Leakage When You Run? 6 Ways To Keep Your Pelvic Floor Happy

November 10, 2020

Running is one of the most popular forms of exercise out there. You can do it alone, it requires almost no equipment, and you can do it nearly anywhere and anytime you want. In the US alone, over 60 million people run for exercise.

But as with all types of athletics, it can take a toll on your body. And unlike, say, your knees or ankles, the effects on your pelvic floor muscles can be less visible and more insidious. And while pelvic floor dysfunction (in various forms) is quite common amongst runners of all ages, it should not be seen as normal or inevitable. Rather, a little education about how running can cause problems and how those problems can be avoided can go a long way.

Is Running Really Correlated With Bladder Leakage?

First things first -- is running really correlated with urinary leakage and other bladder control problems?

The answer is yes, whether you’re asking Google, looking at scientific literature, or just asking your PT or doctor at your next appointment. And unfortunately, it is disproportionally a women's health issue. This recent study found that the prevalence of urinary incontinence amongst athletes was over 45% for women vs. around 15% for men. And the average age of the athletes in the study was 24, so this is not just a problem that rears its head later in life. 

Furthermore, this correlation is primarily tied to impact when one's foot strikes the ground. Thus, it also goes for many other types of sports, particularly ones that involve jumping (like basketball or volleyball). And lastly, female runners who have had children are at even higher risk of exercise-related pelvic floor dysfunction issues.

Why Does Running Provide Challenges For Your Pelvic Floor Muscles (and Your Bladder)?

When you run, the intra-abdominal pressure in your pelvic region increases each time your foot impacts the ground. And even on a short run, you take a lot of steps, so your pelvic floor is being stressed over and over (in contrast to something like a sneeze; sneezing of course also stresses your pelvic floor but does so much less repetitively, although it can cause a larger pressure increase). 

The increase in pressure caused by your foot’s impact with the ground pushes downward and can be difficult for a weak pelvic floor to counteract. Particularly given the repetitiveness, this can result in leakage (basically the textbook definition of stress incontinence), or even exacerbate problems with pelvic organ prolapse.

What Are Some Tips To Avoid Problems?

Everyone’s body is unique, but the below are best practices that can often help:

1. Do your Kegel exercises (and other pelvic floor muscle exercises). Problems stemming from muscle weakness can often be addressed by a strengthening program, and this is no exception -- a strong (while also flexible!) pelvic floor will be better able to withstand the intra-abdominal pressure caused by each impact with the ground, and will be more likely to avoid leakage.
2. But don’t do your Kegel exercises while you’re running. Generally speaking, your pelvic floor muscles are already doing some work when you’re running. They are busy enough and a different time is probably better for doing dedicated pelvic floor muscle strengthening exercises.
3. Breathe! Obviously everybody breathes when they’re running, but being conscious of your breathing, making sure that you’re inhaling and exhaling fully, and not keeping your abdominal muscle groups tense the whole time will help keep your pelvic floor at its best for your runs.
4. Engage your glutes. This part of trying to optimize your running posture in general, but it’s a good thing to focus on. You can also think about loosening your hip flexors, moving your hips and tailbone forward slightly, and keeping a straight spine and low back. Running with the wrong form (especially if you run a lot) can lead to back pain or pelvic pain in addition to pelvic floor dysfunction.
5. Don’t suck in your belly. This usually leads to over-clenching, which puts extra pressure on your core muscles (including those in your pelvic floor) that they don’t want or need when you run. Instead, focusing on your breathing or on activating your glutes as mentioned above is a better use of your attention (however much of your attention you can spare beyond making sure you don’t run into a telephone pole or a tree, that is…)
6. Talk to a physical therapist. Pelvic floor fitness is not one-size-fits-all, and that goes double if you are in a special situation, like returning to running postpartum. Best practices, like the ones in this article, can be useful but especially if you are still having problems after trying some things to resolve them, you should definitely talk to an expert physiotherapist who can provide individualized advice about the right physical therapy plan for you.