Leaking while running is very common for many women. It can happen after having children, or and in some cases it happens to female athletes. Unfortunately, finding a treatment for the problem of leaking while running is not simply found through doing one or two exercises. The top four approaches I recommend to decrease leaking while running are: 1) relaxing the abdominals; 2) posture; 3) strengthening the gluteus medius; and, 4) retrain the system with breath to accommodate the load of running.
There are many contributory factors that cause leaking during physical activity. First, one must identify when they experience leaking- does it occur at the beginning or end of the run? Does it happen while running downhill or only when running fast? Does leaking happen during the entire run, or only after the run? Does leaking occur while jumping?
A few often helpful strategies are to change one’s posture and to change how one engages the abdominals. I’ve seen many patients who held in their abdominals all day long, and even more during higher levels of activity. Studies have shown that women with incontinence can have good activation of the pelvic floor, but over stabilization of the external oblique. People do not need to pull in their abdominals all the time and definitely do not need to be doing it more with higher level activity. There is a pressure system from the diaphragm to the pelvic floor. This system must have the pressure distributed evenly or the system will fail. The diaphragm sits underneath the rib cage, while the pelvic floor is at the bottom of the torso. What is in between the two? The abdominals. If there is constant activation of the abdominals, it will increase the pressure towards the pelvic floor. A good way to see if this is happening is to simply look at the abdominals. There may be a kink in the upper abdominals, pushing out the lower abdominals.
The second most important thing to focus on is posture.
Third, to support the pelvis, you need to have strong gluteus muscles. To test if your gluteus muscles are strong and supportive, one can perform a single leg squat. If the knee moves inward, this indicates that the gluteus medius is not helping to support that activity. During running, each time one takes a step there is impact upon a single leg. If the glutes are not supporting this activity, pressure is placed on other areas such as the knee or pelvic floor. To strengthen this, one can perform a single leg squat in front of a mirror while holding onto a countertop for support. In doing this, one can perform the squat at different depths and with different levels of assistance, i.e. holding on with a whole hand versus a finger for extra support.
Sometimes one needs to change how the brain is working instead of strengthening the pelvic floor. The way to do this is through breath and with graded exposure to the activity of difficulty. If the activity is jumping, then one must unweight that activity and focus on breath. For example, start with plank jumps to improve jumping jacks, or even heel strike without leaking. First, start with a slow plank jack with an inhale, then exhale and jump both feet out. Then, move to inhale jump, exhale jump, and from there one can increase width between the feet, or increase the speed. The breath connects the brain and the activity. From the plank jack, one can perform a supported plank jack on a chair or couch, and then ultimately perform an actual jumping jack. As one transitions the from a plank jack to a jumping jack, they change the load on the pelvic floor. Then most important things to consider are when there is leaking it is a sign that the system needs a new strategy and running cannot be effective with a stiff pressure system.
If you have additional questions, seeking advice from a pelvic floor physical therapist would be a good resource to help get back to the activity you love.
Dr. Courtney Foley, PT, DPT, PRPC is a pelvic floor physical therapist who is currently practicing in Charlotte, NC. Thank you for taking a moment to provide some helpful advice to the Stroller Warriors® community!