Urinary incontinence during exercise is more common than many women realize—but it’s not always just about a weak pelvic floor. In the latest episode of Holistically Well, Dr. Kayla Borchers, a holistic doctor of physical therapy specializing in pelvic floor health, explores groundbreaking research linking under-fueling and urinary leakage, particularly in active women.
Whether you’re a teenage athlete, a recreational runner, or a postpartum mom returning to training, this episode reveals why low energy availability could be sabotaging your pelvic floor function—and what you can do about it.
EPISODE 20 | HOLISTICALLY WELL PODCAST: RED-S SYNDROME AND URINARY LEAKAGE: WHAT ACTIVE WOMEN NEED TO KNOW
Whether you learn best by listening or watching, there is something for you! You can catch the full conversation on the Holistically Well Podcast—available on all your favorite platforms!
🎧 Holistically Well Podcast on Apple | Episode 20
🎙️ Holistically Well Podcast on Spotify | Episode 20
💻 Holistically Well Podcast on YouTube | Episode 20
Key Episode Takeaways
🏃♀️ Urinary leakage during exercise isn’t always due to weak pelvic floor muscles.
🪫 RED-S or low energy availability can compromise pelvic floor function.
🔄 Hormone disruption, chronic constipation, and delayed muscle adaptation are key contributors.
🩸 Active women of all ages should assess fuel intake, recovery, and menstrual health.
🏋️♀️ Holistic care integrates nutrition, exercise, and pelvic floor rehabilitation for lasting results
The Hidden Link Between Under-Fueling and Pelvic Floor Health
For years, urinary incontinence in athletes was attributed primarily to muscle weakness or nerve issues. But new research shows a deeper systemic connection: Relative Energy Deficiency in Sport (RED-S), also known as low energy availability, can make pelvic floor muscles more prone to leakage.
A main focus Dr. Kayla explains in this Holistically Well episode is:
“When your body isn’t getting enough fuel to meet the demands of your activity, every system suffers—including the pelvic floor. Under-fueled muscles fatigue faster, hormone production is disrupted, and passive support structures like ligaments and fascia lose integrity.”
This means that even if you’re performing pelvic floor exercises correctly, urinary leakage can persist if your body isn’t adequately nourished.
If you’re experiencing leakage despite doing the right exercises, schedule a one-on-one consultation with Dr. Kayla or her Team to assess your fuel intake, recovery, and pelvic floor health.
Understanding RED-S and Its Effects
RED-S occurs when there’s a mismatch between energy intake (food) and energy expenditure (training, life stress). It affects multiple systems:
- Hormones
Low estrogen reduces passive support in ligaments and fascia, essential for pelvic floor stability. - Bone Health
Stress fractures and low bone density are common. - Menstrual Function
Irregular or missing cycles are a major red flag. - Digestive Health
Chronic constipation increases intra-abdominal pressure, straining the pelvic floor. - Training Response
Under-fueled muscles adapt more slowly, making exercise and rehabilitation less effective.
A 2023 update by the International Olympic Committee highlights urinary incontinence as a system affected by low energy availability, showing that women with RED-S are 2.5 to 4 times more likely to experience stress or urge urinary incontinence.
Want a personalized plan to restore energy and pelvic floor function? Dr. Kayla offers customized programs for active women and postpartum mothers!
Who Is Most at Risk for RED-S?
Women most affected by RED-S-related pelvic floor issues include:
- Athletes, dancers, and gymnasts
- Recreational runners and CrossFit participants
- New moms returning to sport
- Women in midlife training intensely or trying to lose weight
Even if you’re not actively trying to lose weight, high training volume combined with insufficient fuel can trigger symptoms.
Red Flags to Watch When Leaking During Workouts
Ask yourself if you notice any of the following:
- Irregular or missing periods
- Fatigue or poor recovery
- Chronic injuries or stress fractures
- Digestive issues like constipation
If two or three of these resonate, it may indicate low energy availability affecting your pelvic floor.
If you’re struggling with urinary leakage during workouts, it’s time to look beyond the muscles and address systemic energy needs. Learn more and get personalized guidance with Dr. Kayla! She provides virtual and in-person sessions for holistic pelvic floor and whole-body support.
What You Can Do
Dr. Kayla emphasizes that fueling is foundational—not just for athletic performance or aesthetics, but for pelvic floor health and overall wellness. Practical steps include:
- Prioritizing balanced, nutrient-dense meals
- Monitoring menstrual cycles and ovulation patterns
- Tracking energy intake versus output, especially during high training periods
- Addressing digestive health to reduce strain on the pelvic floor
- Integrating holistic support through physical therapy and nutrition guidance
Holistic Support With Dr. Kayla and Team
At Holistically Well, Dr. Kayla and her Team combine nutrition, movement, and nervous system support to help women optimize pelvic floor health, whether preconception, pregnant, postpartum, or returning to high-intensity training.
She recommends a personalized approach:
“Every patient’s fuel status and recovery are unique. If you’re experiencing urinary leakage or other pelvic floor symptoms, we assess nutrition, hormone balance, and exercise load to support full-body health.”
Explore Dr. Kayla’s Holistically Well programs for preconception, pregnancy, postpartum, and active women!
