If you leak when you run, jump, or lift, that's called stress urinary incontinence (SUI). It's common and it's treatable, and it isn't a fixed trait. In this blog we are going to talk about a few of the predictable factors related to SUI, but most importantly we are going to talk about the factors that might be making your leaking less predictable and why.
Leaking happens when the pressure (demand) on your bladder outpaces your system’s ability (capacity) to keep the urethra closed. Some of these factors you probably already noticed and are pretty linear: more physical stress = more leaking. This might come in the form of volume: longer runs, longer intervals of hopping. It might also come in the form of impact: more force on landing, higher amplitude of hopping, or downhill running.
These mechanical factors can be easier to associate with symptoms and control - read about some of these mechanical factors here. But there are other factors at play that might ‘muddy the water’ and make your leaking related to these mechanical factors less predictable.
So for those of you who experience more leaking on some days than others without changing the mechanics of your task, this blog is for you.
It’s important to understand here is that your pelvic floor is part of a complex system. Locally, the system includes your pelvic floor muscles, the connective tissue supporting the urethra, and the urethral lining itself. Beyond the pelvis, it’s influenced by how you manage pressure when you move, how your hips, knees and feet absorb load. The demand on the system is impacted by mechanical stress but it is also impacted by hormones, mental emotional stress, fatigue, and recovery. Anything that raises the demand or lowers the capacity on a given day moves you closer to that threshold where you are likely to leak. That's why the same run that's dry one week leaks the next. Below are the most common things that shift the balance, what the evidence says about each, and what to do about it.
Does coffee make bladder leaks worse?
Caffeine is the first thing most people are told to cut, but the evidence is more specific than the advice. In a prospective study of 65,176 women in the Nurses' Health Studies, high caffeine intake (450 mg/day or more) was linked to a modest increase in new urgency incontinence. It was not linked to new stress incontinence (Jura et al., 2011). A large NHANES analysis found caffeine above roughly 200 mg/day was associated with leaking overall, but not with any particular type (Gleason et al., 2013).
So coffee doesn't cause SUI. It can still make your leaking worse, for two practical reasons:
Volume. Caffeine and alcohol both increase urine production. A fuller bladder leaks more when you cough or land a jump, so timing matters more than total intake. Two coffees right before a run is a different situation than two coffees spread across a workday.
Mixed symptoms. Many women with SUI also have some urgency. If you notice that sudden "I have to go now" feeling along with leaking on impact, irritants are more likely to matter for you.
Alcohol works similarly, and carbonated drinks and artificial sweeteners are often added to the list. The research on those last two is thin and mostly tied to urgency and frequency, not stress leaking.
The common overcorrection is drinking less water. That tends to backfire. Concentrated urine can irritate the bladder, and low fluid intake contributes to constipation, which is its own problem (more below). A better approach is to drink normally across the day, front-load fluids earlier, and be strategic about timing before workouts or long stretches without a bathroom.
Should Athletes Drink Less Water to Stop Leaking?
For athletes, restricting fluids has a second cost: it hurts performance. Fluid losses beyond about 2% of body weight compromise endurance performance, which is why the American College of Sports Medicine sets that as the line to stay under during exercise (Sawka et al., 2007). If you skip water all morning to stay dry on a lunchtime run, you're starting that run already behind. You'll feel it as higher effort at the same pace, worse heat tolerance, and a harder recovery.
The fix is timing, not volume. ACSM recommends drinking several hours before training so your body has time to absorb the fluid and pass the excess. That lines up well with a bladder-friendly plan:
Front-load fluids 2 to 4 hours before your session, then empty your bladder right before you start.
Sip during longer sessions rather than chugging at aid stations or between sets.
For long or hot sessions, use electrolytes. You'll retain more of what you drink instead of sending it straight to your bladder.
Weigh yourself before and after a few typical sessions to learn your actual sweat losses, then rehydrate to match afterward.
Perimenopause, Menopause, and Bladder Leaks
Estrogen receptors are found throughout the urethra, bladder, vaginal tissue, and pelvic floor. Estrogen helps keep the urethral lining thick and well supplied with blood, which is part of what creates a watertight seal. When estrogen drops, that seal gets less effective even if your muscles haven't changed.
Perimenopause is where many women first notice leaking, or notice it getting worse. Estrogen doesn't decline in a smooth line during this stage. It swings, sometimes widely, from month to month. Symptoms that come and go without an obvious reason often track those swings.
After menopause, lower estrogen becomes the baseline. Leaking often shows up alongside other genitourinary symptoms like vaginal dryness, urgency, or more frequent UTIs (together called genitourinary syndrome of menopause). Local vaginal estrogen improves incontinence compared with placebo in a Cochrane review (Cody et al., 2012). The same review found systemic hormone therapy, particularly oral conjugated equine estrogen, was associated with new or worsening incontinence. Route matters, and it's a conversation worth having with your physician.
Postpartum and breastfeeding. Lactation suppresses estrogen. Combined with tissue recovery after delivery, this is why leaking in the first months postpartum is common. It also tends to improve as cycles return, though not always on its own.
Your menstrual cycle. Some women notice leaking or urgency shifts across the month. The research here is small and mixed, so treat it as something to track rather than a rule. If your symptoms are clearly cyclical, that's useful information to bring to an evaluation.
Why you leak more when you’re tired…
You already know that longer and harder sessions mean more load. What's less obvious is that your capacity to handle that load isn't fixed either. It drops with fatigue, poor recovery, and under-fueling, so the exact same run can land you on either side of the threshold.
Fatigue within a session. The pelvic floor fatigues like any other muscle group. In young women who had never given birth and had mild SUI, 90 minutes of interval training cut maximal pelvic floor contraction pressure by about 20% compared with rest (Ree et al., 2007). If you're dry for the first 3 miles and leak at mile 6, or fine on your first sets of double-unders and not your last, that's the pattern. Put your highest-impact work early in the session while you're fresh, train pelvic floor endurance and not just strength, and build volume gradually.
Fatigue across a training block. Back-to-back hard days, a big mileage week, or the tail end of a heavy block all leave less in the tank. Research looking at the pelvic floor specifically over weeks is limited, but there's no reason to think it plays by different rules than your quads or calves. If your leaking clusters in your hardest weeks, that's information about load management, not a sign you need to stop.
Sleep and stress. Poor sleep and high life stress reduce recovery across the board, and many women notice their symptoms follow. Stress can also show up as habitual bracing, breath-holding, or a pelvic floor that never fully lets go. A muscle that's always partially on has less range left to contract hard when you land a jump. Direct evidence here is thin, so treat it as a pattern to watch for rather than a rule.
Under-fueling. Not eating enough to cover your training is a recovery problem and a hormone problem. Low energy availability suppresses estrogen, which loops back to everything in the hormone section above. Missed or irregular periods in an athlete are a signal worth taking seriously, with or without leaking.
Constipation and straining. A full rectum takes up space and adds pressure on the bladder, and repeated straining loads the pelvic floor and its connective tissue. Athletes run into this more than they'd expect:
Early-morning sessions before you've had a bowel movement
Low-fiber eating before races or long efforts
Travel, schedule changes, and race-week nerves
Iron supplements, which are common in female athletes
Under-drinking, which brings us back to the hydration section
Build a consistent bathroom routine around your training, get enough fiber and fluid on your normal days, and use a footstool on the toilet so you're not straining. If you notice you leak more on mornings you train before going, that's an easy fix.
How to treat stress urinary incontinence…
Knowing your triggers is useful, but managing triggers alone is playing defense. The goal is to raise your capacity so the same loads stop getting you to threshold.
Pelvic floor muscle training (PFMT) is first-line, and the evidence is strong. In a Cochrane review, women with SUI who did PFMT were eight times more likely to report cure than those who didn't (56% vs 6%) (Dumoulin et al., 2018). Programs that work are progressive and run at least 3 months. They train strength, endurance, and fast, well-timed contractions, not just a handful of Kegels when you remember.
Learn to pre-contract. In the context of a one off sneeze or cough, squeezing your pelvic floor just before is a simple, trainable skill. It's often one of the fastest wins.
More on kegels here.
Keep training, and train the whole system. Stopping running or lifting usually isn't the answer. Graded exposure to impact and load, building strength in the system - feet, knees and hips - combined with pelvic floor work and good pressure strategy, builds tolerance. Most women can get back to what they love.
Consider support tools. A pessary or an over-the-counter incontinence insert supports the urethra mechanically. They're a reasonable option for running or sport, either as a bridge while you build capacity or as a long-term choice.
Talk to your physician about vaginal estrogen if you're perimenopausal or postmenopausal and have other genitourinary symptoms.
Get evaluated if:
Leaking is changing what you do, or how you do it
You've tried exercises on your own for a few months without much change
You feel heaviness, pressure, or a bulge in the vagina
You have pain, blood in your urine, or frequent UTIs
Leaking started suddenly or is getting worse quickly
A pelvic health clinician can help you to know what factors make sense for you to focus on, and build a plan around the activities you care about.
The bottom line
Leaking that varies from day to day is a load-versus-capacity problem. Caffeine and alcohol matter mostly through bladder volume and urgency, hormones change how well the urethra seals, and fatigue, under-recovery, under-fueling, and constipation lower your capacity on any given day. Tracking your patterns tells you which levers to pull. Training your pelvic floor raises the ceiling so you don't have to plan your life around them.
Common doesn't mean normal, and it definitely doesn't mean permanent.
Dr. Laura Latham, DC, CSCS, is a sports chiropractor, pelvic health specialist, and co-founder of Back Bay Health in Boston MA. She works with athletes through pregnancy, postpartum, and beyond. If you are struggling with leaking with exercise including running, jumping of lifting, Dr. Laura sees people in person and virtually. Click here to schedule your free discovery call today.
References
Jura YH, Townsend MK, Curhan GC, et al. Caffeine intake, and the risk of stress, urgency and mixed urinary incontinence. J Urol. 2011;185(5):1775-1780. Link
Gleason JL, Richter HE, Redden DT, et al. Caffeine and urinary incontinence in US women. Int Urogynecol J. 2013;24(2):295-302. Link
Sawka MN, Burke LM, Eichner ER, et al. American College of Sports Medicine position stand: exercise and fluid replacement. Med Sci Sports Exerc. 2007;39(2):377-390. Link
Cody JD, Jacobs ML, Richardson K, et al. Oestrogen therapy for urinary incontinence in post-menopausal women. Cochrane Database Syst Rev. 2012;(10):CD001405. Link
Ree ML, Nygaard I, Bø K. Muscular fatigue in the pelvic floor muscles after strenuous physical activity. Acta Obstet Gynecol Scand. 2007;86(7):870-876. Link
Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2018;(10):CD005654. Link
