How to Stop Stress Incontinence When Running
One of the most common issues female runners experience is incontinence. It’s an issue for runners in general, but especially during or after pregnancy and childbirth. And what we really need is a professional’s advice. We can google all we want, but how helpful is that really? Luckily, that’s just what we’ve got here! Laura, the pelvic floor physical therapist I worked with after having Thomas, is here to share all the need to knows!
Without further ado, let’s get into it!
My name is Laura and I am a physical therapist who specializes in women’s pelvic health, pain, and spine. I am absolutely passionate about all things movement and sharing that information with you to feel more confident and free of pain in your body. I am a long time runner who also loves hiking, kayaking, reading, spinning wool and knitting! I’ve been married for 25 years to the love of my life and we have a little rescue dog named Lucy who you will see sneak into my videos from time to time! I have been a reader of Teri’s blog since 2009 and am honored to be able to share knowledge with you.
Stress incontinence is a common (but not normal) form of bladder leakage when running.
Stress incontinence is an unwanted loss of urine with coughing, straining, sneezing, or impact exercising such as running. A leaky bladder impacts your confidence and your motivation to run and be active! Although it can happen to all women, it is especially common after childbirth and in female athletes (even elite runners!). Good news alert! This is fixable with some simple and effective strategies.
This can be a bit complicated as there are a lot of reasons this can happen. Let’s focus on the more common causes:
1. Weak pelvic floor muscles: Your pelvic floor muscles (PFM) are a very important part of staying dry. When not strong enough they cannot hold back urine, gas, or poop.
2. Pelvic organ prolapse: This is when one of your pelvic organs (like your bladder) has descended placing extra pressure on the pelvic floor.
3. Nutritional and fluid intake: Maybe you are not drinking enough water or maybe too much. Maybe you are not giving your body enough nutrition to stay strong.
4. Constipation: Regular bowel movements are critical as a full rectum takes up a lot of space in the pelvic causing irritation to the bladder.
6. Running form and/or past history of running injury: this can greatly impact how your pelvic muscles react with every step
Let’s dive into each of these issues and see how to solve them.
How do you strengthen your pelvic floor? This sounds so very simple, however it is a nuanced skill! Just like any other muscle group in the body your pelvic floor muscles can be strengthened and change your life! Honestly, we are always told to “do your kegels!”; but what does that really mean? Keep reading to learn the details.
This is the most challenging thing for most women I see. When you are practicing your Kegels, it is key you coordinate them in synergy with your breath. Why is this so important? Because your breathing diaphragm and pelvic diaphragm move together like a piston- they go up together and down together. Thus your inhale will relax the pelvic muscles, and the exhale will contract them. Practicing your pelvic floor exercises in this manner is an important way to train you to stay dry during high impact activities.
A good way to begin practicing is in a lying position. Imagine a blueberry sitting right at the entrance of your vagina. As you exhale, imagine picking up (closing around) the blueberry with your pelvic muscles and lifting it up towards your belly button.
Equally important, as you inhale, lower the blueberry all the way back to where it started as you fully relax your muscles. Try doing this 20 times in a row three times a day! Then try doing the same thing in both sitting and standing.
What is it? A pelvic organ prolapse is when one of your pelvic organs (bladder, uterus, or rectum) descends into the vaginal wall. It can be very mild to more progressed where you are able to see and/or feel a bulge in the vaginal area. Sometimes it feels like heaviness. It can be a cause of bladder leakage when running. If you are concerned this might be occurring in your body, please see your OB/Gyn or primary care provider to assess.
Teri has an excellent blog post on this!
It is also good to think about your fluids. If you are experiencing leakage on a run, it is best to avoid these common irritants before you head out:
Not everyone is sensitive to these things, but it is worth a trial of cutting them out before a run for a while to see if it makes a difference.
It is a common error to begin to restrict your fluids in a goal to prevent or minimize the leakage. This actually will make you more prone to leaking because your urine will be too acidic. It can take a little trial and error to find the ideal fluid balance for yourself.
It is ideal to drink 16 ounces of water 2 hours before you run as your body will then be hydrated and also allow you to urinate what is not needed prior to your run. This can be hard to do if you are an early morning runner (this is my struggle!). In this case, you play around with your morning fluids to learn your tipping point. And as always, it’s a great goal to drink half your body weight in ounces of water daily. Hydrating properly is a great long term practice.
A normal bladder is one that only needs to be emptied once every 3-4 hours and can hold up to 12-16 oz with no loss of urine. If you find you are urinating more frequently than this, check out this series on instagram on how to begin holding more.
If you love to run but are holding off due to leakage, I say, “pad up and run on!” This does not mean accepting that you will always leak! It means you will have increased confidence of being protected doing what you love while you are working on the exercises to strengthen and coordinate your pelvic floor muscles. ?
Also consider absorbent underwear that can be washed and used over and over. If a disposable pad works better for you, try and avoid menstrual pads as they do not work as well at protecting you as pads which are specifically for urine leakage. (Your menstrual flow and your urine have very different consistencies).
Your running form makes a tremendous difference on the load placed upon your pelvic floor stability. Your shoes, pace, running surface, pre/post stretches, and weekly mileage all impact your form. Teri has an excellent running program that includes warm up and cool down stretch videos.
Having good strength and motion through your upper and lower body are all important to running form and preventing incontinence. Having a strong hip/core complex is a great place to start. I created a video for you to get you started! Just a gentle reminder to not work through pain. See it here.
I always recommend getting help from a professional when you begin. A pelvic health physical therapist who can assess both your running form and your pelvic floor muscles would be the ideal fit! But sometimes you might need to see a separate PT for running.