Dear CrossFit HQ,

I come in peace. I am hoping to open a respectful dialogue regarding pelvic health for female CrossFitters. I am actually an ally to CrossFit in the pelvic health arena….but you are making it hard to defend CrossFit when you promote videos like “Kelley Jackson Pee-R’s”. On the Facebook thread for the video, you suggested that videos like these gave us opportunities to discuss the issue. So let’s discuss. I am a Women’s Sports Medicine PT who has championed returning women to high levels of fitness after pain or pelvic health issues. My goal is to help fitness and rehab pros recognize the relevance of pelvic health to fitness and sport. Not  just so women don’t leak or men don’t “shart”, but how these issues are related to optimizing their performance (dudes-a “shart” under load is the same issue as women leaking, just coming out of a different exit, and technically it is a form of fecal incontinence).  

A urine leak or a “shart”….leaks pressure….which you need to pull off a PR. Kelley, the athlete who leaked in the video, hasn’t had kids so there really isn’t a reason why she should have a “weak” pelvic floor, that doesn’t make sense either as the only source or the only solution for her leaks. This is a pressure management issue and a whole body participation issue vs just a weak pelvic floor problem. When we look at it that way we can train strategies to contain the pressure and use it toward pulling off the lift vs. losing the pressure out her hoo-hoo. If we treat this like a sports medicine problem and performance optimizing issue vs a pelvic floor problem alone, perhaps we can get the CrossFit community to discuss it in a different way.

You offered an article as your exploration of the topic, and while there was good information in the article there are some mixed messages and unhealthy suggestions we need to discuss. The article suggested that the pelvic floor is trained alongside the rest of the musculature involved in functional, complex movement patterns, AGREE! But it went on to suggest that at maximal efforts the “internal muscles” fatigue leading to leaks. But if all the muscles are trained together, then why is the pelvic floor the only one that fatigues to the point of failure? We must consider other explanations.

The article also offered dehydration as a suggestion. First off, this simply doesn’t work to stop leaks. If Double Under’s are on the board, women run to the bathroom prior to their attempt and they still leak. This is because the bladder is always filling. You would have to be VERY dehydrated to have this actually be an effective strategy for stopping leaks. In addition, we know that when women dehydrate themselves they actually create urgency, frequency and urge incontinence issues. Dehydration concentrates the urine, making it irritating to the bladder and urethra. This makes you feel like you have to go, even when you don’t (urgency) and increases your trips to the bathroom to respond (frequency). You become further dehydrated and the cycle continues. Throw in the inevitable constipation and this can become urge incontinence (UI), which is leaking before you can make it to the bathroom. So dehydration is a very unhealthy and dangerous suggestion that can have bigger consequences overtime.

Over-recruited pelvic floors, very common in female athletes and male weight lifters, can contribute to urgency, frequency, UI and constipation as well. The pelvic floor actually responds to abdominal activation with a synchronized and scaled effort (small ab contraction, small PF contraction, medium-medium, big-big). So heavy abdominal work, can put the pelvic floor on constant high, and over-recruited alert. In an over-recruited state, the pelvic floor has no-where else to go and/or no more effort/power to give when a challenge comes, contributing to leaks. In addition, this can contribute to symptoms of urge, urgency, constipation, painful sex and ultimately for some men, erectile dysfunction. If 55% (the number of women you cited leak during exercise) of male CrossFitters had erectile dysfunction, would you promote how bad-ass their training was and pass it off as a badge of honor with high-fives and big cheers? Would we see t-shirts promoting “I trained so hard, I can’t get hard!” (TM)? Would your position change on how acceptable this is in your community if the pelvic and sexual health of your male constituency was effected at the same rate and magnitude? Would you seek solutions, or simply offer videos applauding it as opportunities to discuss? My guess is….you would try to figure it out.

Welp, a bunch of us have figured some things out. There already ARE solutions and strategies for this that go well beyond just do some kegels. For example, simply adding in more rotational work to WODs can break up a pattern of the over-recruitment of abs that contribute to downward pressure on the continence mechanism (fecal or urinary incontinence). This would also have carry-over to ease the symptoms and consequences of pelvic floor over-recruitment for women AND men.

As I said, I come in peace, simply discussing the issues as you suggested. Ultimately, I am actually trying to help people continue to participate in CrossFit. For you the female or male reader, if you are unwilling to accept these symptoms and issues as normal, there are people out there to help. Feel free to connect with me and I can try to help you find you a practitioner to help in your local area. Or use the US practitioner directory here, Canadian here, and Austrailian here.

My door is always open CrossFit….

Julie

PS We’ve got solutions for impact issues like double-unders too ladies (whether you have had kids or not).

Don’t wanna miss a post? Want bigger discounts on online courses? Subscribe to my newsletter here!