How to Stop Leaking Urine When Running: A Pelvic Floor Physical Therapist's Guide
Leaking urine while running is a common concern, but it is not something you have to simply accept.
As a pelvic floor physical therapist, I see this issue often and know that with the right approach, it can be addressed.
In this blog, I’ll share evidence-based insights to help you understand the underlying causes of urinary leakage during running and provide strategies to help prevent it.
Understanding the Pelvic Floor and Urinary Leakage
The pelvic floor is a group of muscles and tissues that support the organs in your pelvis, including the bladder. These muscles help control urinary continence, and when they are weak, overstretched, or not working properly, they can result in urinary incontinence during activities like running.
There are three primary types of urinary incontinence that athletes may experience
Stress Incontinence: This is the most common type of incontinence that occurs when pressure is placed on the bladder, such as during running, jumping, or coughing. It's typically a result of weakened pelvic floor muscles or the inability to coordinate these muscles with abdominal pressure.
Urge Incontinence: This type occurs when there is an overwhelming need to urinate and is usually associated with an overactive bladder. While it’s less common during running, it can still occur, particularly with certain physical triggers or running after consuming large amounts of fluids.
Mixed Incontinence: This type is a combination of both urge and stress incontinence.
The Connection Between Running and Urinary Incontinence
Research over the last decade has shed light on the relationship between running and urinary leakage.
A systematic review from 2018 found that female athletes, particularly those who run long distances or engage in high-impact activities, experience a higher rate of stress urinary incontinence (SUI) compared to the general population.
This is often due to the repetitive high-pressure forces that running places on the pelvic floor.
Key Causes of Urinary Leakage During Running
Several factors can contribute to urinary leakage while running:
Pelvic floor muscle weakness
Poor coordination of the pelvic floor muscles and abdominal muscles
Increased intra-abdominal pressure
Increased fluid intake or dehydration
Pelvic Floor Muscle Weakness:
One of the most common causes of incontinence is pelvic floor muscle weakness. This can occur after pregnancy, childbirth, or simply as we age. The pelvic floor muscles are responsible for holding the bladder in place and controlling urine flow. If these muscles are weak or not engaging properly, the pressure created during running can overwhelm them, leading to leakage.
Poor Coordination of the Pelvic Floor and Abdominal Muscles:
A 2017 study highlighted the importance of coordinated action between the pelvic floor muscles and the deep abdominal muscles (such as the transverse abdominis). Running increases intra-abdominal pressure, and if your pelvic floor isn't engaging in sync with your abdominal muscles, this can lead to leaking.
Increased Intra-abdominal Pressure:
Running, especially at higher speeds or on harder surfaces, increases pressure in the abdomen. This added pressure can be too much for a compromised pelvic floor to handle, especially if the bladder is already partially full.
Increased Fluid Intake or Dehydration:
Proper hydration is essential, but excessive fluid intake right before running can fill your bladder to the point where it's more prone to leakage under pressure. Conversely, dehydration can lead to concentrated urine, irritating the bladder and contributing to leakage.
What Can You Do to Prevent Urinary Leakage While Running?
Strengthen the Pelvic Floor Muscles
One of the most effective ways to prevent leaking is by strengthening your pelvic floor muscles through pelvic floor muscle training. However, it’s essential to perform them correctly.
A 2016 study in Neurourology and Urodynamics demonstrated that targeted pelvic floor muscle training significantly reduces stress urinary incontinence.
Focus on Pelvic Floor and Core Coordination
It's not just about strength! It’s also about coordination. Research published in the Journal of Strength and Conditioning Research in 2019 shows that improving the coordination of the pelvic floor with the core muscles, especially the transverse abdominis, can help prevent leakage during high-impact activities like running.
How to Train Coordination: Start by engaging your core before you engage your pelvic floor. Try exercises like dead bugs and bird dogs to enhance coordination between your abdominal muscles and pelvic floor.
Mind Your Breathing
Many people unknowingly hold their breath during physical activity, increasing intra-abdominal pressure.
Breathing exercises can help to maintain pressure stability and reduce the likelihood of leakage.
A 2021 study in Sports Medicine found that diaphragmatic breathing, which activates the diaphragm and pelvic floor simultaneously, can reduce stress urinary incontinence.
Breathing Tip: Focus on exhaling deeply during exertion, especially when you push off the ground during running. This helps to activate your core and pelvic floor muscles in unison.
Work on Posture and Alignment
Poor posture can contribute to pelvic floor dysfunction. When you’re running, make sure your posture is upright and your pelvis is in a neutral position. Overarching your lower back can place undue pressure on your pelvic floor and bladder, leading to leakage.
Gradual Progression in Intensity and Mileage
If you’re new to running or returning after a break, it's crucial to progress gradually. Jumping into long runs or high-intensity workouts too quickly can put excessive strain on your pelvic floor. Start with shorter runs and gradually increase intensity while focusing on pelvic floor exercises.
Hydration and Bladder Training
Maintain proper hydration, but avoid drinking too much fluid right before a run. Aim for a consistent, balanced hydration schedule throughout the day. Additionally, if you experience urge incontinence (the sudden need to urinate), bladder training exercises may help you regain control and delay the need to urinate during physical activity.
When to Seek Professional Help
If you’ve tried strengthening exercises and coordinating your pelvic floor muscles but still experience leakage, it might be time to consult a pelvic floor physical therapist. A physical therapist can assess your pelvic floor function, teach you advanced techniques, and help identify any underlying issues such as pelvic organ prolapse or incontinence related to postural imbalances.
Conclusion
Urinary leakage during running is a common yet treatable issue. By understanding the connection between your pelvic floor muscles and running mechanics, you can take the right steps to reduce or eliminate leakage.
Focus on strengthening your pelvic floor, improving coordination with your core, and maintaining proper hydration.
If needed, consult with a pelvic floor physical therapist to receive personalized treatment and improve your quality of life during physical activity.
our pelvic floor health is an essential part of your overall well-being, and with the right care, you can keep running without worry.
Need pelvic floor physical therapy in Jacksonville Beach, FL?
If you’re looking for personalized, one-on-one pelvic floor sessions to address your pelvic health concerns, we provide pelvic health physical therapy services to women in the Jacksonville Beach area.
If you’re looking for providers who will listen to you and help you get to the root cause of your pelvic floor concerns, we’ve got you. We’re here to help you if you’re experiencing pelvic pain, pelvic heaviness, leaking, or are pregnant/postpartum and want to continue safely working out/running/lifting during your pregnancy and get back to your sport after birth.
Get started today by booking a discovery call.
References:
Bø, K., & Sherburn, M. (2018). Evaluation of pelvic floor muscle function and strength. Journal of Urology.
Cundiff, G. W., & Wagner, T. H. (2017). The impact of pelvic floor physical therapy on women with stress urinary incontinence. Neurourology and Urodynamics.
Howell, S., et al. (2019). The importance of pelvic floor and core muscle coordination in sports performance. Journal of Strength and Conditioning Research.
Jerez, E. L., et al. (2021). Diaphragmatic breathing and its impact on pelvic floor function during physical activity. Sports Medicine.
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