Female athletes have redefined strength and endurance, but one common issue still hides in silence: urine leakage during training or competition.

It’s more common than most realize. In certain sports like gymnastics, trampolining, and CrossFit, the rates are particularly high. Still, many women keep silent, assuming it’s a normal side effect of being active or that nothing can be done.

As a urologist, I often meet women who are in top physical condition but quietly avoid certain workouts, limit hydration, or change their routines to hide the problem. It’s not a matter of fitness or discipline; it’s physiology. And, importantly, it’s treatable.

In this article, we’ll look at why leakage happens in female athletes, how common it really is, and what practical strategies can help. Because pelvic floor health deserves the same attention as strength, endurance, or recovery, and ignoring it only sidelines performance.

How common is it?

Urine leakage during exercise, technically called exercise-induced urinary incontinence, is far more common than most athletes or coaches realize. Studies suggest that roughly one in three young, active women experience at least occasional leakage while training or competing.

Despite those numbers, only a small fraction ever seek help. Many believe it’s simply “part of training hard,” or they’re too embarrassed to mention it. Some quietly cut back on hydration or avoid certain movements, choices that can harm both performance and health.

Leakage in athletes isn’t rare, and it’s not something to hide. It’s a sign that the pelvic floor is under strain, not that the athlete is weak or unfit. Recognizing it as a physiological issue, not a personal flaw, is the first step toward prevention and treatment.

Why leakage happens

Two main theories attempt to explain why urine leakage occurs in female athletes during high-impact activity. One proposes that repeated rises in intra-abdominal pressure during training may actually strengthen the pelvic floor through reflexive pre-contraction. The other suggests that these same forces can overload or stretch the pelvic floor if the reflex response is not strong or fast enough to counter the pressure spike.

In practice, most athletes who experience stress urinary incontinence, leakage that occurs when abdominal pressure suddenly rises above what the urethra can contain. Movements such as jumping, sprinting, or landing generate sharp pressure increases, and if the pelvic floor cannot activate in time, urine escapes.

Importantly, this is not a sign of weakness. Many athletes have well-developed pelvic floor muscles, but the coordination or timing of contraction may be insufficient during high-impact activity.

Other factors may amplify the problem: low estrogen levels, which affect tissue elasticity; intense core training, which increases downward pressure; and fatigue or dehydration, which can slow neuromuscular response.

Ultimately, leakage occurs when internal pressure temporarily exceeds pelvic support, and that balance can shift with training load, hormonal status, technique, and fatigue.

Most affected sports

Some sports simply place more stress on the pelvic floor than others. Leakage is most common in activities that involve repeated jumping, landing, or heavy lifting, which all create sharp increases in internal pressure.

Trampolining, gymnastics, running, and CrossFit are among the highest-risk disciplines. Even elite athletes, Olympians and professionals, report leakage during peak training periods. By contrast, low-impact sports such as swimming, cycling, and rowing rarely cause symptoms because body weight is supported and vertical forces are lower.

Understanding which activities carry a higher risk allows athletes and coaches to anticipate problems early and tailor training to protect pelvic health, without compromising performance.

Why it matters

For many athletes, leakage isn’t just a physical issue; it’s an emotional one. The fear of losing control mid-competition can quietly shape how women train, compete, and even see themselves as athletes.

Some restrict fluids before events to “be safe.” Others avoid certain movements, cut sessions short, or hide behind dark clothing. Over time, that avoidance chips away at confidence and performance.

The psychological toll is real: shame, anxiety, and withdrawal from sport are common. And medically, repeated strain without proper recovery can make symptoms worse over time. Recognizing and addressing the issue early prevents both physical and emotional burnout.

What we can do about it

The good news is that leakage in athletes isn’t something to accept or “work around.” It’s a sign of overload on the pelvic floor, and like any other part of the body, it can be retrained.

1. Pelvic floor training. The pelvic floor is part of the core system, working with the diaphragm and abdominal muscles to stabilize the body. For athletes, timing matters as much as strength. Physiotherapists who specialize in pelvic health teach reflex coordination through biofeedback, ultrasound, and movement-based retraining.

2. Breathing and core mechanics. Holding the breath during effort (the Valsalva maneuver) traps pressure in the abdomen and pushes it downward. Learning to exhale during exertion helps redistribute that pressure and improves pelvic stability.

3. Hormonal and nutritional balance. Low estrogen from overtraining or under-nutrition can reduce pelvic tissue elasticity. Restoring energy balance and normal cycles supports tissue strength. In perimenopausal athletes, local estrogen therapy may help.

4. Practical supports. Absorbent sports underwear or supportive pessaries can offer reassurance during training or competition. They’re not a cure, but they allow athletes to stay active while addressing the underlying issue.

5. A team approach. Optimal care brings together urologists, physiotherapists, nutritionists, and coaches. When everyone communicates, athletes regain both performance and confidence.

The stigma and the conversation we need to have

Pelvic floor health remains a taboo topic in sports. Few athletes discuss it openly, and few are ever asked about it. That silence forces adaptation rather than resolution (skipped hydration, restricted movement, or quiet withdrawal from competition).

Breaking the stigma starts with conversation. Coaches and clinicians who bring up pelvic health normalize it as part of routine care. For athletes, speaking up isn’t weakness; it’s part of owning performance. True strength includes listening to the body, not hiding from it.

Conclusion

Leaking during sport isn’t a failure of fitness; it’s a signal that the body’s pressure systems are out of sync. Like any imbalance, it can be corrected.

With proper pelvic floor training, breathing mechanics, and supportive care, most athletes can regain full confidence in their bodies. It’s time to move this issue out of the shadows of embarrassment and into the mainstream of athletic health.

The strongest athletes aren’t the ones who push through silence; they’re the ones who listen, adapt, and keep moving forward, stronger, and in control.

Martina Ambardjieva is a dedicated urologist and medical educator with extensive experience in both clinical practice and academic instruction. She earned her MD from the University “Sv. Kiril i Metódij” in Skopje and is a PhD candidate in urological oncology, with a focus on bladder carcinoma. Her scholarly work includes numerous publications in oncologic urology, urinary calculosis, and men’s health.

Dr. Ambardjieva currently serves as a urologist at the PHI University Surgical Clinic “Naum Ohridski” and completed her residency training at the University Urology Clinic in Skopje. Earlier in her career, she practiced as a general medical doctor at Sante Plus General Hospital and completed a medical internship at the University of Ljubljana.

In addition to her clinical responsibilities, Dr. Ambardjieva is a teaching assistant at the Medical Faculty in Skopje. She works additionally as a collaborator for Dr. Telx. She has held leadership positions in the European Medical Students’ Association and actively participates in international medical education and policy. She has attended numerous congresses and workshops in France, Italy, Canada, and Turkey, and serves as a delegate for the European Association of Urology (EAU), contributing to cross-border initiatives in urology. Certified in laparoscopic surgery, she continues to integrate patient care, research, and education in her professional work.