Hello friends, it’s hard to believe but we are coming up on another new year! Many of us set New Year Resolutions that involve exercise, often starting a new exercise routine. So picture this: You’re excited and ready to live a healthier life. You just got new clothes and shoes for Christmas and signed up at your local gym. You hop on the treadmill to start a jog only to notice you just leaked a little pee! Now your excitement to exercise has just been dampered. Leaking pee with exercise is a sign of a condition called stress urinary incontinence, and it’s often caused by pelvic floor muscle dysfunction. Even if the amount of leakage is a little (like just a few drops) this is often a sign that the pelvic floor muscles aren’t working properly. So what do you do now? Should you just stop running and jumping?
Let’s first talk more about stress incontinence. High performance female athletes are at an increased risk of urinary incontinence (Sorrigueta-Hernandez, 2020). It is often a barrier to women’s participation in sports activities (Hamilton, 2023; Kinder, 2023; Leitner, 2018). While there is no evidence that strenuous exercise itself causes stress urinary incontinence, the impact activity makes symptoms prevalent which may not have been noticed without physical activity (Leitner, 2018).
The pelvic floor plays a large role in maintaining continence with all activities, but especially with high impact activities like running (Bo, 2020). The pelvic floor muscles sit at the bottom of the pelvic bone, spanning from the pubic bone in the front to the tailbone in the back. During running, the pelvic floor muscles act like a trampoline. They support the bladder to keep it in the right place. When landing, they need to have the flexibility and excursion to “give” as well as the support and strength to rebound or “bounce back.” They also need to be coordinated and strong enough to keep the bladder outlet closed to avoid urine loss, as the pelvic floor muscle wrap around the urethra and when they contract help to keep it closed.
To prevent urinary leakage, the pelvic floor muscles need to be able to contract quickly and reflexively to withstand the impact of ground reaction forces created with each stride. These forces can be up to 2.4-3.9 times our body weight (Koenig, 2020) Pelvic floor muscle strengthening has been shown to treat and prevent stress urinary incontinence (Kinder, 2023). Poor pelvic floor muscle endurance can contribute to stress urinary incontinence (Steimling, 2023). Continence mechanisms include not only the pelvic floor muscles but also ligaments and fascia (Hamilton, 2023).
Running increases intra-abdominal pressure throughout activity and for extended periods of time (Steimling, 2023). Intra-abdominal pressure is the scientific term for the amount of pressure that is in our abdomen. The pressure inside our abdomen changes throughout the day with movements, changing positions, breathing, and contracting our abdominal muscles (Bo, 2020). Managing intra-abdominal pressure is crucial to allow to pelvic floor muscles to do their job well (Bo, 2020). To help manage this pressure, the abdominal muscles need to be able to contract at the same time as the pelvic floor (Leitner, 2018). Not manging this pressure well leads to the leakage of urine.
Some factors that increase the risk of developing stress incontinence are:
Constipation (Sorrigueta-Hernandez, 2020)
Family history of urinary incontinence (Sorrigueta-Hernandez, 2020)
Eating disorders (Sorrigueta-Hernandez, 2020)
History of urinary tract infections (UTIs) (Sorrigueta-Hernandez, 2020)
History of a vaginal delivery (Hamilton, 2023)
Perineal trauma (Hamilton, 2023)
Assisted delivery (Hamilton, 2023)
Surgery (Hamilton, 2023)
Age (Hamilton, 2023)
So what can we do about leakage with running? Please keep in mind that while we are pelvic floor therapists, we are not YOUR therapists. The information in this blog is intended for educational purposes only and does not replace evaluation and treatment by a licensed healthcare provider. If you are experiencing urinary leakage, talk with your providers to find the best treatment options for you.
Pelvic floor muscle strength and endurance is an important aspect of treating urinary incontinence; however, despite pelvic floor muscle training, sometimes called Kegels, many women remain symptomatic with high impact activities like running (Steimling, 2023). This is because stress incontinence in the female athlete is a multifactorial issue (Kinder, 2023). Other parts of the body are interconnected with the pelvic floor muscles, especially in dynamic activities like running. Pelvic floor muscle activity is influenced by fascial structures, hip strength , and foot mobility (Leitner, 2018; Sorrigueta-Hernandez, 2020). A comprehensive approach to include addressing all aspects of pelvic floor muscle functon is best. Exercise programs should address intra-abdominal pressure management, rotational movements, and the speed of contraction of the pelvic floor muscles (Kinder, 2023). Research has shown that strengthening the hip external rotator muscles has been shown to improve pelvic floor muscle strength because contraction of the obturator internus (a hip muscle) is thought to help lift the pelvic floor muscles (Leitner, 2018).
Physiotherapy (also known as physical therapy) is a conservative treatment option that leads to an improvement in continence control in female athletes (Sorrigueta-Hernandez, 2020). Physical therapist are specially trained to treat parts of the body like the hips and back. Pelvic floor physical therapists received additional training on the pelvic floor muscles and other important aspects like intra-abdominal pressure management.
Don’t let leakage stop you from running or exercising. There are so many benefits of physical activity including(Bo, 2020):
Reduced risk of dementia
Reduced risk of some cancers
Reduced risk of excessive weight gain
Improved cognitive function
Reduces progression of chronic conditions like osteoarthritis, high blood pressure, and type two diabetes
If you are experiencing leakage with running, we recommend to “pad up and play on” while you get the help you deserve. Knowing that leaking is a warning sign that your body isn’t managing pressure well is important, but being afraid to exercise and do what you love and what your body craves leads to other problems! The benefits of exercise often outweigh the risks, but a pelvic floor therapist can help you exercise without leakage. Ask you provider for a referral to one near you, or find on at www.mypfm.com/find-a-pt.
You may also find internal support options helpful. It is common to use tampons, or other internal vaginal supports, to prevent leakage with high-impact activities (Sorrigueta-Hernandez, 2020). Being fitted for a medical device called a pessary is a often a good long-term solution. You can read more about pessaries in our blog here.
Remember, that urinary leakage is not normal and there is help out there. Everyone deserves to run free without the worry of incontinence!
To learn more about your pelvic floor muscles, check out these great resources:
Watch our YouTube playlist on Bladder Concerns and Your Pelvic Floor
Watch Netflix for Your Pelvic Floor at Pelvic Flicks
Learn more about your pelvic floor on our Instagram
Visit our Amazon store for our favorite pelvic health products
Sign up for our email newsletter
For providers, join our Ambassador Program and most of our courses are included with your membership!
Pelvic Floor Dysfunction in Runners: Into to Running Gait Analysis with Dr. Amanda Olson, PT, DPT, PRPC
Postpartum Return to CrossFit with Dr. Reg VanVelzen, PT, DPT, OCS and Dr. Emily Reul, PT, DPT
Rehabilitation and Gait Strategies for Pelvic Floor Dysfunction in Runners with Dr. Amanda Olson, PT, DPT, PRPC
Written by Emily Reul, PT, DPT
References
Bo K, Nygaard IE. Is physical activity good or bad for the female pelvic floor? A narrative review. Sports Med. 2020;50(3):471-484.
Hamilton HM, Mariano M, Kakar RS. Prevalence and associated factors of urinary incontinence in female recreational runners. J Womens Pelvic Health Phys Ther.2023;47(2):75-89.
Kinder J, Cheuy V, Davenport TE. Integrating pelvic health and orthopedic programs to treat incontinence at the community level for female runners: a pilot study. J Womens Pelvic Health Phys Ther. 2023;47(3):191-202.
Koenig I et al. Pelvic floor muscle activity patterns with women with and without stress urinary incontinence while running. Ann Phys Rehabil Med. 2020;63(6):495-499.
Leitner M, et al. Evaluation of pelvic floor kinematics in continent and incontinence women during running: an exploratory study. Neurourol Urodyn. 2018;37(2):609-618.
Sorrigueta-Hernandez A et al. Benefits of physiotherapy on urinary incontinence in high-performance female athletes metanaylsis. J Clin Med. 2020;9(M,10):3240.
Steimling M, Roberto M, Steimling M. Running gait retraining in the management of a multiparous runner with chronic stress urinary incontinence: a case study. J Womens Pelvic Health Phys Ther. 2023;47(2):114-121.