How Not to Pee Yourself While Running - Part 2: Running with Pelvic Floor Dysfunction

Part 2 of this blog series is written by Dr. Lauryn Beecher and Dr. Caroline Wickler of Pelvic Health & Wellness in Milwaukee, Wisconsin.

Running is a valuable, accessible, and popular form of exercise for many and provides numerous physical and mental health benefits. However, what if you're dealing with pelvic floor problems such as urinary incontinence or pelvic organ prolapse that complicate your running experiences? These often-overlooked concerns can impact your running routine and overall well-being. In this blog post, we'll delve into the connection between pelvic floor and running, and provide you with valuable insights and strategies to help you continue running comfortably and confidently.

Understanding the Pelvic Floor and Running

In Part 1, we discussed the function and role of the pelvic floor muscles. They support and stabilize the pelvis and pelvic floor organs, prevent the loss of urine and feces, allow for the evacuation of urine and feces, and play a vital role in sexual health. 

Running introduces a different set of challenges for the pelvis and pelvic floor muscles to withstand. The mechanics and physical demands of running place more pressure and strain on the pelvic floor than walking. Every time your foot hits the ground there is a jarring force that must be managed in the pelvic floor. The pelvic floor stabilizes the pelvis throughout all phases of running. There is also an increase in intra-abdominal pressure and a change in breathing that places more load on the pelvic floor. If the body is not conditioned for this type of exercise, running has the potential to exacerbate current pelvic floor issues or create new ones. 

Urinary Incontinence: Pelvic Floor Underactivity Vs. Overactivity

One of the primary pelvic floor complaints in the general population and especially in runners is urinary incontinence (involuntary loss of urine), while running. What causes this? We can start by generalizing pelvic floor dysfunction as two different conditions: Underactive (weak) and Overactive (tight/tense). 

Underactive pelvic floor muscles are associated with weakness. An underactive pelvic floor has decreased strength, more atrophy, typically cannot coordinate muscle contractions as well, and fatigues quickly after generating a contraction. Symptoms of a weak pelvic floor can be urinary incontinence, fecal incontinence, inability to orgasm, decreased vaginal sensation, heaviness or fullness at the vaginal opening, or low back or hip pain.  

Overactive pelvic floor muscles are associated with rigidity, tightness, and high tone. An overactive pelvic floor is one where muscles are chronically shortened and have an inability to relax. Symptoms of an overactive pelvic floor are urinary incontinence, constipation, pelvic pain, impaired vaginal sensation, low back or hip pain. 

A critical takeaway from this is that urinary incontinence can result from EITHER an  Underactive or Overactive pelvic floor.

Running with an Underactive Pelvic Floor

Runners with an underactive pelvic floor may have issues with urinary leakage, a feeling like something is heavy or falling out of their vagina or pressure in the pelvic floor, and aberrant running mechanics due to less stability of the pelvis.

Running with an Overactive Pelvic Floor

Runners with an overactive pelvic floor may experience urinary incontinence, or pelvic or abdominal pain due to the rigidity of the muscles and their decreased ability to absorb the forces from running. 

The Kegel Myth

A widely-known pelvic floor exercise, the Kegel refers to a contraction of the pelvic floor muscles. The Kegel Myth is that Kegels will fix your pelvic floor issues and urinary incontinence. Kegels may be appropriate and helpful if prescribed for someone experiencing pelvic floor underactivity or weakness. However, if performed by someone with pelvic floor OVERactivity where the muscles are already too tense or tight, this will not fix their incontinence problem, but will likely worsen their symptoms. Especially for runners who oftentimes experience higher tone pelvic floor muscles, isolated kegels will not be the answer.

Pelvic Floor Assessment

If someone is experiencing persistent pelvic floor dysfunction, especially with running, and is unsure how their pelvic floor is functioning it is invaluable to be assessed by a pelvic floor physical therapist. They are the musculoskeletal experts who can directly assess pelvic floor musculature to identify what is happening and why it’s happening. They can thoroughly assess and evaluate other areas of the body that may have impairments that contribute to the current pelvic floor issue. 

Problems in the pelvic floor do not typically happen in isolation. It often compensates for other parts of the body that are not functioning optimally or is a response to a certain trauma or injury. Pregnancy and childbirth can contribute to pelvic floor dysfunction. Improper running mechanics, weakness in the hips and abdomen, impaired breathing, and poor pressure management are all factors that contribute to pelvic floor dysfunction.

Sneak Peek

How can you address these areas that are affecting the pelvic floor function? The final blog post of our series will detail out the most beneficial exercises complete with video demonstrations so you can start optimizing your running today! Hint: It’s more than just Kegels!