By Dr. Julie Pettit-Lane

What better way to enjoy the warmer weather than to take our workouts outdoors, whether running outside or tackling WODs with running in them. But as the intensity and volume of running ramp up, you may notice some urine leaking. Does leaking hold you back from running? Does it cut your runs short or keep your intensity down?

Leaking with running is extremely common, with research reporting that about 40% of female athletes experience leaking during training. This is seen in runners, CrossFitters, and functional fitness athletes alike. And while it is common in postpartum athletes, it also occurs in athletes who have never been pregnant.

There has been a big shift to bring awareness to these symptoms, which is great. While this helps decrease shame and embarrassment, wouldn't it be even better to not worry about leaking at all? The thing is, you can do something about it and the answer is not to just stop running!

Why Urine Leakage Happens While Running

The pelvic floor muscles play a crucial role in continence. These muscles close off the urethra to prevent urine from leaving the body, and relax to allow urine to pass when you choose to void (though it's worth noting there is more to storing and voiding urine than just the pelvic floor).

Leaking occurs because of several limitations with these muscles:

Strength
Overactivity
Coordination

The most common cause is that the muscles are not strong enough to resist the pressure placed on the pelvic floor. Think of a shoulder press: at some point, the shoulders and arms are not strong enough to lift the weight pushing down toward the ground. An increase in force from the abdomen down to the pelvis, intraabdominal pressure, becomes too much for the pelvic floor to resist. This can happen during a cough, sneeze, laugh, jump, lift, or run.

Leaking can also be caused by overactive pelvic floor muscles or poor coordination of the pelvic floor muscles.

When pelvic floor muscles are overactive, they lack the necessary mobility and/or are fatigued and unable to contract fully to prevent leaking. Think of a strict pull-up: if you are holding your chin above the bar and someone tells you to "contract more," you can pull up slightly, but there is not much movement available. And if you held that chin-over-bar position for 60 seconds and were then asked to do as many strict pull-ups as possible, you likely wouldn't be able to do as many as you can do fresh, because your arms are now fatigued. The same is true for the pelvic floor.

As for coordination: to catch a ball tossed at you, you must move your arm at the right time and to the right place. If the ball is already behind you before you move your arm, you will miss it. The same applies to the pelvic floor. If the muscles contract after impact rather than before, the timing is off and the sphincter is not closed in time to prevent leaking.

This is why the pelvic floor must be strong, mobile, and coordinated to close off the urethra and prevent leaking.

The Biggest Mistakes Runners Make

What do runners commonly try when they experience leaking? The first is to do all the Kegels. Under the assumption that the pelvic floor is weak, doing Kegels throughout the day can be helpful, but only if done correctly. Are you contracting and fully relaxing with each rep? Are you even engaging your pelvic floor, or just squeezing your glutes, abdominals, and/or adductors (a very common mistake)? And Kegels alone will not help in the case of an overactive or uncoordinated pelvic floor.

Another mistake? Just ignoring it. Running through symptoms knowing you will need to change clothes or use pads. But over time, symptoms may, and often do, worsen.

Another attempted fix? Just stop running. If you avoid the activity that makes you leak, you won't leak! But you are running for a reason: for fitness, health, wellness, challenge, competition, or the joy of running itself. Is that something you want to give up? Some are okay with that; many are not.

How to Fix Urine Leakage While Running

The first step is to find the root cause. As mentioned, the pelvic floor may be:

Not strong enough
Not mobile (overactive)
Not coordinated
Some combination of these

But pelvic floor function is only one part of the picture. Other factors to consider include:

Breathing: for pressure management and coordination with the pelvic floor
Core: strength and posture, since a mismatch can create more stress at the pelvic floor
Hip and leg strength and mobility: limitations here can cause increased stress and compensation at the pelvic floor

The second step is to fix the issue by addressing limitations such as:

Pelvic floor mobility, strength, and/or coordination
Coordination between the diaphragm and pelvic floor
Building strength through full range of motion
Impact preparation and drills

The third step is to perform and prevent:

Gradual return to running with progressive loading
Ongoing strength and mobility work to prevent injuries and leaking in the future

Key Exercises That Actually Help

Here are some things to get you started.

First, take a look at your posture while running. Ideally, record yourself in your running environment (treadmill, road, track, or trail). What is your rib position? Your ribs should be stacked over your pelvis. Think of a skiing stance. That slight forward lean often puts people in a better position.

Second, practice pelvic floor coordination drills. The pelvic floor should be contracted before impact. Practice this with squats, lunges, hops, and single-leg hops.

Third, incorporate single-leg strength exercises. Some of our favorites for runners include:

Single-leg calf raises
Single-leg bridges
Sidelying hip abduction (try this in a side plank!)
Single-leg squats
Standing clamshells

Finally, work through impact progressions. Starting with the least demanding movements (heel raises, mini squat jumps) and progressing toward hopping, bounding, and eventually running.

Summary

Leaking urine during running is common, but not normal. There is so much that can be done about it!

While weakness is one possible cause, coordination and pressure management issues can also play a role and are equally addressable.

You do not need to stop running to solve this. There may or may not be a brief pause in running, but the goal is to get you back to running without limitation.

Follow the three-step process: find the root cause, fix it, and return stronger.

Where to find a pelvic PT in South Portland who can help you with leaking during running.

Look for someone who specializes in pelvic health with a return-to-sport focus. A good sign is if they have weights heavier than 50 lbs in the clinic, and ideally they have experience working with runners and active adults.

Starting with table exercise is great. It can build a strong foundation. But you shouldn't stay there! If you are not up and on your feet within a few visits, and returning to running is your goal, it may be worth looking elsewhere.

Most importantly, the assessment and progressions should be individualized to you and your specific goals. If your therapist cannot explain the why behind an exercise or plan, that's worth questioning.

At Infinite Capacity Physical Therapy, we help athletes and active adults manage pain and pelvic symptoms so they can continue training and living active lives. We would love to help you get back to running confidently and without leakage!

Schedule a FREE Discovery Call today to start your journey to leak-free running.

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