Leaking While Running Is NOT OK - Part 1
Do you…
make sure to pee before and sometimes during your workout, just in case?
wear a pad when you run because leaking is usually a thing?
intentionally wear dark colored clothing to hide any leakage that might happen?
If you answered yes to any of these questions, you are not alone.
I want to talk about something that most people don’t openly discuss, especially since it often evokes feelings of embarrassment or shame. Many think they have to just “deal with it” and therefore don’t talk about it. Leaking urine while exercising is a sign of pelvic floor dysfunction. While this condition impacts both sexes, prevalence among women is much higher due to to anatomical differences at the pelvis and commonly arises after childbirth. However, it is important to note that many women suffer from these conditions who have never had children. Pregnancy, delivery and postpartum are not prerequisites for pelvic floor dysfunction. This is a common misconception and something I’ll be explaining in more detail throughout this three part series.
Now, for the sake of this post I will be speaking about the female pelvic floor, but men, this info is important for you to know too. There are many women in your lives that are silently suffering with this condition. By reading and sharing this post with others, you are helping spread awareness about pelvic floor conditions, and for that I thank you from the bottom of my heart. The more openly we can talk about these challenges and educate people that there are ways to correct these issues (by working with a Pelvic Floor Physical Therapist) the better.
Urinary incontinence (aka leaking) is a medical condition that refers to an involuntary loss of urine caused by increased pressure or sudden muscle contraction of the bladder (1-6). This condition is subdivided into three main categories: Stress Urinary Incontinence (SUI), Urgency Urinary Incontinence (UUI) and Mixed Urinary Incontinence (MUI). SUI is the most common, affecting nearly one in three women (1-6) – that’s a lot! SUI occurs when increased pressure is placed downward on the bladder that is too much for the pelvic floor to counteract resulting in leakage. This often arises with coughing, sneezing, jumping, and running. While this condition is common, especially in women after having children, it is by no means normal, and can easily be treated with pelvic floor exercises and movement re-education (7-9). UUI refers to an overactive need to void. You know that signal we get from our brain that tells us we need to go to the bathroom? With UUI that signal isn’t reliable and alerts the person well before the bladder has reached its full capacity, causing a sudden urge to void prematurely or sometimes a sudden release of the bladder before someone’s had the chance to make it to the bathroom. Lastly, MUI is a mix of UUI and SUI together. For the rest of this post, I will be referring to SUI as it relates most directly to leakage while exercising.
I mentioned above that SUI is the result of a sudden increase in pressure. So how does this pressure system in our abdomen get overloaded and cause those unwanted leakage episodes? Let’s take a look at how our core team is organized and how it’s responsible for regulating our intra-abdominal pressure to meet the demands of our movements and activities.
Your core team is made up of four key players: the diaphragm (primary breathing muscle), abdominals, spinal muscles, and pelvic floor. They work together as a team to create a “corset” of stability for our torso, and are responsible for the alignment of our ribcage and pelvis. When we take a breath in, the diaphragm relaxes and lowers to allow for air to enter the lungs. When this happens, the pelvic floor also relaxes and lowers to accommodate the pressure change above. When we exhale, the opposite happens, creating a reflexive contraction in both the pelvic floor and diaphragm, causing them to lift in response. This reflex also helps activate the abdominals and the spinal muscles.
However, these natural reflexes can become altered when the body is being loaded beyond its capacity. This is especially true during pregnancy and postpartum periods, but can occur at any age regardless of bearing children. During physical activity, leaking often happens when women hold their breath (often without noticing) or breathe more shallowly using more of their neck and upper chest muscles to try and create stability. These altered breathing strategies interfere with the coordination of the core team and can cause pressure buildups that, due to gravity and unique features of the female anatomy, are most readily released downward on the pelvic floor. If the pelvic floor isn’t strong enough to counteract this pressure then the organs within the pelvic cavity, like the bladder, experience extra pressure, resulting in involuntary urine release.
So now that you have a better understanding of how leaking occurs, let’s apply this to running. When you’re running, each leg is accepting approximately six to eight times your body weight with each step. That’s a significant amount of force that your body has to absorb up through your legs, pelvis and torso, in order to continue propelling yourself forward. Now imagine if you’re running with a core team that isn’t able to maintain an efficient pressure system throughout the duration of your workout. This is how SUI develops, and why leakage episodes arise. If these symptoms are left untreated, hip and low back pain often develop as those areas of the body will try to compensate for the imbalance in pressure being placed on the pelvis. These substitution patterns, however, can only last for so long before the system begins to break down.
The good news is, SUI is easily treatable with corrective exercises that address the following: breathing mechanics, Kegels, deep core strengthening and hip strengthening (7-9). Pelvic Floor Physical Therapists specialize in the treatment of urinary incontinence and can give you specific strategies based on your individual situation to help you overcome leaking. As a pelvic floor physical therapist myself, I work with many runners who have suffered for years with these symptoms, thinking this was their new normal and had no idea there were ways to re-educate their pelvic floor and core team to run without leaking. There is a lot that can be done to correct these symptoms conservatively, and the best part? You’ll be a stronger, more efficient runner as a result!
In part 2 of this series I’ll be discussing the following:
Proper breathing mechanics
How to correctly perform a Kegel
How to pair breathing with Kegels to optimize deep core activation– tying it altogether
How to find a Pelvic Floor Physical Therapist near you!
Sources
Bø, Kari. “Urinary incontinence, pelvic floor dysfunction, exercise and sport.” Sports medicine (2004): 451-464.
Nygaard, Ingrid E., et al. “Urinary incontinence in elite nulliparous athletes.” Obstetrics and Gynecology (1994): 183-187.
Davis, Gary, et al. “Urinary incontinence among female soldiers.” Military Medicine (1999): 182-187.
Minassian, Vatche A., Harold P. Drutz, and Ahmed Al‐ “Urinary incontinence as a worldwide problem.” International Journal of Gynecology & Obstetrics (2003): 327-338.
Wesnes, Stian Langeland, et al. “The effect of urinary incontinence status during pregnancy and delivery mode on incontinence postpartum. A cohort study.” BJOG: An International Journal of Obstetrics & Gynaecology5 (2009): 700-707.
Mason, Linda, et al. “The experience of stress incontinence after childbirth.” Birth (1999): 164-171.
Dinc, Ayten, Nezihe Kizilkaya Beji, and Onay Yalcin. “Effect of pelvic floor muscle exercises in the treatment of urinary incontinence during pregnancy and the postpartum period.” International Urogynecology Journal (2009): 1223-1231.
Bø, Kari. “Pelvic floor muscle training is effective in treatment of female stress urinary incontinence, but how does it work?.” International Urogynecology Journal (2004): 76-84.
