We all know how our legs feel after a week of hard, heavy training. Our quads are like rocks. Our hamstrings are screaming at us. Our calves feel like knotted up balls of yarn. Our feet are on fire, and we dread taking the stairs. Sometimes after a hard race, even our arms are sore from all the pumping back and forth in a frantic attempt to regain the lead.
What if I told you that running doesn’t just stress your legs, back, and core? What if there are other muscles that get fatigued from running -ones you probably never think about?
If I gathered everyone reading this – assuming more people read this than just my mom and my fiance (assuming he actually even reads this?) – into one room, and asked you all to “raise your hands if you’ve ever peed yourself while running!” I bet NO ONE would raise their hands. You’d all just exchange weirded-out looks, saying loudly, “WTF? only babies and old ladies pee themselves! Why would she ask that? That’s gross!”
No one wants to admit it, much less talk about it in public, but I bet the majority of you runners reading this have at some point, peed yourself while running. Or at the very least, you’ve had a very serious urge to duck into the woods. A subset of you likely experience this on every run. You don’t talk about it with anyone for one of two reasons:
- it’s gross, or
- it’s totally normal. Everyone does.
Well…..I dunno, pee is a biological function that we all do, if we didn’t we’d get ammonia poisoning. If you look at it medically, it’s not gross. And, while the prevalence of urinary incontinence during running is ASTRONOMICALLY HIGH – most people experience it – it is NOT NORMAL!
Why do runners experience urinary incontinence? Well, the pelvic floor is comprised of skeletal muscle – the same type of muscle that’s in your quads, glutes, hamstrings, and calves. Your leg muscles get fatigued from consistently cranking out long, hard runs – so does the skeletal muscle in your pelvis! And as those muscles fatigue, it gets harder and harder for them to hold in the contents of the bladder….and you leak. The medical term for this is stress urinary incontinence. It’s also very common in post-partum women; their pelvic floors are fatigued from, you know, holding up a giant baby for nine months.
As runners, we train our quads, glutes and hamstrings not just through running, but through strength training (or at least, you should be!) that type of training allows our muscles to tolerate the loads of running and protect our joints from injury. Our pelvic floor muscles, on the other hand, we don’t really ever think about! So we don’t train them, but we stress them during hard run training – often to their breaking point.
Since this kind of stress urinary incontinence is an issue of skeletal muscle weakness…good news, you can train the muscles to get stronger so that you no longer leak while running!
The most commonly known way to train the pelvic floor is Kegel exercises. To do this, it’s easiest to start laying on your back with your knees bent up so that your feet are flat on the floor. You should also probably empty your bladder before doing this or it’s kinda uncomfortable. Simply try to envision drawing the contents of your pelvis up and in – like you’re trying to hold your bladder. A good way to determine whether you’re using the right muscles is what we call the “stop test”. While you’re urinating, see if you can voluntarily stop the flow for a second or two – note what that feels like, because those are the muscles you want to recruit during kegels.
The pelvic floor is just like any muscle in that you want to train both endurance and quick-reaction strength. For endurance training, simply hold a kegel for 5-10 seconds, rest for an equal amount of time, and repeat. For “quick reaction” strength (gotta be able to hold it in when you sneeze, right?), simply do a set of 10 quick kegels in a row, on-off, on-off, and then rest; try for three sets.
You’ll want to do these several times a day, and gradually build up to trying them in more demanding positions – sitting, then standing, so that you’re now working against gravity. Eventually, try to gain enough strength and control so that you can do these while walking, and THEN, ultimately, while running. After awhile, you won’t even have to think about it – your pelvic floor will be strong enough to hold everything in while you run.
Remember, stress urinary incontinence during running might be COMMON, but it is NOT NORMAL. If you’re struggling with performing kegels on your own, or have been doing it for awhile and it’s not helping, try to see a pelvic health specialist PT! They can do a thorough exam and help you find ways to train that muscle that are effective for you.
Run happy…..and run dry!
Special thanks to Carol Figuers, PT, Ed.D at Duke University DPT for the pelvic health content!