There’s a belief so widespread that most people have never questioned it: bladder leaking is what happens to women after childbirth, and eventually to older women.
Here’s a set of figures that complicates that considerably.
Athletes are almost three times more likely to experience urinary incontinence than sedentary women. Prevalence ranges from around 10.9% in low-impact sports such as cycling to 80% in high-impact activities like trampoline gymnastics.
A systematic review covering 22 studies and 7,507 women aged 12 to 69 found prevalence ranging from 5.56% in low-impact activity to 80% in trampolining, with high-impact activities showing roughly 1.9 times the prevalence of medium-impact activities.
And a great many of these women have never given birth.
In one survey of 245 nulliparous, physically fit women aged 18 to 40, 22.9% reported urinary incontinence — and among those, around 61% had stress incontinence.
So if you’re a fit woman in your twenties who leaks during box jumps and has assumed something is wrong with you specifically, the data says otherwise.
The Finding That Changes the Explanation
Here’s the part that should reframe how you think about this.
The obvious assumption is that leaking means a weak pelvic floor. It’s the assumption behind essentially all the advice given.
But a case-control study comparing nulliparous athletes with untrained women measured pelvic floor strength directly — and found no significant difference between the groups. The athletes averaged 45 hPa; the untrained women 43 hPa.
Despite that, 61.1% of the athletes experienced urinary incontinence, compared with 12.5% of the untrained women.
Same strength. Five times the leaking.
Which means weakness isn’t the whole story. What differs is the demand. Athletes generate far higher intra-abdominal pressures, far more frequently, at far greater speed — repeated jumping, landing, heavy lifting, sprinting, and rapid direction changes.
The pelvic floor isn’t failing because it’s weak. It’s failing because the load exceeds what it can currently manage, and because the timing of its response may not match the speed of the demand.
That’s a load-versus-capacity problem — which is exactly how every other sports injury is understood, and it responds to the same logic.
Where It Shows Up Most
The pattern follows impact.
Highest: trampolining and gymnastics, where figures reach around 80%.
High: track and field, various ball sports, CrossFit-style training, running.
One CrossFit study of 50 women found 20% reported incontinence, mostly of moderate severity — and notably found an association between a previous history of incontinence and current symptoms.
Lower: swimming, cycling and other low-impact activities.
The predictable triggers athletes describe: double-unders, box jumps, heavy squats and deadlifts, sprinting, plyometrics, and the landing phase of anything.
Why Nobody Talks About It
Several things compound.
It’s assumed to be normal in the sport. In gymnastics and CrossFit particularly, leaking is so common that it’s treated as an unremarkable part of training — sometimes even joked about.
It’s assumed to require childbirth, so young nulliparous athletes conclude it must be something else, or something shameful.
Coaches don’t ask, and athletes don’t volunteer.
And there’s a specific fear that raising it will mean being told to stop training.
The result is a highly treatable problem being managed privately — with dark shorts, extra products, going to the bathroom before every session, and quietly avoiding certain movements.
The Two Quiet Costs
First, the avoidance. Athletes modify around it — skipping the double-unders, reducing the load, avoiding the running portion. That’s a real cost to training, and it accumulates.
Second, and more important: research on young athletes notes that incontinence in this population may increase the risk of developing stress urinary incontinence later in life.
So the framing of “it’s fine, everyone does it” isn’t just socially awkward — it may be storing something up.
Treating it in your twenties is considerably easier than treating it in your fifties.
What Actually Works
Pelvic floor muscle training is recommended as first-line treatment, and it’s been studied specifically in young nulliparous female athletes.
But given the strength finding above, the program should look different from the standard advice.
Coordination and timing, not just strength. If your floor is already reasonably strong, adding raw strength addresses less than teaching it to activate at the right instant.
Training under the conditions where it fails. A pelvic floor that performs well lying down tells you very little about how it behaves during a box jump. Progression needs to move toward the position, speed and load of your actual sport.
Pressure management. How you brace, how you breathe under load, and whether you’re holding your breath and driving pressure downward through heavy lifts. This is frequently a bigger factor than the floor itself.
Assessment first. Because some athletes have the opposite problem — an overactive pelvic floor held in constant tension, which can also produce leaking and which gets worse with more squeezing. Given how much bracing and core work athletes do, this is not rare.
And load management. Temporarily reducing the specific movements that provoke it while capacity is built, rather than either pushing through or abandoning them.
What Not to Do
Don’t stop training. The reflex to give up impact work has a real downside, particularly for bone and muscle over the long term.
Don’t dehydrate before sessions. Common, understandable, and it worsens performance while doing nothing for the underlying problem.
Don’t go “just in case” before every set. It trains the bladder to signal at lower volumes.
And don’t just do more Kegels. If your floor isn’t weak, more squeezing isn’t the answer — and if it’s overactive, it’s the wrong direction entirely.
For Coaches and Parents
Ask, don’t wait to be told. Athletes won’t raise it. A general statement that this is common, treatable, and not a reason to stop training makes it possible for someone to speak up.
Take it seriously in young athletes. High-impact sports in adolescence show the highest prevalence figures of any group, and the long-term implications make early attention worthwhile.
And don’t treat it as a rite of passage. Being common isn’t the same as being normal, and it’s certainly not the same as being untreatable.
When to See a Physician
See your physician for: blood in your urine, pain or burning with urination, recurrent urinary infections, inability to empty your bladder, leaking that started suddenly, or fever with urinary symptoms.
And urgently for leaking accompanied by back pain, leg weakness, or numbness in the groin or inner thighs.
One more worth mentioning: if you’re an athlete with incontinence alongside irregular or absent periods, restricted eating, or a history of stress fractures, that combination warrants proper evaluation — those things travel together more often than people realize.
Keep Training. Fix the Problem.
Leaking during sport is common, it’s not a sign of weakness in the way people assume, and it’s genuinely treatable — usually without reducing what you do.
Hays County Physical Therapy offers a free discovery visit at no cost and no obligation. You’ll get a proper assessment of your pelvic floor function, your pressure management, and how you’re loading under the demands of your actual sport — plus a plan that keeps you training.
Nothing you describe will be new to us, and nobody is going to tell you to take up swimming.