When the weather is finally nice here in Wisconsin, there’s nothing better than throwing on some running shoes, listening to a favorite playlist or podcast, and getting outside. What’s not enjoyable, however, is the reality that a nice summer run can lead to leaking and soaked underwear. Incontinence while running is a big problem for many women. Let’s talk about why it happens and what you can do!
Blame it on the babies...or not?
A large percentage of women experience stress incontinence while running. In fact, a study1 from 2014 found that 46% of the female athletes surveyed reported incontinence. Even more interesting, the participants were all elite runners and cross-country skiers and three quarters of the women had never had children1. Did you catch that? 75% of the women who experienced leakage (even with coughing and sneezing) never had babies!
Having a baby is not the only cause of incontinence. In the pelvic floor physical therapy (PT) world, we often see women who are (or were) long-distance runners, gymnasts, or dancers and have dealt with incontinence issues prior to having children. Some have never even had children and still deal with leaking. Don’t get me wrong: childbirth can have a major impact on the pelvic floor, but the information in this post applies to all female runners, whether they’ve had kids or not.
So why does incontinence while running happen?
- Pelvic Floor Issues
Perhaps the most common recommendation anytime someone hears the word incontinence is “do more kegels”. In reality, especially for the athletes listed above, strength of the pelvic floor muscles is often not the issue. The issue comes from pelvic floor overactivity, a fancy way of saying your pelvic floor muscles are too tight.
What is Pelvic Floor Tightness/Overactivity?
Pelvic floor tightness is when the pelvic floor can’t completely relax to function properly. If the muscles are too tight, they simply can’t squeeze any harder to keep urine from leaking out because they are already squeezing at rest. See the “Testing for Overactive Pelvic Floor Muscles” section below to test your own pelvic floor.
2. Pelvic Organ Mobility
Also worth noticing as a cause of incontinence while running is pelvic organ mobility. When we move, jump, or run throughout the day our organs, especially the bladder, uterus, and rectum, need to move with us. If there are adhesions or restrictions in the connective tissue that wraps around these organs, it can cause pelvic floor issues because this connective tissue connects directly to the pelvic floor muscles. Therefore, we need good mobility or movement to our pelvic organs to help our pelvic floor function to its best ability.
Testing for Overactive Pelvic Floor Muscles
Here’s a fairly simple test you can try to see if your pelvic floor muscles are possibly tight:
- Sit on a firm surface
- Do a kegel. Do you feel a pull away from the chair you're on?
- Now relax, without pushing down. Do you feel just a little more pressure than you did when you were squeezing?
- Last, bear down (similar to pushing for a bowel movement or forcing out gas). Do you feel more pressure against the chair?
If you answered “no” to any of the questions above, it’s likely that your pelvic floor is overactive (aka too tight). You may want to talk to a pelvic floor physical therapist to get a further assessment because this is usually not something you can fix on your own.
This isn’t a perfect assessment to determine if you have a tight pelvic floor, but other symptoms of pelvic floor tightness can include: pain with intercourse, low back/hip/groin pain, incontinence, or vaginal pressure/heaviness.
How to stop incontinence while running
MOST IMPORTANTLY: See a pelvic floor physical therapist (PT) to help you with your incontinence while running, or any incontinence while we’re at it! Even better if your pelvic floor therapist is trained in visceral mobilization (a fancy way of saying we can address the connective tissue within the abdomen and pelvis, as referred to in the section about pelvic organ mobility above). A pelvic floor PT can help you work on pelvic floor overactivity and all of the issues contributing to your leakage; addressing the pelvic floor usually requires looking at most of the body because the pelvic floor does so much for our whole body!
Aside from pelvic floor PT, here are a few things you can implement on your own right away:
- Working on your running form
Having more of a mid-foot strike with a slight forward lean can help to distribute forces through the lower body and lessen the force through the pelvic floor muscles. Also being more aware of your posture can change how your pelvic floor functions. Watch that you aren’t leaning back as you run as this increases the direct forces to the pelvic floor muscles. This position will also help the pelvic floor muscles to work easier. You can also lessen the impact by running on softer surfaces like a dirt trail instead of running on a concrete path.
2. Hip and gluteal strength
For stability of the pelvis and low back, it is key to have strong hips and glute muscles. Make sure you spend time working on strength to support your pelvis and take the load off your pelvic floor. A few exercises that strengthen your hips and glutes can include: squats, lunges, clamshells, and bridges. Also, if you’re looking for some great core exercises that are pelvic floor safe check these out:
3. Help your pelvic floor relax by DEEP BREATHING
Take a moment to sit still and notice your breathing. When you are resting do you feel your shoulders mostly moving, or does your belly rise and fall as you breathe in and out? If you sense most of the motion happening in your chest or shoulders, it is key to take time to work on belly breathing for a few minutes per day. A pelvic floor physical therapist will also help relax tight pelvic floor muscles via manual therapy.
4. Eat to support your pelvic floor
Making sure to eat enough fiber and drink enough water can help to prevent constipation to keep your pelvic floor healthy. Constipation can lead to further overactivity of these muscles. Proper hydration is also key, as more concentrated urine irritates the bladder and leads to more leakage.
Don’t use “just a little” as an excuse
Even if you are someone who leaks “just a little,” your incontinence while running still needs to be addressed. The sign of your bladder leaking, especially while running, is your body’s way of indicating a problem. Left untreated, your incontinence issues could become a bigger problem, especially as you approach menopause.
If you’ve tried the tips above without seeing improvement, now is the time to get help from a pelvic floor therapist. Get ahead of your incontinence before it becomes an even bigger issue or injury. At Revitalize Physical Therapy, we even offer virtual appointments to help treat this common (but not normal) issue! Contact us HERE to get back to more enjoyable running again, where the only trickle you’ll feel is sweat dripping from your brow (instead of down your leg)!
- Poświata A, Socha T, Opara J. Prevalence of stress urinary incontinence in elite female endurance athletes. J Hum Kinet. 2014;44:91‐96. Published 2014 Dec 30. doi:10.2478/hukin-2014-0114. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4327384/