “bad.”
It means the surface changes the demand.
The body has to organise differently depending on whether it is landing on concrete, grass, a treadmill, woodland trail, a sprung floor, a soft mat, sand, or a trampoline.
The foot, ankle, hip, pelvic floor and diaphragm all receive a different conversation from the ground.
For some women, a softer or more yielding surface may give the body more time to organise, absorb and recoil.
For others, a very unstable surface may feel more threatening or harder to control.
So again, the question is not simply:
“Can she jump?”
or
“Can she run?”
The better question is:
“Can her system organise on this surface, at this speed, with this amount of yield, for this length of time?”
Because the pelvic floor is not responding to impact in the abstract.
It is responding to this impact.
This body.
This breath.
This footfall.
This surface.
This level of safety.
This level of readiness.
That means surface choice can be part of pelvic floor programming.
Not because we are trying to avoid impact forever, but because we are choosing the right amount of impact for the body to learn from.
The foot, the hip and the pelvic floor
If the arch of the foot is our lowest diaphragm, then it plays a huge role in how impact travels through the body.
The foot has to sense the ground.
It has to adapt.
It has to move through tiny spirals, pronation, supination, eversion, inversion, yielding and recoil.
The hip also influences what the foot is being asked to do.
If the hip is stiff, the femur head is not gliding well, or the pelvis cannot organise around the thigh bone, the foot may compensate.
If the foot cannot yield or sense clearly, the pelvic floor may receive a less organised message from below.
So when someone leaks during running or downhill walking, I am not only thinking:
“Is the pelvic floor strong?”
I am also thinking:
“Can the foot receive the floor?”
“Can the hip share load?”
“Can the pelvis move around the femur heads?”
“Can the ribs respond?”
“Can the breath stay available?”
“Can the pelvic floor prepare before the load arrives?”
Because if the lowest diaphragm cannot sense, yield and recoil, the pelvic diaphragm may be left trying to respond without the full story.
The pelvic floor may be intelligent.
But even intelligent tissue needs good information.
So what has actually failed?
Not necessarily the pelvic floor.
More often, one or more of these systems has reached its current limit.
1. Breathing mechanics may have reached their limit
If the ribs are stiff, the diaphragm cannot descend and recoil well.
If the abdominal wall is gripping or collapsing, pressure has fewer places to go.
If someone holds their breath as they run, jump, lift or rush to the toilet, the system becomes more rigid.
Instead of:
inhale, ribs widen, diaphragm descends, pelvic floor lengthens and responds, exhale, recoil
we may get:
impact, breath hold, pressure spike, brace, downward force, leak
That is not just a pelvic floor problem.
That is a pressure-management problem.
2. Timing may have reached its limit
This is huge.
Coughing, sneezing, running and jumping happen quickly.
The pelvic floor needs to respond in milliseconds.
If the response is too late, too much, too little, too rigid or poorly coordinated, leakage can happen.
That does not mean the pelvic floor is incapable.
It may mean the timing is not yet trained for that task.
This is why slow, isolated squeezes may not fully prepare someone for running, jumping or downhill walking.
The body needs reflexes.
It needs rhythm.
It needs graded exposure.
It needs to practise the actual demands of life.
3. Posture may have reached its limit
I do not mean posture in the old-fashioned sense of “stand up straight.”
I mean proper dynamic organisation.
Can the ribs, pelvis, spine, head and feet organise in a way that allows pressure to move and load to be shared?
If someone is running with the ribs flared, bum tucked under, jaw clenched, chest collapsed, eyes down, pelvis behind the feet, or a heavy braking pattern, the pelvic floor may receive load from above and below.
The issue is not “bad posture.”
It is a strategy that may not work well under higher demand.
4. Proprioception may have reached its limit
Proprioception is the body’s sense of where it is in space and time.
If the body cannot clearly sense the feet, hips, pelvis, ribs or bladder state, it cannot adjust quickly.
The person may not notice they are gripping with their jaw.
They may not feel that one foot is landing just a little harder than the other one.
They may not sense that they are periodically holding their breath.
They may not feel their pelvis rotating or their ribs collapsing.
They may not realise they are rushing, bracing or overstriding.
Sometimes leaking is not the first thing that went wrong.
It is the first thing loud enough for us to notice.
5. Load sharing may have reached its limit
The pelvic floor is not supposed to manage impact alone.
The feet, calves, hamstrings, glutes, adductors, deep hip rotators, spine, ribs, diaphragm, abdominal wall and nervous system are all part of the load-sharing team.
If the hips do not help, the pelvic floor gets more work.
If the feet do not absorb, the pelvic floor gets more work.
If the ribs are rigid, the pelvic floor gets more work.
If the nervous system is braced, the pelvic floor gets more work.
The leak may be saying:
“The system above and below me did not help quickly enough. Help!”
6. Fatigue may have exposed the limit
This matters with running, longer walks and downhill movement.
A woman may be fine for five minutes, ten minutes or twenty minutes, and then she leaks.
That tells us something really useful.
The system has capacity, but not enough endurance yet.
It may not mean:
“I can’t run.”
It may mean:
“At this point, my timing, recoil, breath, hip control, foot absorption or bladder support drops off.”
That gives us a training map. I love a map…
7. The bladder-brain system may have reached its limit
Not all leaking is the same.
Leaking when you cough, jump or run is not the same as leaking when you are rushing to the toilet after getting out of a swimming pool.
Urgency has a different flavour.
Cold water, caffeine, getting out of the pool, the sound or sight of toilets, damp swimwear, anxiety, habit loops and “I hope I make it” thoughts can all turn the bladder signal up.
In this case, the issue may not be strength.
It may be bladder sensitivity, nervous system threat, urgency conditioning and the ability to down-regulate while walking.
So again, the question is not:
“Why is the pelvic floor still weak?”
It may be:
“Why does the bladder-brain system feel unsafe here?”
Running research: what does it actually tell us?
But does leaking mean you are damaging your pelvic floor?
This is where the research becomes really interesting.
A study by Bérubé and McLean looked at what happens to the pelvic floor after a 37-minute treadmill run in women with and without running-related stress urinary incontinence.
The researchers found that after the run, there were some temporary changes in pelvic organ support.
In simple terms, the bladder neck and pelvic organs appeared to sit a little lower after running.
That might sound worrying at first, but this is the important part:
The pelvic floor muscles themselves did not show a clear drop in their ability to contract.
So the run seemed to create a temporary change in the support system, but it did not necessarily mean the pelvic floor muscles had become weak, exhausted or damaged.
This matters because many women assume:
“If I leak, my pelvic floor must have failed.”
Or:
“If things feel heavier after running, I must have made my prolapse worse.”
But the research suggests it may not be that simple.
The body has both active and passive support systems.
The active system includes muscles that can contract, respond and recoil — including the pelvic floor, deep abdominal wall, diaphragm, hips and surrounding muscles.
The passive system includes connective tissue, fascia, ligaments and the support structures that help hold the pelvic organs in place.
After running, the passive support system may show a temporary change, a bit like tissues responding to load.
That does not automatically mean damage.
It may simply mean the body has been loaded and now needs recovery, better load sharing, or a more gradual build-up.
Think of it like this.
If you go for a long walk and your feet feel tired afterwards, it does not automatically mean your feet are damaged.
If your legs feel heavy after climbing a hill, it does not mean your legs have failed.
It means your tissues have been asked to do work.
The question is whether your body can recover, adapt and become more resilient over time.
A later study looked more closely at the amount of pelvic floor loading during running. Interestingly, the researchers did not find that greater pelvic floor loading clearly explained the temporary drop in pelvic organ support after the run.
So it was not as simple as:
More impact equals more damage.
Or:
More load equals more leaking.
This is important because women are often scared into thinking that impact is automatically bad for the pelvic floor.
But the picture is much more nuanced.
It may not only be about how much load there is.
It may be about how that load is managed.
How does the foot meet the ground?
Can the ankle, knee and hip absorb impact?
Can the pelvis organise over the thigh bones?
Can the ribs move?
Is the breath held or flowing?
Is the pelvic floor gripping or responding?
Is the nervous system braced or settled?
Is the bladder calm or already on high alert?
Has the body warmed into rhythm, or has it gone straight into impact from a place of fear?
This is why I do not like reducing leaking to one simple explanation.
Leaking does not always mean the pelvic floor has failed.
Sometimes it means the whole system has reached its current limit.
The pelvic floor may be trying to respond, but if the feet, hips, ribs, breath, fascia, bladder and nervous system are not sharing the work well, it can end up carrying more than its fair share.
So instead of asking:
“Is running bad for my pelvic floor?”
A better question might be:
“Is my body currently prepared for this amount of running, on this surface, at this speed, with this level of fatigue, bladder fullness, breath control and confidence?”
That is a very different conversation.
And it gives us somewhere hopeful to go.
Because if leaking is feedback, we can use it.
We can adjust the load.
We can build gradually.
We can improve breath and pressure management.
We can train the feet and hips to absorb impact.
We can help the ribs and diaphragm move better.
We can calm the bladder-brain connection.
We can rebuild trust in movement.
And we can stop treating the pelvic floor as if it is the only part of the body responsible for continence.
Leaking does not always mean damage. It often means your body is showing you where its current capacity, coordination or confidence needs support.
Leaking is rarely one muscle waving a white flag
This is the heart of it.
Leaking is rarely one muscle waving a white flag. It is usually the whole system saying:
“This is the point where I can no longer organise pressure, timing, posture, load and sensory information quickly enough.”
That does not mean we panic.
It means we listen.
It gives us a starting point.
Can we improve rib movement?
Can we improve hip glide?
Can we improve foot awareness?
Can we improve breath mechanics?
Can we reduce bracing?
Can we train reflexive response?
Can we build impact gradually?
Can we calm bladder urgency?
Can we improve the body’s ability to prepare before the load arrives?
This is why I do not simply tell women to squeeze harder. Because continence during movement is not just about strength. It is about response.
What should we train instead?
This does not mean pelvic floor muscle training has no place. I think there has to be a place for the traditional voluntary muscle contractions (done well) alongside whole body training with the pelvic floor in mind.
Especially if the goal is running, jumping, lifting, hiking, sneezing without fear, or walking downhill without leaking.
We need to train the whole system.
That might include:
360-degree breathing
rib mobility
foot awareness
hip rotation and glide
pelvic movement around the femur heads
jaw release
thoracic mobility
graded impact
downhill preparation
strength training
reactive drills
rhythm and recoil
bladder calming strategies
nervous system regulation
Hypopressives
TRE or somatic release where appropriate
The aim is not to avoid load forever. The aim is to build the body’s ability to receive, distribute and respond to load. So the pelvic floor is not left doing all the work alone.
A different way to think about leaking
Instead of asking:
“Why is my pelvic floor failing?”
Try asking thses questions instead:
“What was the demand?”
“Was I tired?”
“Was I rushing?”
“Was my bladder irritated?”
“Was I holding my breath?”
“Was I landing heavily?”
“Was I downhill?”
“Was I premenstrual?”
“Were my ribs stiff?”
“Were my hips sharing load?”
“Could my feet feel the ground?”
“Did my body have enough time and information to prepare?”
This changes the conversation.
It takes us away from shame, from fear.
It takes us away from blaming one small group of muscles. And it brings us back to the body as a whole, intelligent system.
The pelvic floor is intelligent, but it needs options
Your pelvic floor is not stupid, or lazy, or simply weak. It is super intelligent:
It is sensory tissue.
Responsive tissue.
Predictive tissue.
It is part of your breathing system, your postural system, your pressure system, your continence system, your sexual system, your emotional protection system and your movement system.
But if the rest of the body has lost options, the pelvic floor can only do so much.
It needs information.
It needs timing.
It needs breath.
It needs movement from above and below.
It needs a nervous system that does not feel under threat.
It needs hips, feet, ribs and spine to help.
So perhaps the question is not:
“How do I make my pelvic floor stronger?”
Perhaps the better question is:
“How do I help my whole body respond better?”
That is where the work begins. Hallelujah
Final thought
Leaking is not a sign of failure. It is really important feedback. It is the body showing us where the current strategy reaches its limit.
And once we know that, we can begin to change the strategy.
Not by forcing.
Not by gripping.
Not by squeezing harder and hoping for the best.
But by rebuilding breath, timing, proprioception, posture, pressure management and whole-body load sharing.
Because the pelvic floor does not need to do everything. It needs a body that can work with it.
If you woyld like to work with me in person or online get in touch - Work with me
Studies and research to explore
Leitner M, Moser H, Taeymans J, Kuhn A, Radlinger L. Pelvic floor muscle displacement during voluntary and involuntary activation in continent and incontinent women: a systematic review.International Urogynecology Journal. 2015.
This systematic review looked at pelvic floor muscle displacement during voluntary and reflex activation in continent and incontinent women. It supports the idea that pelvic floor function is not simply about isolated squeezing, but about how the pelvic floor behaves under different types of activation.
Leitner M, Moser H, Eichelberger P, et al. Evaluation of pelvic floor muscle activity during running in continent and incontinent women: an exploratory study.Neurourology and Urodynamics. 2017.
This study found that running appears to trigger pelvic floor muscle pre-activation before heel strike and reflex activation after heel strike, suggesting the pelvic floor prepares for impact rather than simply reacting after the event.
Moser H, Leitner M, Baeyens JP, Radlinger L. Pelvic floor muscle activity during impact activities in continent and incontinent women: a systematic review.International Urogynecology Journal / related impact activity literature.
This area of work highlights that impact activities can produce involuntary and reflex pelvic floor activity, supporting the need to look beyond slow voluntary contractions alone.
Luginbuehl H, Lehmann C, Baeyens JP, Kuhn A, Radlinger L. Involuntary reflexive pelvic floor muscle training in addition to standard training versus standard training alone for women with stress urinary incontinence: study protocol for a randomized controlled trial.Trials. 2015.
This paper argues that activities such as sneezing, coughing, running and jumping require fast, reflexive pelvic floor responses, while standard pelvic floor physiotherapy often focuses on voluntary contractions. It provides a strong rationale for training reflexive responses, not just isolated squeezes.
Bérubé MÈ, McLean L. The acute effects of running on pelvic floor morphology and function in runners with and without running-induced stress urinary incontinence.International Urogynecology Journal. 2024.
This study found that a 37-minute treadmill run caused transient strain in passive pelvic floor support tissues in runners with and without running-induced stress urinary incontinence, but did not show concurrent changes in pelvic floor muscle contractile function.
Bérubé ME, Hitchcock R, Graham R, McLean L. Is pelvic floor loading in female runners associated with post-run changes in pelvic floor morphometry or function?Continence. 2025.
This study found that the magnitude of pelvic floor loading during running did not appear to explain the transient loss in static pelvic organ support after running, suggesting the relationship between running load, support and continence is more nuanced than “more load equals more damage.”
Bérubé ME, Niederauer S, Graham R, et al. The feasibility of using an intravaginal intra-abdominal pressure sensor during running to evaluate pelvic floor loading and its association with running-induced stress urinary incontinence.International Urogynecology Journal. 2024.
This study explored whether intravaginal pressure sensing during running could help evaluate pelvic floor loading exposure and its relationship to running-induced stress urinary incontinence.
