Understanding Your Pelvic Floor: A Game Changer for Active Women

By Dr. Katie Cast, PT, DPT, PCES

Leaking urine is extremely common, especially in the female population. The involuntary leaking of urine is also known as urinary incontinence (UI). 

The prevalence of urinary incontinence is not known as cases are likely vastly underreported. Many studies have reported the prevalence to be anywhere from 25-45% of women, with prevalence increasing with age (Milsom et al., 2019). One study found that 22.9% of ACTIVE women that have never given birth reported symptoms of urinary leaking (Alves et al., 2017). In fact, females participating in high impact sports that are repetitive are at the highest risk for experiencing urinary leaking (Casey et al., 2017).

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Why are leaks so common with running?
Running is a very advanced, high impact activity! It takes a lot of strength and coordination to be able to run (correctly). The activity of running also creates a lot of impact and stress to the pelvic floor (running is like jumping on one leg). If the pelvic floor is not functioning correctly or becomes overloaded, leaks can happen as a result.

I’m leaking with running - what can I do about it? 
The pelvic floor needs to be functioning properly in isolation AND within the context of the entire body, and pressure created from the impact of running needs to be managed properly to reduce stress on the pelvic floor to be able to run without leaks. Here are a couple things to look at that can help:

Running Form
Running form is EXTREMELY important, especially if you are dealing with pelvic floor issues such as leaking. Running with good form reduces the stress on the pelvic floor and optimizes the function of the pelvic floor so it can do its job. Take a video of yourself and check out your form! 

Some things to consider:

• Slight forward lean
  • This creates a better alignment of the diaphragm over the pelvic floor; they need to be able to function together. 
  • Think ribs stacked over pelvis, or think about leading with your upper body rather than your hips.
• Level hips
  • When you analyze your running from the front or back, your hips should stay relatively even as you run. Hips that “drop” (on one or both sides) can be a sign of hip weakness. The hip is very closely related to the pelvic floor and can be a contributing factor to leaks.
• Mid-foot strike
  • Running with a longer stride where the heel of the foot hits first creates a much larger force from the ground up through the pelvic floor (creating additional pelvic floor muscle stress). 
  • Instead, landing with the middle of the foot results in less force through the pelvic floor and more force actually pushing you forward (we want this!).

Breathing
Breathing is very closely related to pelvic floor function! The diaphragm (the big muscle under the rib cage, AKA the main muscle responsible for breathing) functions together with the pelvic floor. 

• Many runners have poor breathing patterns (“shallow breathing”) that involves inhaling up into the neck and shoulders. This interferes with the function of the diaphragm and therefore the function of the pelvic floor, and can contribute to leaking.
• The goal is to maintain a DEEP breathing pattern while running.

Pelvic floor muscle function
The BEST way to get back to running without leaking is seeing a pelvic floor Physical Therapist for a full evaluation. We can assess your pelvic floor muscles for deficits that may be directly contributing to leaks with running. Importantly, we can assess for impairments in other areas of the body as well that may be contributing to leaks (abdominals, hips, etc.).

• Pelvic floor rehab isn’t just about Kegels. Kegels can be helpful if the pelvic floor muscles are actually weak, but this isn’t always the case. Strength is just one part of the picture. Sometimes the pelvic floor muscles aren’t functioning properly because they are too tight, in which case Kegels can actually make things worse. This is why an individual assessment is always best. We don’t all need the same exact exercises.
• Keep in mind: pelvic floor weakness or dysfunction can be present even if you have never given birth.

Leaking with running is relatively common but is NOT normal and can be addressed through physical therapy treatment with a trained pelvic floor specialist. Contact us today to talk about how our pelvic floor + postpartum corrective exercise trained Physical Therapists can guide you back to running and feeling like yourself again.

Learn More About Your Pelvic Floor

References:
Casey EK, Temme K. Pelvic floor muscle function and urinary incontinence in the female athlete. Phys Sportsmed. 2017 Nov;45(4):399-407. doi: 10.1080/00913847.2017.1372677. Epub 2017 Sep 5. PMID: 28845723.
Alves JO, Luz STD, Brandão S, Da Luz CM, Jorge RN, Da Roza T. Urinary Incontinence in Physically Active Young Women: Prevalence and Related Factors. Int J Sports Med. 2017 Nov;38(12):937-941. doi: 10.1055/s-0043-115736. Epub 2017 Sep 26. PMID: 28950397.
Milsom I, Gyhagen M. The prevalence of urinary incontinence. Climacteric. 2019 Jun;22(3):217-222. doi: 10.1080/13697137.2018.1543263. Epub 2018 Dec 21. PMID: 30572737.