Do you make sure to pee before and sometimes during your workout, just in case?
Do you wear a pad when you run because leaking is usually a thing?
Do you intentionally wear dark colored clothing to hide any leakage that might happen?
If you answered yes to any of these questions, you are not alone.
I hope I haven’t scared you off with the title and intro questions for this week’s blog post. What I’m about to share is important. I want to talk about something that most people don’t openly discuss, especially since it often evokes feelings of embarrassment or shame. Many think they simply “have to just deal with it,” and thus, don’t often talk about it. Leaking urine while exercising is a sign of pelvic floor dysfunction. While this condition impacts both sexes, prevalence among women is much higher due to to anatomical differences at the pelvis, and commonly arising after pregnancy and childbirth events. However, it is important to note that many women suffer from these conditions who have never had children. Pregnancy, delivery and postpartum are not prerequisites for pelvic floor dysfunction. Say what?! Yup, you read that correctly. This is a common misconception, and something I’ll be explaining in more detail throughout this two part series. Now, for the sake of today’s post I will be speaking about the female pelvic floor specifically, but men this info is important for you to know, too. There are many women in your lives that are silently suffering with this condition. By reading this post and sharing it with others, you are helping spread awareness to others about pelvic floor conditions, and for that I thank you from the bottom of my heart. The more openly we can talk about these challenges and educate people that there are ways to correct these issues by working with a Pelvic Floor Physical Therapist the better.
Urinary incontinence (aka leaking) is a medical condition that refers to an involuntary loss of urine caused by increased pressure or sudden muscle contraction of the bladder (1-6). This condition is subdivided into three main categories: Stress Urinary Incontinence (SUI), Urgency Urinary Incontinence (UUI) and Mixed Urinary Incontinence (MUI). SUI is the most common, affecting nearly one in three women (1-6) – that’s a lot! SUI occurs when increased pressure is placed downward on the bladder that is too much for the pelvic floor to counteract resulting in leakage. This often arises with coughing, sneezing, jumping, and running type activities. However, any loss of urine that occurs when pressure suddenly, increases regardless of the activity, would fall under this category. While this condition is common, especially in women after having children, it is by no means normal, and can easily be treated with pelvic floor exercises and movement re-education (7-9). Note, I’ll expand more on this soon. UUI refers to an overactive need to void. You know, that signal we get from our brain that tells us we need to go to the bathroom? With UUI that signal isn’t reliable and alerts the person well before the bladder has reached its full capacity, causing a sudden urge to void prematurely or sometimes a sudden release of the bladder before someone’s had a chance to make it to the bathroom. Lastly, MUI is a mix of UUI and SUI together. For the rest of this post, I will be referring to SUI as it relates most directly to leakage while exercising (1-6).
I mentioned above that SUI is the result of a sudden increase in pressure. So how does this pressure system in our abdomen get overloaded and cause those unwanted leakage episodes? Good question. Let’s take a look at how our deep core system is organized and how it’s responsible for regulating our intra-abdominal pressure to meet the demands of our activities. The deep core is made up of four key players: the diaphragm (primary breathing muscle), transversus abdominus, multifidi (deep back muscles), and pelvic floor. When we take a breath in, the diaphragm relaxes and lowers to allow for air to enter the lungs. When this happens, the pelvic floor also relaxes and lowers to accommodate for this pressure change above. When we exhale, the opposite happens, creating a reflexive contraction in both the pelvic floor and diaphragm, causing them to lift in response to the pressure system that’s been decreased with our exhale. This same reflex also assists with activating the transversus abdominus with the multifidi. These four muscles work together to create a muscular corset of stability for our torso, and they are responsible for facilitating our ribcage to pelvis alignment.
However, these natural reflexes can become altered when the body is being loaded beyond its capacity. This is especially true during pregnancy, delivery, and postpartum periods, but can occur at any age regardless of bearing children. During higher levels of physical activity, if there’s a disruption of the coordination of this deep core system, leakage is often the first symptom. This often happens when women begin to deploy a breath holding strategy (often subconsciously!) or breathe more shallowly using more of their neck and upper chest muscles to try and create stability within their bodies. These altered breathing strategies decrease the efficiency of the deep core system, and thus place increased forces on the pelvic floor, which leads to pelvic pain, leakage challenges, and feelings of instability (1-9). When there is too much pressure in our deep core system, the easiest direction for this pressure to be released is downward. This is due to the anatomical construction of female bodies, but also due to gravity. As this pressure escapes downward, it often places increased forces on the internal organs that live within the pelvic cavity. The most common victim in this situation is the bladder, which results in an involuntary leakage episode if the pelvic floor isn’t strong enough to counteract this pressure change.
So now that you have a better understanding of the pressure system, let’s apply this to running. When you’re running, each leg is accepting approximately six to eight times your body weight with each step. That’s a significant amount of force that your body has to absorb up through your legs, pelvis and torso, in order to continue propelling yourself forward. Now imagine if you’re running with a deep core strategy that isn’t able to maintain an efficient pressure system throughout the duration of your workout – eek! This is how SUI develops, and why leakage episodes arise. If these symptoms are left untreated, hip and low back pain often develop as those areas of the body will try to compensate for the imbalance in pressure being placed on the pelvis. The body is smart and adjusts as needed to complete a task. These substitution patterns, however, can only last for so long before the system begins to break down.
The good news is, SUI is easily treatable with corrective exercises that address the following: breathing mechanics, Kegels, deep core strengthening and hip strengthening (7-9). Pelvic Floor Physical Therapists (PFPT) specialize in the treatment of urinary incontinence and are an excellent resource for helping to address these issues and provide a specific home program to meet your individual needs. As a PFPT myself, I work with many runners who have suffered for years with these symptoms, thinking this was their new normal, and had no idea there were ways to re-educate their pelvic floor and deep core systems to run without leaking. There is a lot that can be done to correct these symptoms conservatively, and the best part? You’ll be a stronger more efficient runner as a result. Now who doesn’t like that?!
In part 2 of this series I’ll be discussing the following: