Core Focus DPT

Let’s get one thing straight, leaking urine, even a little, is not a normal part of aging. It’s common, yes, but it’s not something you just have to live with. So many women (and men!) shrug off those small leaks during a workout, a sneeze, or a laugh, assuming it’s inevitable after having kids or hitting a certain age. But bladder leaks are a sign of an underlying imbalance, not an irreversible condition.

Bladder leakage, or urinary incontinence, can have many root causes beyond childbirth. It can happen to runners in their 30s, teachers in their 40s, or grandparents in their 60s. The truth is, our bladder health depends on how well our entire system works together. Our muscles, breathing, posture, and even hormones all play a role.

Understanding why leakage happens opens the door to treating it, not hiding it. And that’s where physical therapy comes in. Pelvic floor–trained physical therapists look beyond the bladder itself to uncover what’s really contributing to the problem.

1. Posture and Pressure Imbalance

One of the most overlooked causes of bladder leaks is posture. You might not think standing tall or slouching has much to do with your bladder, but your body’s alignment directly affects pressure inside your abdomen.

Imagine your core as a pressurized canister. The top is your diaphragm, the bottom is your pelvic floor, and the sides are your deep core and back muscles. When you breathe, move, or lift something heavy, this system manages the pressure inside the canister. If your posture collapses, say, slumping at your desk or arching your back excessively, your body has to compensate, and that pressure can push downward onto your bladder and pelvic floor.

Over time, that extra force weakens your pelvic muscles and makes leaks more likely, especially during activities that increase pressure like coughing, jumping, or running. Physical therapists teach you how to restore balance and alignment, retraining your breathing and movement patterns so that your pelvic floor isn’t constantly under stress.

Simple changes like adjusting how you stand, how you breathe during exercise, or how you lift a heavy load can reduce downward pressure and give your bladder the support it needs.

2. Hormonal Changes

Hormones play a major role in how our muscles and tissues function, especially estrogen. During perimenopause and menopause, estrogen levels drop, which can cause the tissues of the bladder and urethra to become thinner and less elastic. The pelvic floor muscles may also lose some of their natural tone, coordination, and responsiveness.

But hormonal changes alone aren’t the whole story. When the body adapts to changes in strength, breathing, or even chronic stress, muscle coordination often becomes disrupted. For example, someone who’s been holding tension in their abs or glutes for years might have a pelvic floor that’s overly tight rather than weak, leading to leaks when it can’t relax at the right time.

And it’s not just women in menopause who experience this. High-intensity athletes, women postpartum, and even men recovering from prostate surgery can have similar coordination issues. The good news? Physical therapy can help retrain these muscles to respond appropriately—contracting, relaxing, and coordinating with the rest of the body during movement.

3. Chronic Coughing or Respiratory Issues

Chronic coughing from allergies, asthma, smoking, or even lingering respiratory infections can place repetitive stress on your pelvic floor. Each time you cough, you increase pressure inside your abdomen. If that pressure is directed downward instead of being dispersed evenly, your pelvic floor absorbs the impact over and over again.

This repeated strain can fatigue or overstretch the pelvic muscles, eventually leading to stress incontinence (leaks during exertion). A physical therapist can teach strategies to manage pressure when coughing, improve breathing mechanics, and strengthen supporting muscles so your pelvic floor can recover rather than brace with every cough.

4. High-Intensity or Improper Exercise Habits

Yes, even your workouts can contribute to bladder leaks, especially if you’re doing high-impact or heavy-lifting routines without proper core control. Exercises like jump squats, box jumps, or double-unders in CrossFit can spike intra-abdominal pressure. If your breath-holding or bracing pattern isn’t well-coordinated, the pressure has nowhere to go but down.

The goal isn’t to stop exercising, it’s to move smarter. Physical therapy helps you learn how to exhale with exertion, maintain alignment, and activate your pelvic floor and core muscles dynamically. Once you master pressure management, you can get back to lifting, running, or jumping without worry.

5. Muscle Coordination and Timing Issues

You can have strong pelvic floor muscles and still experience leaking if they don’t activate at the right time. The pelvic floor must coordinate with your breath and movement contracting before a sneeze, not after it. If those reflexes are delayed, leakage happens even when strength isn’t the problem.

Physical therapy focuses on retraining this timing through biofeedback, guided exercises, and breathing techniques that improve how your pelvic floor, diaphragm, and deep core communicate. When these systems fire in harmony, your bladder stays supported through every movement, cough, or laugh.

How Physical Therapists Retrain the Body for Better Control

When you see a pelvic health physical therapist, the goal isn’t just to make your muscles stronger, it’s to help your body work smarter. A well-functioning pelvic floor must be able to both contract and relax at the right time.

Your therapist will assess how you move, breathe, and manage pressure during everyday activities—like lifting, coughing, or exercising. You might be surprised to learn that many bladder leaks stem from breath-holding or bracing habits that create too much internal pressure. PTs use breathwork and core coordination drills to teach your diaphragm, deep core, and pelvic floor to work together again.

Some of the techniques may include:

• Diaphragmatic breathing to reconnect your breath and pelvic floor.
• Pressure management training to reduce strain on the bladder during exertion.
• Pelvic floor retraining to improve muscle timing and endurance.
• Functional strength work to restore control in real-world movements like squatting or jumping.

Physical therapy also helps identify external contributors—like tight hips, restricted rib mobility, or low back stiffness—that may be disrupting your pelvic balance. The approach is always individualized because everyone’s “why” behind leaking is different.

Takeaway: Don’t Settle for “Normal”

Leaking isn’t just part of aging, motherhood, or menopause, it’s a sign your body needs support. Whether your leaks happen while running, sneezing, or laughing, there’s always a reason behind it, and that reason can be treated.

Physical therapy helps you find that root cause and gives you the tools to retrain your body for better control, confidence, and freedom in daily life. With the right approach, you can move without worry and live without pads or fear of accidents.

It’s never too late to take back control of your bladder health. You don’t need to accept leaks as your “new normal.” You just need to learn how your body works and how to make it work for you again.

Disclosures & Disclaimers

Hey there! Just a heads-up. When you click on my links and make a purchase, I might get a tiny commission. It doesn’t affect my honest reviews and comparisons one bit! I’m all about recommending stuff I’ve personally tried, genuinely love, thoroughly researched, and wholeheartedly endorse.

** The views and opinions expressed on this site belong to Vigeo Ergo Consulting LLC. Any advice or suggestions offered herein are not a replacement for medical advice from a physician or other healthcare professional. My blogs are for informational and entertainment purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment.