How Ice Baths Might Help You Stop Peeing Yourself
Written by Sarah Loogman
It’s not uncommon, but it is absolutely a problem.
The incontinence of, especially women, during physical exercise should be a concern of any doctor, therapist, coach or other practitioners of strength, health and wellness. The complexity of the matter, however, makes this phenomena hard to pinpoint and countless women feel the necessity to choose resignation when it comes to this issue.
The first and most obvious question for a woman experiencing exercise-induced incontinence is if they have given birth. Whether by cesarean section or vaginal delivery, the pelvic floor may have undergone intense physical trauma that can offer a very clear explanation to the structural damage done to the contractional capacity of the bladder and other pelvic organs. Not all childbirths are traumatic in this way, however, and increasingly more research is available today regarding natural childbirth methods, breathing techniques and “hypnobirthing” that can dramatically decrease the injury to a mother during childbirth.
For a woman who has had a traumatic delivery, however, the answer is at least more clear in learning how to recreate the stability and structure of the pelvic floor through a well-periodized progression of exercises to increase eccentric, concentric and isometric control of the pelvic muscles. Kegel’s, low-impact and pilates-like exercises are commonly recommended to postpartum mothers.
But what if you haven’t given birth? Or what if the Kegels just aren’t doing it?
There are a variety of other traumas that a person can incur to the pelvic region that could inhibit one’s ability to control the bladder, especially under high-intensity or high-impact exercise. Most apparently so would be that of sexual abuse and assault, especially of children. It is not uncommon for children of sexual assault to begin to manifest symptoms of such abuse as, among other things, incontinence or wetting of the bed. These same issues may persist or resurface in adolescence or adulthood, even once the “mannerism” has been trained out of the child. It is not entirely clear the relationship between incontinence and sexual assault, though there are many lenses by which experts have theorized this phenomena that provide a valid perspective.
Trauma of the sexual sort will be apparent in other areas, as well, not limited to pelvic pain (especially during sexual intercourse), inability or difficulty to orgasm, a lack of proprioception of the muscles of the pelvic floor and gluteus, as well as an anterior or posterior pelvic tilt that can cause chronic pain or acute injury of the lower back.
The impact of sexual trauma is devastating and is an incredibly complex (but entirely possible) healing process that involves comprehensive reunion of emotional, physical, mental, relational and even (or especially) spiritual health. For a person who has experienced sexual assault, this may help to identify some of the root matter of incontinence that persists or reappears even during adulthood or may have been revealed by the introduction to exercise. If you are the victim of sexual assault, you should seek out the broad spectrum of research, resources and experts available to healing in this manner.
As a side note: men will more often manifest pelvic issues as rectal and abdominal wall herniations rather than incontinence, which is more common in women. This could have correlating factors to male victims of sexual abuse, who are less researched than female victims of sexual abuse.
But what if you don’t fit into either category? Or what you’re doing still isn’t working?
If you’re of the rare category of people who has neither given childbirth nor had to endure sexual abuse and yet you still wrestle with incontinence, you may be frustrated by the lack of answers. So here’s a theory:
The periaqueductal gray area (PAG) is an area of the midbrain that surrounds the cerebral aqueduct, the pathway that innervates the spinal nerve from the brain to the base of the spine. The PAG is still being researched and is not fully understood by scientists, but we do know that it has a powerful impact on the nervous system as a whole and in particular, that it is responsible for the natural and stimulated analgesic (pain-regulating) affects on the body. Simply put, this light-colored gray matter is the protecting gatekeeper of how information gets from your body to your brain and helps you avoid the perception of pain.
Synthetic opioids, such as those you are prescribed after a surgery, are effective because of their impact on the PAG. Research shows that this area of the brain is also activated by intense experiences such as a car accident, traumatic brain injury, or limb loss which could better explain how people “in shock” may not experience pain in the manner that we’d normally expect. It may be similarly plausible that other intense experiences such as sexual assault, loss of a loved one or divorce could activate our brains ability to avoid pain. Interestingly enough, the PAG is impacted by cold immersion, too.
So what’s this got to do with peeing during your workout?
Among the autonomic processes that are regulated by the PAG, an easy one to skip over is that of bladder control. A lack of ability to regulate the midbrain may help to explain the matter of female incontinence that doesn’t otherwise arise from childbirth or sexual abuse. And it may be entirely possible that practicing ice bath therapies could be a part of the solution.
If you struggle incontinence and you are frustrated by a lack of solutions or have been offered by a doctor to simply stop doing certain exercises, try a routine of cold showers or ice baths instead. It just might make all of the difference.
For some instructions on how to start your cold immersion practice, read our blog on ice baths for beginner’s here.
Additional Sources:
The Role of the Periaqueductal Gray Matter in Lower Urinary Tract Function. Aryo Zare, Ali Jahanshahi, Mohammad-Sajjad Rahnama’i, Sandra Schipper, Gommert A. van Koeveringe. Mol Neurobiol. 2019; 56(2): 920–934. Published online 2018 May 26. doi: 10.1007/s12035-018-1131-8.
Behbehani MM. Functional characteristics of the midbrain periaqueductal gray. Prog Neurobiol. 1995 Aug;46(6):575-605. doi: 10.1016/0301-0082(95)00009-k. PMID: 8545545.
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