How Not to Pee Yourself While Running - Part 1: Overview of the Pelvic Floor

Part 1 of this blog series is written by Dr. Lauryn Beecher and Dr. Caroline Wickler of Pelvic Health & Wellness in Milwaukee, Wisconsin.

The human body is an intricate network of systems acting to maintain health and overall well-being. Among these systems, the pelvic floor muscles play a crucial role in supporting vital organs, controlling bodily functions, and enhancing sexual health. However, these are often overlooked and underestimated in their significance.

In this blog series we will begin by exploring the anatomy, function, and importance of pelvic floor muscles. In the following blog posts, we’ll come to understand their role during running, problems you might encounter, and how to optimize these muscles and the body to improve running performance. 

Understanding Pelvic Floor Muscles

The pelvic floor muscles form a supportive sling-like structure that stretches across the base of the pelvis. Located between the pubic bone and the coccyx, and connecting sit bone to sit bone, the pelvic floor is a combination of muscles, tendons, and connective tissues. Like all other muscles in the body, the pelvic floor needs to be able to contract, relax, and lengthen depending on the intended goal.

Function of the Pelvic Floor Muscles

Support and Stability

One of the primary functions of the pelvic floor muscles is to act as a foundation and maintain the position of the pelvic organs, preventing pelvic organ prolapse. When these muscles are strong and appropriately coordinated, they help prevent organs from descending and shifting out of place, which could lead to pressure, heaviness, or problems with bowel and bladder function.

Controlling Urinary and Fecal Continence

The pelvic floor muscles are also crucial in maintaining continence. They work in tandem with the urethral and anal sphincters to control the release of urine and feces. They must be able to contract to prevent the release of urine and stool, as well as lengthen to allow urine and stool to pass. An overactive, weak, or discoordinated pelvic floor can result in issues like incontinence or constipation. 

Sexual Function and Pleasure

Beyond their role in bodily functions, the pelvic floor muscles are integral to sexual health and pleasure. These muscles are responsible for maintaining an erection as well as the rhythmic contractions experienced during orgasm in both men and women.

Factors Affecting Pelvic Floor Muscle Function

Age and Hormonal Changes

As we age, the pelvic floor muscles may decrease in thickness and have less lubrication due to hormonal changes and decreased muscle mass. Hormones like estrogen play a vital role in maintaining the health and elasticity of pelvic tissues.

Sedentary Lifestyle and Lack of Physical Activity

Sitting for long periods of time can lead to weakened pelvic floor muscles. Regular physical activity, specific pelvic floor strengthening, and proper diaphragmatic breathing can significantly contribute to muscle strength and function.

Impact of Pregnancy and Childbirth

During pregnancy, the pelvic floor muscles experience increased pressure due to the growing fetus. Optimizing strength and flexibility of these muscles during pregnancy can help reduce the risk of postpartum complications. Additionally, conditioning the pelvic floor muscles to stretch can aid in the birthing process, making it easier to push during labor.

Chronic Constipation and Straining During Bowel Movements

Straining during bowel movements or the constant weight of stool in the rectum can put undue pressure on the pelvic floor muscles, contributing to their weakening over time. Addressing chronic constipation and adopting proper bowel habits can help maintain pelvic floor health.

Common Pelvic Floor Disorders

Urinary Incontinence

Urinary incontinence is a prevalent issue that affects millions of people worldwide. Stress incontinence, urge incontinence, and mixed incontinence are some common types. Stress incontinence occurs when pressure on the bladder, such as coughing or sneezing, leads to leakage. Urge incontinence involves a sudden and strong urge to urinate, resulting in involuntary leakage.

Pelvic Organ Prolapse

Pelvic organ prolapse occurs when the pelvic floor muscles weaken, causing the organs to descend into the vaginal canal or rectum. This condition can lead to discomfort, pressure, and pain in the pelvic region.

Constipation

Constipation affects approximately 16 out of 100 adults in the United States. It occurs when there are less than 3 bowel movements in a week, if stools are hard or dry and painful or effortful to pass, or if there is a feeling of incomplete emptying. Constipation can place excess pressure and strain on the pelvic floor and lead to other pelvic floor dysfunction.

Painful Intercourse

Dyspareunia, or painful intercourse, can often be associated with pelvic floor dysfunction. It is more often overactivity or tension of pelvic floor muscles that contributes to painful intercourse. It can significantly impact relationship intimacy and emotional well-being.

Considerations for Maintaining and Improving Pelvic Floor Muscle Function

Pelvic Floor Strength and Length Exercises

Pelvic floor muscles need to have a balance between strength and flexibility to function well. Pelvic floor relaxation postures and stretches can help to decrease overactive or tight muscles. Kegels, or pelvic floor muscle contractions, can help the strength and endurance of the muscles to aid in continence and stability.

Incorporating Other Supportive Activities

Activities like yoga, Pilates, and other breathwork can complement pelvic floor exercises, as they focus on core strength and body awareness. Engaging in these exercises can provide additional support to the pelvic floor.

Proper Posture and Body Mechanics

Maintaining good posture and body mechanics, especially during toileting, can help reduce unnecessary strain on the pelvic floor muscles. Practicing mindful movements and avoiding excessive lifting or straining can preserve pelvic floor health.

Lifestyle Adjustments

Adopting a healthy lifestyle that includes a balanced diet, regular exercise, and stress management can positively impact pelvic floor function.

When to Get Help

If individuals experience persistent pelvic floor issues that disrupt their daily lives, seeking guidance from a physical therapist specializing in pelvic health can make a significant difference in well-being. Pelvic floor physical therapists are able to specifically evaluate the pelvic floor muscles as well as other musculoskeletal issues that impact their function.

Sneak Peek 

Now that we’ve got an overview of pelvic floor structure and function, Part 2 of this series will introduce the specifics of running and pelvic floor dysfunction with the goal of understanding what may be wrong and where to safely begin addressing these issues.