There are many questions you might ask as a female runner. One of which is not asked often enough: ‘Is it okay to accidentally pee during exercise?’. It’s something that many women experience when running and yet there’s not much advice out there. This guest blog by pelvic floor expert Louise Field, who created the Adore Your Pelvic Floor programme, will run over three in-depth parts to give you the lowdown on everything you need to know about your pelvic floor and running.
The second blog in this series looks at exercise and running during pregnancy. We explore how this impacts on pelvic floor health too. You can read that here: Can I exercise or run during pregnancy?
Is it okay to accidentally pee during exercise?
Today I want to talk about running. So many of the women I speak to would desperately love to get back to the sport they love, but feel they’ll never be able to run again as they constantly pee when they try, or have been told it’s dangerous or not suitable for postnatal women. Friends and healthcare providers may helpfully suggest,’Why don’t you take up another sport? Swimming perhaps?’ While this is well-meant advice, it’s not useful and doesn’t take into account the many reasons why women run.
We run for fitness, to maintain a healthy weight, for our mental health, to find a moment of solitude in a chaotic day or to be with our friends and enjoy the social aspects of a running group. The infuriating thing for me is that the majority of women can get back to running. They just need to learn how to properly recruit their pelvic floor and rehabilitate these muscles properly.
I’m not going to lie; as a bundle of energy, for me personally, when I was in this position, this was a tough journey. It involved me learning to listen to those nagging voices that told me I needed to rest and show myself some TLC. It was about building strength and endurance in the pelvic floor muscles, with the synergy of the core unit. I had to learn to consider my fitness choices and the impact they were having on my physical and mental health. This meant I had to slow down, listen to my body; I just needed to know how.
What causes the accidental leaks?
There are so many factors and life experiences that can bring on this kind of incontinence.
A few include:
- Pregnancy and childbirth
- The menopause and age
- Some medical conditions
- Chronic constipation or inflammatory bowel conditions, such as IBS, Chron’s disease and ulcerative colitis
- High tone muscles or low tone muscles
- Poor posture
- Faulty breathing mechanics
A healthy functioning pelvic floor depends on all the muscles in the pelvic floor – yes, there are many muscles in the pelvic floor – having a balance of good resting tone, strength, length, endurance and the ability to be able to work in a coordinated way with your breath and the rest of the body.
Can it be fixed?
Well, let’s first take a breath! A really good breath and a full-on sigh. Good, let’s get to the stuff you want to hear: ‘How do I fix this?’ The great news is we can ABSOLUTELY REGAIN a balanced, REACTIVE and EFFECTIVE pelvic floor group.
Would you happily and sensibly take rehab/physio for an injured knee or ankle? Absolutely! If it enables safe exercise, to continue with sport, and performing better, it’s common sense. In fact, when we have an injury it is often the subject of much discussion with friends, family and fellow runners. Advice is often offered from all quarters: applying RICE, strapping, physio exercises, etc.
Why is it any different when considering the muscles within our pelvis? Many women are embarrassed to admit they’re having difficulty with managing continence or have no idea that Women’s Health Physiotherapists even exist.
Ironically, once one women in a group admits she’s having problems with incontinence or a prolapse, often several more in the group will admit they too are struggling with similar issues. The number of times I hear, ‘You’ll never believe it; three of the five women I run with also have the same ‘pee issues’ and symptoms when running as me!’. It’s a tough one, but as we open up and talk about these issues we raise greater awareness and can work to support each other.
So let’s look into this a little deeper. The feet, knees, pelvis, back and posture all play a part in how well our pelvic floor group is able to function. Breath also plays a huge part in the role of an effective pelvic floor group. In fact, the first thing I look at in any woman I am working with is the breathing mechanics.
How do we perform a pelvic floor contraction?
Good question! We’re told we can do our pelvic floor exercises any place at any time, and yet many of us don’t know quite how. As with all exercises, it’s important to perform the exercise correctly, as technique is always vital to gain results.
Practising pelvic floor exercises can prevent and reverse small pelvic organ prolapse and leaking. Performing the exercises can be tricky at first, but here is how to get started:
- Sit down, take a big sigh and relax (this is important).
- The first exercise is to draw in and up from the back exit, as if you’re stopping yourself from passing wind. Continue to lift internally towards the vagina, and up and towards the inside of the pubic bone. Aim to hold for up to 10 seconds. Completely release and then rest for 10 seconds. Repeat this 10 times.
- Using the same principle, the second exercise is to draw up internally for 1 second, completely release, rest for 1 second and repeat 10 times.
- With both of these exercises it’s important to continue breathing steadily throughout and to let go fully after every repetition.
- Practice both of these exercises up to three times a day.
You can see a video about pelvic floor exercises here: https://youtu.be/NoMVqAIZqRE. Especially for you, I have also added a real-time ultrasound video explaining and showing you how the pelvic floor contracts and then relaxes. As with every muscle in the body, the pelvic floor should be able to relax, contract and release. You will see in this second video using the ultrasound, how the pelvic floor reacts to a cough and the reaction of the bladder under load.
So, back to the pee question…
In the meantime, the answer to my initial question: ‘Is it okay to accidentally pee during exercise?’ No, this is urine being forced from the bladder because the pelvic floor group is not able to react under the repetitive load. We need a good, flexible and balanced group of muscles working synergistically with our core unit. These deeper muscle groups are often overlooked as we focus on the outer layer of more visible muscle groups.
However, I personally believe working on my weakest link will allow me to attain my best strength possible. I absolutely want to consider my pelvic floor 100% , for the here and now, while also considering my pelvic floor for my later years too.
Using the principle of training my inner core means my pelvic floor is in the best condition, with top-notch reactions on load and impact allowing me to tell incontinence to JOG OFF ELSEWHERE!
If you love to run and jump, our next blog is packed with resources, tips and exercises you can apply to your current training programme or to get you back to running now and keep your pelvic floor healthy for life. We’ll also look at some sound evidence and advice on exercising during pregnancy.
Introducing Louise Field
Health and physical activity is my career and an extremely important aspect of my life. As a proud mother of five boys, I have a special interest in empowering women, in particular, helping women restore good pelvic floor function to enable them to get back to physical activity. After I personally suffered a significant pelvic floor injury, I was horrified to discover that this could not only rob me of the exercise I loved, but my career as well. When I looked for advice on how to rehabilitate my pelvic floor muscles and get back to full fitness, I found the available information was limited and often contradictory. One of the recommendations suggested to me was that I should stick to walking or swimming short distances for the rest of my life.
As a fit young mum who loves to move and teach exercise, this was NOT going to cut it! So I began my journey to educate myself and learn every thing I could about the pelvic floor and how to rehabilitate it. From talking to other women, using my own personal experiences and working closely with specialist women’s health physios, my passion and dream combined to share the evidence I learned along the way – the endorsed Adore Your Pelvic Floor Programme was born. I now offer seminars to organisations and fitness professionals and health care workers accredited training on how to provide women with the understanding and skills they need to keep their pelvic floors healthy for life, so they can pursue the activities and sports they love.
Useful references and links