Running & Urinary Leakage (And How to Fix It)
Runners are crazy people. Please don’t take offense! I mean it with love. I’ve found that runners, more than most people who enjoy a particular type of exercise, will keep running through anything: knee pain, hip pain, hamstring tears, broken ankles, pelvic floor issues…
I’m certainly not saying running is bad for you (your pelvic floor included) but running can put a lot of strain on your body. Your running form and how your body manages pressure while running play a huge role in whether you’re strengthening or just straining your pelvic floor and the other muscles in your body.
Let’s talk about some symptoms that likely mean you’re putting too much strain on your pelvic floor when you run: urinary leakage, feelings of heaviness in your pelvic floor, and increased pelvic pain. If you’ve been running for a long time without a break in training and you’ve just started experiencing these symptoms or they’re getting worse, my advice is to stop running and address the issues. Again, I know runners hate to stop running. But if you don’t address the root cause of the problem, the problem will get worse. Consistent strain to the pelvic floor can lead to things like prolapse and chronic pain. If you’re recently postpartum and experience these symptoms when you get back into running, you’re likely doing too much too soon and also need to back off running until you address the root cause of the problem.
One primary role of our pelvic floor is support. Your pelvic floor literally forms the floor of your core and supports all the organs above it. Your pelvic floor is also unique in that it is under voluntary and involuntary control. If you’ve ever had to stop the flow of urine or tried a Kegel (a pelvic floor muscle contraction), you know you can intentionally (voluntarily) contract your pelvic floor muscles. But these muscles also work throughout the day to help keep us upright and support us through our daily activities.
When you run, your pelvic floor has to absorb increased stress. Each time you land, ground reaction forces travel through your foot, up the leg, and into your pelvis. When your core system is functioning properly, your pelvic floor involuntarily activates before landing to absorb this stress.
This system can break down in a number of ways, leading to problems like leakage, heaviness, and pain. One way this system can break down is through coordination deficits. This is when your pelvic floor muscles aren’t able to quickly and involuntarily react to an increase in stress during a high-impact activity like running. Another coordination deficit can occur when your pelvic floor muscles and your diaphragm (your breathing muscle) aren’t in sync while you’re running. Additionally, changes in muscle tone, whether that’s weakness or hyperactivity, can also prevent your pelvic floor from absorbing stress like it should.
So, what can you do about it?
First and foremost, you should consider being seen by a pelvic floor physical therapist who can assess internally whether your pelvic floor is weak or overactive and how it manages pressure. A pelvic floor PT will also be able to assess what’s going on with your feet, knees, hips, trunk, and shoulders – in other words, look at how your body is functioning as a whole when you run. There’s just no replacement for a personalized plan of care.
You may want to self-assess whether you’re making some common mistakes that can negatively affect your pelvic floor’s ability to manage the load placed on it when running. Please keep in mind, though, that every body is different and what may work for one person might not work for another (cue the importance of a personalized plan).
Abdominal wall is too stiff or you grip your abdominals throughout the run. You may be sucking in during your run, especially through your upper abs, or you may feel like you want to keep your core engaged during your entire workout. This can be problematic for a couple of reasons. One, your abdominals also have to absorb shock as you run and if they are too rigid, they cannot perform this function. Two, gripping your abdominals can prohibit your diaphragm from functioning optimally, and you need to be able to breathe well as you run. Try reducing any gripping throughout your abdominals as you run and allow your belly and ribcage to expand as you breathe.
Poor rib cage and chest posture. Your rib cage should be mostly stacked over your pelvis as you run, and you should avoid over-arching your lower back. Too much arch in your lower back lengthens your abdominal wall and makes it more difficult for your core to function like it should. It also decreases the efficiency of your diaphragm. Try softening your rib cage: imagine your nipples pointed straight ahead (as opposed to up toward the sky when our chest is poking out or down to the ground when we are slumped too much).
Feet too far in front of the body when you land. Speaking of your chest, you should aim to land with your chest over your feet. Your feet should not land too far out in front of your chest. Stretching your feet out too far in front of your body lengthens your hamstrings, which can not only lead to a hamstring injury, but it also keeps your ankles, knees, and hips from effectively absorbing that ground reaction force. Instead of your hamstrings doing the work to pull you through your stride, you actually want your glutes and quads to push you forward. Of course, effective absorption of ground reaction forces reduces the strain to the pelvic floor.
Landing too hard. One of the easiest to recognize, but not necessarily one of the easiest problems to fix. If you hear your feet thumping on the ground when you run, just imagine how much of a pounding your pelvic floor is taking. Quiet landing is a good indication that your pelvic floor can more effectively absorb shock. But, there are a lot of factors that can play a role in hard landings: running too fast, incorrect shoe choice, poor form, rigid posture, etc. Play around with the tips above, adjust your speed, and consider talking to someone at your local running store about your footwear to see if you can make some adjustments that will soften your landing.
Runners with urinary leakage, pelvic pain, or feelings of heaviness, there is hope! You don’t have to leak pee when you run. And you don’t necessarily have to stop running to avoid further problems down the road. But you do have to address the source of the problem. If you try the tips above without seeing changes or you’re just ready for a personalized plan, reach out to your favorite pelvic floor PT for help!
Thanks for reading! If you found this helpful, help promote awareness of pelvic floor issues and SHARE it! Let’s normalize talking about peeing, pooping, and sex.
