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Does Running Strengthen Pelvic Floor Muscles? Myths vs. Facts

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Does Running Strengthen Pelvic Floor Muscles? Myths vs. Facts

By 09/06/2024

6 Min Read

Today, I’m addressing common myths and presenting factual information about whether running strengthens pelvic floor muscles, providing runners with evidence-based practices to maintain pelvic floor health. Does pelvic floor health matter for runners? Yes, absolutely.

Does Running Strengthen Your Pelvic Floor? It Depends.

The pelvic floor muscles play a role in the function of the whole body, and require a whole-body approach to rehab and ongoing training. While runners are well known for having knee, foot, and hip injuries, many runners also suffer from pelvic floor issues. Fortunately, addressing pelvic floor muscle imbalances tends to help with foot, knee, and hip pain. 

Maintaining a healthy pelvic floor is just as crucial for runners as for everyone else. However, the higher loads that running places on the body overall make pelvic floor health particularly important for runners. The pelvic floor is the combination of muscles, connective tissue, and nerves that sit at the bottom of your pelvis, almost like a hammock. The pelvic floor provides support for your pelvic organs, assists with respiration, digestion, excretion, sexual function and reproduction, and provides stability to the spine as part of the core system. That’s a lot for one relatively small bundle of tissue. 

Your pelvic floor muscles are, of course, connected to many other muscles via tendons and ligaments, and working on those muscles is one of the primary ways to address pelvic floor issues. The glutes, inner thighs, hip flexors, and the many muscle groups that comprise the core are all intrinsic to your pelvic health. 

A healthy pelvic floor can withstand and resist the loads placed on it every day–if you run regularly, your pelvic floor muscles should be able to manage that load effectively. At the same time, for some people, running leads to overrecruiting and overdeveloping some muscles and underutilizing others. You might notice that you feel generally “tight” all over, or specifically in your hips and pelvis. You might notice urine leakage during a run, feel urgency during or immediately after a run, or notice difficulty urinating or defecating. All of these can be signs that your pelvic floor is not effectively handling the load of running well. 

Signs that your pelvic floor is working well: little to no discomfort when you run, regular bowel and bladder habits (i.e., you don’t need to know every rest stop along your routes). Sex is comfortable and orgasm achievable, assuming there are no other confounding factors. You feel relaxed when it’s time to relax. Let’s dive a little deeper by breaking down myths and facts.

Pelvic Floor Muscles

Common Myths About Running and Pelvic Floor Strength

Myth 1: Running Alone Can Strengthen the Pelvic Floor

Running provides many benefits. Cardiovascular conditioning, mental health benefits, staving off the consequences of a relatively sedentary life, to name just a few. As you land, your glutes, quads, and abdominal muscles support and stabilize the hips, spine and pelvis. Your torso counter rotates to offset the load of landing on one foot. And when you push off, the extension of your hip, facilitated by the plantar fascia, Achilles tendon, and calf, helps propel you forward. The repetitive motion of running strengthens all of these muscle groups.

All of these muscle groups also connect to the pelvic floor muscles. However, running alone is not enough to strengthen the pelvic floor. If your running form allows the pelvic floor to engage and release in sync with your running cadence, you’re not causing any harm to it. That said, the increased force that running transmits through your pelvic floor won’t strengthen it if it’s already weak. A weak pelvic floor may struggle to properly engage and release, whether due to tightness, laxity, or lack of coordination with movement and breath. Instead of pushing through pain or ignoring symptoms, it might be necessary to pause, focus on rehab, and return to running stronger than ever.

Myth 2: All Types of Running are Beneficial for Pelvic Floor Health

What you need to know about this myth is that it’s about form. No matter how far you run or how fast, your running form is what will determine how your pelvic floor muscles respond to running. One study found that women who trained at higher effort levels do not have a higher incidence of pelvic floor dysfunction, but over 50% of the women in the survey did have some degree of dysfunction. So intensity is not necessarily a definitive factor in whether you will have pelvic floor issues as a runner. 

What makes a difference to your pelvic floor? How your body moves when you run. Some general guidelines:

  • Land at the fore-to-mid foot
  • Maintain a slight forward lean (as if falling forward instead of leaning back), so that your feet land below or slightly behind your pelvis
  • Relax your abdomen so that your core muscles can work reflexively. Sucking in your abs creates excessive intra-abdominal pressure and makes you work harder to breathe
  • Rotate from the ribcage, not just the arms (here’s a great exercise to help your body experience rotation)
  • Land softly instead of slamming your feet into the ground

Myth 3: Pelvic Floor Issues Only Affect Women

While women’s health is still massively under-researched in general, one area that is better publicized is pelvic health. But unfortunately, this means that many people who were assigned male at birth make the mistaken assumption that pelvic floor health is only relevant to people with vaginas. And that’s just wrong. If you have a pelvis, you have a pelvic floor. That means that if you’re a runner with a penis, you may also be at risk of pelvic floor dysfunction. Due to differences in anatomy, there are slightly different symptoms and issues:

  • Urinary Incontinence
  1. Stress incontinence: Leaking urine during activities like running due to pressure on the bladder.
  2. Urge incontinence: A sudden, intense urge to urinate, sometimes resulting in leakage.
  • Pelvic Pain
  1. Chronic or acute pain in the pelvic region can be triggered or worsened by running.
  • Pelvic Floor Muscle Dysfunction
  1. Overactive or underactive pelvic floor muscles leading to pain, discomfort, or urinary issues during or after running.
  • Prostatitis
  1. Inflammation of the prostate gland, which can cause pelvic pain, urinary symptoms, and discomfort during physical activities like running.
  • Rectal Continence
  1. Incontinence: Inability to control bowel movements, leading to accidental stool leakage during running.
  2. Constipation: Straining or difficulty passing stool, which can worsen during running due to the increased pressure on the pelvic floor and abdominal muscles.
  • Erectile Dysfunction
  1. Though less common, dysfunction in the pelvic floor muscles can contribute to issues with erectile function, particularly in those with chronic pelvic floor tension or pain.
  • Pelvic Organ Prolapse
  1. Rare in men but can occur, particularly after prostate surgery, where the pelvic organs may descend from their normal position, causing discomfort or a sensation of pressure.

These conditions can be influenced by the repetitive impact and stress that running places on the pelvic floor muscles. If you’re experiencing any of the symptoms mentioned, it’s essential to consult with a pelvic floor physical therapist who specializes in your anatomy. 

Pelvic Floor Muscles

Facts About Running and Pelvic Floor Strength

How Running Can Positively Impact Pelvic Floor Health

Running is an excellent way of maintaining overall physical well-being. It provides benefits such as bone density, cardiovascular conditioning, and time spent in community with others. If your pelvic floor is functional and responsive, running will help it stay that way. While there is evidence that a high training volume may affect your pelvic floor function, it has not been definitively proven that running alone is responsible for pelvic floor dysfunction. Rather, it is more likely that the higher loads and impacts of running increased the effect of already-existing imbalances. Keep on running if you’re doing so pain and symptom-free.

Potential Negative Effects of Running on the Pelvic Floor

On the other hand, if you are experiencing the symptoms of pelvic floor dysfunction, it is worth pausing to assess why the dysfunction is happening. Are you using improper running techniques? Are you running without warming up or cooling down? Are you neglecting to cross-train, or are you overtraining? All of these factors can contribute to pelvic floor dysfunction. One of the biggest obstacles to progress I see in my clients is that running serves as both an emotional and physical practice. Thinking about slowing down or even stopping running to heal your pelvic floor can be daunting. Many of the runners I’ve worked with have a hard time slowing down to do gentle exercises that release tension in their pelvic floor muscles, resulting in those muscles staying tight and tense. So paradoxically, the activity they do to release stress ends up causing more stress long-term. 

If you’re noticing that you have some of the symptoms discussed in this article, don’t despair. There are many ways you can keep some of the intensity of running as you learn to work with your pelvic floor muscles. Hill walking, both forward and backward, is one of the best ways to strengthen your pelvic floor and experience a bit of intensity. And there’s a bonus–you’ll be doing good work for your knees and ankles at the same time. Your pelvic floor specialist will help you find other ways to keep some of your conditioning while you rehab your pelvic floor.

Scientific Studies and Evidence

Where’s the evidence for all of this? Here are three recent studies about running and the pelvic floor.

Bonaldi L, Mascolini MV, Todesco M, Zara A, Rossato C, Fede C, Fontanella CG, Stecco C. Urinary Incontinence and Other Pelvic Floor Dysfunctions as Underestimated Problems in People under Forty Years: What Is Their Relationship with Sport? Life. 2024; 14(1):67. https://doi.org/10.3390/life14010067

This relatively small study investigated whether healthy subjects of all genders, under the age of 40, experienced symptoms of pelvic floor dysfunctions, and whether activity levels seemed to be a factor in their symptoms. Notably, they write in their discussion of the results,

 “From the quantity to the quality of each specific sport, running seems to be the riskiest sport for pelvic floor dysfunctions, in line with what was reported by Selecka et al. about running [15]. In the current study, runners showed a higher prevalence of fecal and urinary leakage during sport activity (32% and 28%, respectively), and in general (42% and 28%). See Table 6. Rodriguez-Lopez et al. [16] reported a lower urinary leakage in athletes during training such as running, at 19.6%. Regarding sedentary people, in the current study, these showed the highest percentage of urinary leakage in general (38% of them) and while coughing or sneezing (20%), compared to the sporty population.”

Sade, S., Naor, I., Rotem, R. et al. Pelvic floor disorders among amateur runners. Arch Gynecol Obstet 309, 2223–2228 (2024). https://doi.org/10.1007/s00404-023-07351-8

This study focused on “the impact of amateur running on [pelvic floor dysfunction], quality of life (QoL), and sexual function.” Of interest, the results were somewhat inconclusive–while a much higher proportion of participants experienced pelvic floor-related symptoms than the general population, there were few differences among the different training regimens that the subjects adhered to–it didn’t matter whether or not they did yoga or Pilates, or only ran, or considered themselves “high-effort” runners. Notably, “Apart from orgasms intensity no significant differences were noted between the ‘High- effort’ and ‘Moderate-effort’ groups.” The high-effort groups had more intense orgasms. This study is worth reading if you’re wondering whether you should pursue pelvic floor physical therapy to help with symptoms–the answer is yes.

Steimling, Michael PT, DPT1; Roberto, Michael PT, DPT2; Steimling, Melinda PT, DPT3. Running Gait Retraining in the Management of a Multiparous Runner With Chronic Stress Urinary Incontinence: A Case Study. Journal of Women’s & Pelvic Health Physical Therapy 47(2):p 114-121, April/June 2023. | DOI: 10.1097/JWH.0000000000000265 

This case study is one example of how simple some of the changes you might need to make are when it comes to pelvic floor symptoms: “Running gait retraining, with emphasis on reducing impact, may reduce symptoms of [stress urinary incontinence].” While it is not wise to extrapolate from a single case to a universal rule, starting with small tweaks is often a good way to discover what the culprit is when it comes to pelvic floor dysfunction in runners.

Can Running Strengthen Your Pelvic Floor?

Short answer: yes and no. But that shouldn’t stop you from running if running is what you love. If you’re experiencing pelvic floor-related symptoms, pause and get yourself evaluated. If you’re symptom-free but want to be proactive, make small changes, like integrating targeted exercises for your pelvic floor, so you can keep running for years to come.

FAQ

1. What are the best exercises to strengthen the pelvic floor alongside running?

Exercises focusing on the core, glutes, and inner thighs will help strengthen your pelvic floor. Examples of those exercises are bridges, squats (modified to meet your body’s mobility needs), and reverse marching. Restorative exercises like child’s pose will help your pelvic floor relax. 

2. How does age affect the relationship between running and pelvic floor strength?

As you age, muscle tone and elasticity naturally decline, which can weaken the pelvic floor muscles and increase the risk of disorders like incontinence. Hormonal changes (e.g., in peri and postmenopausal women) can also affect pelvic floor strength and tissue health. Older runners may need to incorporate more focused pelvic floor and core exercises into their routine and might need to adjust running intensity and frequency to prevent strain on the pelvic floor.

3. What are the signs that running is negatively affecting my pelvic floor?

  • Urinary leakage during or after running, even in small amounts.
  • Pelvic pain or discomfort that increases with running or afterward.
  • A feeling of heaviness or pressure in the pelvic area, which could indicate a prolapse.
  • Difficulty controlling bowel movements or noticing stool leakage during or after running.
  • Chronic lower back pain, which is frequently associated with pelvic floor dysfunction.

4. What role does core strength play in maintaining pelvic floor health for runners?

Core strength provides stability to the pelvis and supports the pelvic floor muscles during running, and distributes the forces exerted more evenly. Weak core muscles can lead to improper form and overcompensation, increasing stress on the pelvic floor and contributing to dysfunction.

5. Is it safe to start running if I already have pelvic floor issues?

Consult a healthcare professional before starting or continuing a running routine if you have existing pelvic floor issues. You may need to start with low-impact exercises and pelvic floor rehabilitation exercises to build strength and stability before introducing running. If cleared to run, consider modifying your running routine with shorter distances, reduced intensity, and incorporating more rest days to avoid exacerbating symptoms.

6. Can using a treadmill versus outdoor running impact pelvic floor health differently?

Treadmill running generally provides a more consistent, cushioned surface, which can reduce the impact on the pelvic floor compared to harder, uneven outdoor surfaces. However, the action of the belt on a treadmill can alter your running gait, so be mindful that training on a treadmill may affect how running outdoors feels. 

Outdoor running may involve more variability in terrain and surface hardness, potentially increasing the strain on the pelvic floor. Weather conditions and other environmental factors outdoors (like heat or humidity) can also affect how your body responds, including the pelvic floor, during a run. 

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