Running and Leaking Urine: Why Your Pelvic Floor Isn’t the Only Thing at Fault
Stress Urinary Incontinece
For years, the conversation around stress urinary incontinence has focused almost exclusively on strengthening the pelvic floor.
While that’s certainly part of the picture, current research paints a much more complex, and hopeful, story. Your entire body plays a role, from how you absorb impact to how you breathe, stabilize, and move.
Running and leaking urine is very common.
Research shows stress incontinence affects up to 44% of female runners and between 10.88% and 80% of female athletes depending on the sport and training volume.
More broadly, stress urinary incontinence impacts about 46% of adult women, making it a widespread issue rather than a rare or niche problem.
Something this common deserves more than a one-dimensional solution.
Running and Leaking Urine: Major Contributors
The pelvic floor is a group of muscles that supports your bladder and helps control continence, but it does not work in isolation. It functions as part of a coordinated system.
If other parts of that system are not doing their job effectively, the pelvic floor is forced to compensate or may not be able to keep up with the demands placed on it.
Major contributors to this system are:
Core stability
Hip strength
Running mechanics
Pressure management
Training volume
Lumbopelvic control
One major contributor is core stability. The deep abdominal muscles, including the transversus abdominis and obliques, work closely with the pelvic floor to manage pressure and provide stability.
Research shows that women with stress urinary incontinence tend to have reduced abdominal muscle thickness and poorer core stability. There is also a direct relationship between symptom severity and decreased core control.
When the core is not supporting the body well, the pelvic floor is placed under greater strain.
Hip strength is another often overlooked factor. The gluteal muscles and hip adductors play an important role in controlling pelvic position and absorbing force during running.
Research has shown that combining hip strengthening with pelvic floor training leads to better outcomes than pelvic floor exercises alone. When the hips are weak, pelvic stability is reduced, and forces are not distributed efficiently, increasing the demand on the pelvic floor.
Running mechanics also play a significant role in stress urinary incontinence. Recent research has found that runners with stress urinary incontinence often demonstrate less efficient impact absorption.
They tend to absorb less energy at the ankle, shift more force to the hips, and show reduced shock absorption through the leg.
Interestingly, some of these runners have pelvic floor strength and endurance equal to or even greater than those without leakage. This suggests that the issue is not simply pelvic floor strength, but how forces move through the body during running.
Another important factor is how the body manages pressure. Leakage occurs when intra-abdominal pressure exceeds what the urethra can resist.
This pressure increases during activities like running, jumping, heavy lifting, and even chronic straining such as constipation. If the body does not coordinate breathing, core activation, and pelvic floor timing effectively, the system becomes overwhelmed and leakage can occur.
Training volume also plays a role in stress urinary incontinence. A recent meta-analysis found that each additional hour of training per week increases the odds of urinary incontinence by six percent.
This highlights that it is not just the type of activity that matters, but also the total load placed on the body over time. Every system, including the pelvic floor, has a capacity, and exceeding that capacity without proper support or recovery can contribute to symptoms.
Lumbopelvic control ties many of these factors together. This refers to how well the trunk and pelvis are stabilized during movement.
Women with stress urinary incontinence often demonstrate inferior performance on tests of core control and reduced trunk endurance.
There is also a relationship between symptom severity and decreased physical performance. When the trunk and pelvis are not well controlled, the pelvic floor once again has to compensate.
Treatment beyond the pelvic floor
The good news is that treatment does not need to be limited to “pelvic floor” exercises alone. Research supports a comprehensive, whole-body approach.
This can include improving core stability, strengthening the hips, addressing breathing and pressure management, and retraining movement patterns, especially during running.
A pelvic floor clinical specialist evaluates the full picture (movement patterns, strength, coordination, and individual symptoms) to design a personalized lumbopelvic stabilization program tailored to the person, rather than relying on generic kegels or pelvic floor exercises and hoping they produce results.
If you are running and leaking urine, it does not mean your body is failing. It means that something in the system needs better coordination.
The pelvic floor is only one part of a larger picture that includes strength, timing, movement, and load management.
The bottom line is that running and leaking urine is often treated as a localized issue, but the evidence clearly shows it is a whole-body problem.
When you address not just the pelvic floor, but also your strength, stability, breathing, and biomechanics, you are far more likely to see meaningful and lasting improvement and return to running with confidence.
Need pelvic health physical therapy in Jacksonville Beach, FL?
If you’re looking for personalized, one-on-one pelvic floor sessions to address your stress incontinence or 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:
Inefficient Impact Absorption and Reduced Shock Attenuation in Female Runners With Stress Urinary Incontinence. Journal of Biomechanics. 2025. Campos NC, Fonseca ST, Nunes LJ, et al.New
Urinary Incontinence in Female Athletes: A Systematic Review. International Urogynecology Journal. 2018. de Mattos Lourenco TR, Matsuoka PK, Baracat EC, Haddad JM.
Stress Incontinence in Women. The New England Journal of Medicine. 2021. Wu JM.
Comparison of Abdominal Muscle Thickness and Lumbopelvic Control Among Women With and Without Different Severity of Stress Urinary Incontinence. International Urogynecology Journal. 2026. Hwang UJ, Kwon OY, Kim M.New
Core Stability in Women With and Without Lower Urinary Tract Symptoms: The CORE-LUTS Study. International Urogynecology Journal. 2026. Bennis S, Kumar A, Chatwin HV, et al.New
Effect of Pelvic Floor and Hip Muscle Strengthening in the Treatment of Stress Urinary Incontinence: A Randomized Clinical Trial. Journal of Manipulative and Physiological Therapeutics. 2020. Marques SAA, Silveira SRBD, Pássaro AC, et al.
Urinary Incontinence in Women: A Review. The Journal of the American Medical Association. 2017. Lukacz ES, Santiago-Lastra Y, Albo ME, Brubaker L.
Conservative Interventions for Treating Urinary Incontinence in Women: An Overview of Cochrane Systematic Reviews. The Cochrane Database of Systematic Reviews. 2022. Todhunter-Brown A, Hazelton C, Campbell P, et al.
Urinary Incontinence in Women Athletes: Umbrella Review and Meta-Analysis of Sport-Related Factors. Sports Medicine. 2026. Domínguez-Pérez N, Sevilla-Arrabal I, Navarro-Brazález B, Torres-Lacomba M, Courel-Ibáñez J.New
The Relationship Between Urinary Incontinence, Physical Performance, and Physical Activity Levels in Women With Low Back Pain. International Urogynecology Journal. 2025. Duray M, Kara B, Yaşar P.New
Alternative Exercise Regimens for Stress Urinary Incontinence in Women: A Systematic Review and Meta-Analysis. International Urogynecology Journal. 2026. Hao J, Yao Z, Remis A, et al.New
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