Running is an amazing form of exercise; it can improve your bone density with its consistent impact, it can strengthen the entire lower extremity, it often gets you outside, which has been shown to support your mental health. It’s great.
Unless you find yourself leaking? Which probably doesn’t feel so great.
You’re strong, right? You’re running, you’re taking on hills, but why are you leaking?
To be clear, I’m not talking about sweat or discharge here, but bladder leakage. You take your tights off and the smell faintly of urine.
I want to say first and foremost, there’s nothing bad about you or your pelvic floor if you’re leaking. It’s not a failure on your part.
It is a sign that your body isn’t coordinating efficiently, and can’t actually tolerate the load it’s under.
Let’s back pedal a little bit, and talk about what running is, what our pelvic floor is, and what it means when you leak when you’re running.
Running is controlled falling, propelled from the glutes and pelvic. We need to be able to stabilize on one leg, push off, maintain an air borne position, and elastically land with stability, and propel forward again. We’re falling forward from one leg to the next. Running relies a great deal on the elasticity of our muscles and tendons to store energy and then rubberband forward.
And, not everyone experiences running as a light, floaty experience. It can hurt our knees and joints, and feel like a heavy impact sport, most often because of how we’re running, or we lack the strength necessary for the elasticity and muscle control.
For example, if you’re a solid heel striker, you’re actually creating a huge impact that’s shooting straight up through the bones of your leg into your pelvis. Heel striking is a lot like “hitting the brakes,” because the force is being absorbed by your bones (landing on that calcenus), and is also angled posteriorly. That’s right; you’re reaching your leg out in front of you, bringing the weight of your body down and forward. The ground responds opposite to this force, IE, the brake that is slowing you down.
However, if you land with a more forefoot, or middle of the foot strike, you land with your ankle, knee, and hip more bent, which allows the force to be absorbed by the rubberbands of your muscles. They can then elastically load and then release that energy to continue to help propel you forward. Essentially, the force is absorbed and dispersed throughout your body, rather than being jolted through your bones and up to your pelvis. If your muscles are weak, they don’t have the capacity to transfer and absorb that force either, so you don’t have rubber bands, you just have more rigid cords that are going to send load straight up to the pelvis.
And that brings us to the pelvic floor, which lives in the pelvis, along with your bladder. See the connection? If you don’t yet, just wait!
The pelvic floor is a sling of muscles at the bottom of the pelvis, and is the muscular foundation for our core. It supports a great deal of the organs, helps manage pressure in the abdomen, and also controls what comes in and out of our pelvis. The organs of the pelvis include our bladder, our reproductive organs, and our bowels. I like to imagine the bladder as a little balloon. The bladder can elastically stretch as it fills with fluid, just a like a balloon, and it responds to pressure just like a balloon; it’ll squirt if you squeeze it too much.
The pelvic floor help regulate pressure that’s delivered into the pelvis, and they also help regulate the sphincters that help us control our continence.
If you’re a heel striker, you’re shooting force straight into the pelvis, and the pelvic floor needs to work overtime to stabilize with each step, as well as to disperse the force throughout the pelvis, and it needs to contract around those sphincters so even if the bladder gets pressurized, it can’t leak. If your pelvic floor is weak, you can automatically see how challenging that might be. Small and weak muscles competing against big force.
Therefore, one of the ways to address leakage with running is considering your stride.
However, it’s also important to consider the coordination and strength of your pelvic floor. You can change your stride all you want, but if your pelvic floor isn’t also engaged, inevitably, it will leak. It’s like trying to prevent leakage in the roof by replacing the walls; it will certainly help, but you still need to patch the whole.
The pelvic floor are contractile, skeletal muscles, which means you can use your conscious control to coordinate them, even though most of the time, they’re working on their own.
Every time you run and land, these muscles need to contract and coordinate to make sure your organs don’t jumble around, don’t get squished, and that the sphincters of your bladder and your bowels stay closed.
Running is an endurance sport, so these muscles don’t only need strength, they need endurance. Most often when people tell me they’re leaking, they fall into two groups; the group where it happens immediately on the first step, and the second group, where it tends to happen at the end of a long run. With the first group, I focus more on coordination right off the bat, while on the second group.
So what does coordination of your pelvic floor look like when you run? Don’t try to think about just contracting your pelvic floor all the time; it’ll suck. Imagine trying to hold a bicep curl the whole time you run; it won’t feel great, and your bicep probably won't work that well later in the day.
Rather than focusing on coordination during the run, think about coordinating it in strengthening routines, where you can control more of what’s going on.
The same way I don’t try to get my runners stronger just by running, I don’t try to strengthen the pelvic floor just by running.
You need to first coordinate your pelvic floor with your breath. You can read more about how to connect with your pelvic floor here. Essentially, the pelvic floor should “drop” and “lengthen” when you inhale, reducing the pressure as you inhale. As you exhale, it needs to contract up and in, like you’re stopping the flow of urine. Here’s an awesome video about coordinating the two.
Because you’re a runner, we then need to get your pelvic floor on board in running specific positions.
For example, I train people with a side lying TA lift, one of our deep core muscles, and I have them coordinate with every exhale, lifting as they exert. Then, you can progress to a side plank. And once you’re there, lift that top leg off the ground. This will engage your hips and lateral stabilizers, which you need to keep you upright when you’re running.
I also train bridges, and single leg bridges. To engage the pelvic floor, make sure that you first can coordinate your pelvic floor and diaphragm, and then exhale on exertion. With the bridges, that’s when you’re pushing your hips to the ceiling. Your pelvic floor should contract as you push into extension. Running is essentially a single leg bridge flipped 90 degrees, so being able to coordinate, contract, and feel stable here is key.
Use the exercises to build yourself a strong foundation, and if you find yourself still having problems, reach out to get scheduled so you can run without worrying about leakage!
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