Pelvic-floor health is often associated only with women and pregnancy. However, it matters to every HYROX athlete, including men, and dysfunction can affect bladder and bowel function, comfort and sexual health.
In an episode of the Rox Lyfe podcast, pelvic-floor occupational therapist and HYROX coach Erica Bermudez explains what the pelvic floor does, the symptoms athletes should not ignore and why HYROX can expose problems that remain unnoticed during everyday life or easier training.
Your Pelvic Floor Does Far More Than You Might Realise
The pelvic floor is a group of muscles at the bottom of the pelvis. Erica describes it as a hammock supporting the abdominal contents from below.
These muscles work alongside the diaphragm, abdominal muscles and back muscles. They contribute to walking and squatting, as well as bladder, bowel and sexual function.
“We would never ignore our glutes when we’re training. Why would we ignore all of these muscles?” Erica says.
Pelvic-floor dysfunction does not always present as an obvious problem in the pelvis. Possible symptoms can include urinary leakage, constipation, pelvic pain, groin pain, persistent hip or lower-back pain, and needing to urinate unusually frequently.
Men may experience a sensation Erica describes as feeling like a golf ball is positioned between the legs. Sexual symptoms can include erectile dysfunction, premature ejaculation or pain after ejaculation. Women may experience pain during sex or orgasm.
These symptoms can have several possible causes, so they do not confirm a pelvic-floor problem. However, they warrant professional assessment if they persist or interfere with daily life.
Why HYROX Can Expose a Previously Hidden Problem
An athlete may be able to complete everyday activities, strength sessions or a comfortable 5K without symptoms, yet experience leakage or pain during a longer run, a hard workout or a HYROX race.
HYROX combines running with impact, heavy loads and high levels of abdominal pressure. Athletes then reach wall balls when the muscles responsible for managing that pressure are already fatigued.
Erica has worked with athletes who could run a 5K without leakage but experienced it uphill or over longer distances. The issue appeared only as the demand increased.
Breath-holding can add to that demand. Athletes often hold their breath and brace hard during sled pushes, sled pulls or wall balls. Erica wants them to avoid doing this indiscriminately through an entire station.
“By the time you’re at the wall-ball station, your pelvic-floor muscles are holding on for dear life,” she says.
Breathing and Pressure Management Matter
Erica uses a water bottle to explain abdominal pressure. The diaphragm sits at the top, the pelvic floor at the bottom, and the abdominal wall and spine surround the sides. Squeezing the bottle increases the pressure inside it. If the muscles cannot manage that pressure effectively, symptoms may occur.
She encourages athletes to notice whether they exhale during impact and exertion or routinely hold their breath. Slower drills such as box breathing may also help them relax an overactive pelvic floor and regulate their nervous system.
Core training should extend beyond crunches and forcefully tightening the superficial abdominal muscles. Erica highlights the transverse abdominis, a deeper muscle that works closely with the hips, back and pelvic floor.
To feel this area working, place your fingers just inside your hip bones, inhale through your nose and exhale as though blowing out birthday candles. Gently draw in the lower abdomen without aggressively gripping the upper abdominals.
Kegels Are Not a Universal Solution
The common response to almost any pelvic-floor concern is to prescribe more Kegels, which involve deliberately contracting the pelvic-floor muscles. Erica warns that this may be unhelpful when nobody has established what the underlying problem is.
A symptomatic pelvic floor may be weak, excessively tense or poorly coordinated. Repeatedly contracting muscles that already struggle to relax could aggravate the issue.
“If you’re doing 30 Kegels a day on muscles that are not working correctly, you’re just going to lead to more issues,” Erica says.
She compares it with an injured bicep that cannot complete a full curl. The response would not be to perform 50 more curls without understanding the injury.
An individual assessment can establish whether the priority is strength, relaxation, coordination, pressure management or another intervention.
Race-Day Habits
Pelvic-floor health is influenced by what an athlete does throughout the week, not only by their technique during a race.
Erica sees nervous athletes visit the toilet five or ten times before racing “just in case.” Repeated precautionary trips can reinforce the feeling that the bladder must be emptied before it is full. She encourages a sensible hydration routine and calming strategies such as breathing or gentle stretching.
She also advises athletes to examine habits such as constantly squeezing their glutes, holding their abdomen rigid, drinking too little water or regularly straining because of constipation.
Pregnancy and Postpartum
Pregnancy increases the pressure placed on the abdominal and pelvic-floor system. Erica recommends that pregnant athletes speak to their doctor about training and pay particular attention to breathing, pressure management and pelvic-floor function throughout the week.
Postpartum issues such as diastasis recti, rib flare and an overactive pelvic floor may contribute to leakage or pain. Erica recommends consulting a pelvic-floor specialist before returning to the full demands of HYROX, especially when symptoms are present.
Progression should reflect the individual’s delivery, recovery, symptoms, medical advice and current capacity rather than an arbitrary date.
Former gymnasts may also warrant attention. Erica encounters women with a history of gymnastics who have experienced leakage following years of jumping and high-pressure movements. A symptom should not be accepted as normal simply because it is common.
Coaches Should Ask, Listen and Refer When Necessary
Athletes may never mention leakage, pelvic pain or constipation unless a coach creates an appropriate opportunity.
Erica suggests including questions about incontinence and pelvic pain within an initial client questionnaire. In conversation, a coach can ask permission before raising the subject.
The coach does not need to diagnose the problem. Their role is to notice warning signs, respond without embarrassment and refer the athlete to a qualified professional.
“You might not be a pelvic-floor specialist, and that’s fine. You can always refer out to a pelvic-floor therapist,” Erica says.
For the athlete, leakage or pain during HYROX is not something they automatically need to tolerate, hide or solve with more Kegels. It is useful information about how their body is handling pressure and fatigue. With an appropriate assessment and an individual plan, they can address the cause and build towards the demands of training and racing more confidently.
Erica Bermudez offers virtual pelvic-floor evaluations and can be found through her website, ThePelvicFloorOT.com, and on Instagram and TikTok at @thepelvicfloor_ot
