“Why Is My Client Leaking During Exercise… Even Though She’s Doing Pelvic Floor Work?”

One of the most common questions personal trainers ask when working with women is:

“If my client is already doing pelvic floor exercises, why is she still leaking during training?”

The problem is that most people have been taught to think about pelvic floor dysfunction in isolation. Leakage during running, jumping, or lifting is immediately labelled as “weak pelvic floor muscles,” and the solution becomes more activation drills, more Kegels, or more cueing.

But the pelvic floor does not function independently.

It is part of a dynamic pressure-management and force-transfer system involving the diaphragm, abdominal wall, rib cage, glutes, adductors, fascia, hips, and nervous system. Its role is not simply to contract. Its role is to respond reflexively and coordinate efficiently during movement, load, impact, and changes in intra-abdominal pressure.

This distinction matters enormously for personal trainers.

Because most urinary leakage does not occur lying on the floor during isolated contractions. It occurs during:

• running

• jumping

• lifting

• coughing

• fatigue

• high-force bracing

• rapid pressure changes

In other words, symptoms often appear when the body fails to coordinate pressure and movement efficiently under demand.

The Science Personal Trainers Need to Understand

The pelvic floor works closely with the diaphragm and abdominal wall to regulate intra-abdominal pressure (IAP). During breathing and movement, the diaphragm and pelvic floor should move in coordination, while the surrounding musculature helps distribute and transfer force throughout the trunk and pelvis.

However, movement quality changes pressure management.

If a client:

• excessively flares the ribs

• loses pelvic control

• overextends through the lumbar spine

• breath-holds under load

• collapses through femoral internal rotation

• lacks gluteal control

• or cannot tolerate force efficiently

…the pelvic floor may become mechanically disadvantaged regardless of how much isolated pelvic floor work is being performed.

This is one reason symptom presentation is often movement-dependent rather than purely strength-dependent.

Research increasingly supports this integrated model. An RCT comparing pelvic floor muscle training alone versus pelvic floor training combined with glute max, glute med, and hip adductor strengthening found the combined group experienced greater reductions in leakage frequency (Marques et al., 2020). Interestingly, measured pelvic floor strength outcomes between groups were not significantly different.

Mechanistically, this suggests improvements may have occurred through:

• improved lumbopelvic stability

• better pressure distribution

• enhanced force transfer

• improved timing and coordination

• and more efficient reflexive muscle recruitment patterns

Not simply stronger isolated contractions.

This is critical because continence is largely reflexive. The pelvic floor must react rapidly to changes in pressure during dynamic movement. It is not realistic to expect women to consciously “squeeze their pelvic floor” every time they jump, sprint, or brace under load.

The body needs an efficient strategy, not just a stronger isolated muscle.

Why This Matters for Personal Trainers

As coaches, we are not diagnosing pelvic floor dysfunction or determining pelvic floor strength. That remains within the scope of pelvic health clinicians. However, coaches absolutely influence:

• movement exposure

• load progression

• fatigue management

• breathing strategies

• exercise selection

• impact tolerance

• and movement quality

This means programming can either support pressure management… or challenge it beyond what the client currently has capacity for.

Many personal trainers unknowingly create environments where women repeatedly compensate through:

• breath holding (Talasz et al., 2022)

• excessive bracing

• lumbar extension

• poor hip mechanics (Walsh et al., 2026)

• pelvic instability

• or inefficient force transfer

Over time, this may contribute to symptom aggravation.

Understanding this changes how coaches view women’s training entirely.

Actionable Things Personal Trainers Can Start Looking At

This does NOT mean coaches should fear movement or remove all high-impact training. It means coaches need to understand how to progressively build tolerance and improve movement efficiency.

Some practical things to start observing include:

1. Breathing Strategy Under Load

Does the client excessively breath-hold during effort?

Do they lose rib positioning during lifts?

Can they maintain pressure control without aggressive bracing strategies?

Breathing mechanics directly influence diaphragm and pelvic floor coordination.

2. Hip and Pelvic Control

Watch for:

• excessive pelvic shifting

• hip drop during single-leg tasks

• femoral internal rotation collapse

• over-reliance on lumbar extension instead of hip extension

The glutes and deep hip musculature significantly influence pelvic positioning and force transfer.

3. Fatigue-Dependent Compensation

Many clients only demonstrate symptoms under fatigue.

Observe:

• changes in breathing

• loss of trunk control

• altered landing mechanics

• reduced force absorption

• excessive gripping strategies

Movement quality under fatigue often reveals the real problem.

4. Exercise Selection and Progression

Not every client currently has the capacity for high-impact or high-pressure tasks.

This does not mean avoiding them forever.

It means asking:

• Has the client developed adequate load tolerance?

• Can they manage pressure efficiently first?

• Is progression occurring too aggressively?

• Are they compensating to achieve performance?

Good coaching is not about removing challenge. It is about sequencing challenge appropriately.

The Bigger Problem in the Fitness Industry

Most education around women’s health still teaches personal trainers isolated tools instead of systems thinking.

Coaches are given:

• corrective exercises

• activation drills

• postpartum modifications

• random cues

…but rarely taught:

• how pressure management works

• how movement influences symptom presentation

• how fatigue alters coordination

• how the hips influence continence mechanics

• or how to build prevention-focused programming strategies

This is why so many personal trainers feel uncertain when working with women experiencing symptoms.

Because they were taught exercises, not frameworks.

Why I Created The Functional Pelvic Floor Coach™ Mentorship

The goal is not to turn personal trainers into pelvic health physiotherapists.

The goal is to help coaches better understand:

• women’s physiology

• movement strategies

• pressure management

• exercise implications

• symptom patterns

• and prevention-focused programming

Because women deserve coaches who understand how their bodies function during real movement and real training environments.

That is exactly why I created the Functional Pelvic Floor Coach™ Mentorship.

This 12-week online mentorship is designed to provide coaches with a prevention-focused framework for working with women across training, movement, physiology, and dysfunction patterns.

Not another toolbox.

A system.

The next intake begins July 11th, 2026.

Learn more