How Running and Pelvic Floor Health Are Interconnected

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How Running and Pelvic Floor Health Are Interconnected: What Every Runner Should Know

8 Min Read

Not every runner experiences pelvic floor issues, but all runners should be aware of the interconnectedness of running and pelvic floor health. While running may increase your risk of pelvic floor dysfunction, there is also evidence that with proper training, it is possible to maintain or improve your pelvic floor function while continuing your running activities.

Table of Contents

Don’t Ignore Your Pelvic Floor

If you’ve ever been out for a run and found yourself facing a sudden urge to pee or a sudden cramping sensation in your bowels, you have experienced one of the less-pleasant effects of running on your pelvic floor. You might also experience leaking when running. Neither urgency nor leaking is ideal, and it’s certainly not convenient whether you’re running at the park with your children, running a leisurely mile, or training for your next ultramarathon.

Runners aren’t the only people who have pelvic floor issues: other athletes who participate in high-intensity sports are also likely to find themselves at increased risk of pelvic floor dysfunction. However, the percentage of runners versus members of the general population who experience pelvic floor dysfunction symptoms is much higher. In one study, the rate of stress urinary incontinence among runners is as high as 52.7% as opposed to 28% in the general population.

Whether you’re an amateur runner or a seasoned pro, it’s wise to learn more about the ways running affects your pelvic floor.

The Impact of Running on the Pelvic Floor

Let’s do a quick review of where and what the pelvic floor is.

The pelvic floor is the collection of muscles, nerves, and connective tissues that support the organs that rest in the pelvis. The function of your pelvic floor is fivefold:

Support for the internal organs
Regulate elimination of feces and urine
Sexual and reproductive function
Stabilize the trunk and play a role in core and respiratory mechanics
Provide a “sump pump” to lymph as part of the circulatory system

The muscles of the pelvic floor are connected to the muscles of your trunk and legs. Most of the things you do with your body rely in some way on your pelvic floor. And your pelvic floor function is influenced by most of the things you do. One of the most important functions of the pelvic floor is to regulate intra-abdominal pressure as part of the core and breathing systems.

Intra-ab-what?

Intra-abdominal pressure (IAP) is the pressure inside your abdomen. That pressure increases and decreases based on the loads on your body, including things like breathing and moving. You can visualize IAP in action by squeezing a balloon or a partially deflated ball–if you squeeze in the middle, the balloon bulges above and below where you’re squeezing. If you squeeze too hard, the balloon pops. Ideally, your body is able to respond to normal increases in pressure without you even noticing it. Sometimes, you’ll experience excessive pressure, like when you sneeze or cough or move a heavy object. Ideally, your pelvic floor should manage this increased pressure; allowing it to yield to the force without leaking urine.

However, for many people, the pelvic floor is unable to yield and rebound under pressure, so even everyday loads like sneezing become an overload. In those cases, you may experience pain, leakage, or in some cases, aggravation of conditions like diastasis recti or pelvic organ prolapse.

What makes the pelvic floor have a hard time managing IAP? Many factors come into play, but for many of my clients, the culprit is overactive pelvic floor muscles. Overactive pelvic floor muscles tend to hold too much tension throughout the day. So when a bigger pelvic floor load comes along, the muscles are already fatigued and unable to bear the additional load. For many runners, the impact of running causes a reflexive tightening of the pelvic floor muscles.

Does Running Help the Pelvic Floor?

The good news is that, just like with most activities, you can train your body to manage the increased load of running by scaling your training to allow time for your pelvic floor to learn how to manage the load. You can train your core and pelvic floor to work better together with your breath, and you can learn to relax your pelvic floor muscles.

For runners who manage their intra-abdominal pressure well, running is a great part of an overall wellness program. The pelvic floor is deeply responsive to emotional stress–so if you use running to help stay emotionally regulated, running can be nourishing and supportive.

Some studies have shown that runners tend to have thicker levator ani muscles (one of the main muscles making up the pelvic floor). This anatomical difference does not correspond with a difference in function. What’s more important to note is that every person’s body has its own capacity to manage the load. This is part of the wonderful variability of bodies and genetic expression. If you’re someone who loves running, whose body also manages the increased impact of running well, you’re likely maintaining, if not improving, your pelvic floor function by lacing up your shoes and getting out on a run.

Pelvic Floor Dysfunction and Running

High-impact exercises like running may play a part in the development of pelvic floor dysfunction for some people. Most amateur runners are not deeply steeped in the optimal biomechanics of running. Often people just start running and hope for the best. If you injure a joint, like a knee, you’re lucky if we meet with a physical therapist who assesses the whole gait cycle with an eye to improving overall body mechanics instead of just treating the knee injury–and that’s if you decide to seek help at all.

But what about your pelvic floor? How many runners do you know who tell you about wearing a pantiliner or knowing all the bathrooms along their running route? It’s probably more than one. Instead of accepting these symptoms as normal, let’s get smart about approaching running as if it were any other kind of novel athletic activity: with proper training and cross training. Unless you are a naturally gifted runner, you’re likely taking whatever movement patterns you use for the rest of your life out on your run with you. And that includes your tendency to grip your pelvic floor muscles, or your habit of placing more weight on one foot with every step, or a habit of breathing shallowly, all of which are magnified and multiplied massively when you pick up your pace and distance by running.

Common pelvic floor issues in runners include but are not limited to:

Urinary Incontinence

Stress incontinence: Leaking urine during physical activities like running due to pressure on the bladder
Urge incontinence: A sudden, intense urge to urinate, sometimes resulting in leakage

Pelvic Organ Prolapse: A condition where pelvic organs (bladder, uterus, or rectum) drop from their normal position, potentially causing discomfort and a feeling of pressure or fullness
Pelvic Pain: Chronic or acute pain in the pelvic region, which can be exacerbated by running or other high-impact activities
Fecal Incontinence: Inability to control bowel movements, leading to accidental stool leakage during running.
Pelvic Floor Muscle Dysfunction: Overactive or underactive pelvic floor muscles leading to pain, discomfort, or issues with bladder and bowel control during or after running
Vulvodynia: Chronic pain or discomfort around the vulva, which can be aggravated by the repetitive motion and impact of running

While this is a long list of problems, most can be addressed with pelvic floor exercises or physical therapy. If you’re already running regularly, you’re halfway there: the biggest obstacle to successful pelvic floor healing is sticking with a rehab plan.

Balancing Running and Pelvic Floor Health

The question to ask is not “Is running bad for your pelvic floor?” It’s really: “How do I balance running and pelvic floor health?”

Identifying Risk Factors

It is much more common for runners who have been pregnant to have pelvic floor issues, although this is also true of the general. Pregnancy and birth are the top risk factors for pelvic organ prolapse, for example, whether the prolapse occurs shortly after the birth or ten, even 20 years later. If you’re returning to running postpartum, it is a good idea to start slowly and to work with a pelvic health physical therapist as you begin training. Your body goes through major changes during pregnancy and birth, and getting reacquainted with your body postpartum can take several months.

Other conditions that may predispose runners to pelvic floor issues are overactive pelvic floor muscles, underactive pelvic floor muscles, and connective tissue disorders such as Ehlers-Danlos syndrome. People who have these kinds of connective tissue disorders often have a lower tolerance for high-impact training. However, strength training at a reasonable pace and with appropriate scaffolding is highly beneficial, so if you have hypermobile joints, and you love running, make sure that you’re balancing your running with strength training and working with a trainer who understands hypermobile bodies.

Tips for Preventing Pelvic Floor Problems while Running

Preventing pelvic floor problems while running is relatively simple, but can be difficult without guidance. Your training schedule should include pelvic floor relaxation techniques, pelvic floor strengthening techniques, and dynamic movements that get your hips, glutes, and core in various ways, similar to how they engage when running.

Strengthening Exercises

I love these two sequences for cultivating supple strength in the pelvic floor.

Kneeling Lunge with Block and Dowel

You can use a couple of stacked books and a mop handle for this exercise, if you don’t have a yoga block and dowel handy. Here’s a video if that’s easier for you to follow.

Kneel with your left knee and shin on a yoga block, with your back toes tucked under you on the floor
Your right leg is in a lunge with your right foot on the floor in front of you
Imagine you are a clock: 12:00 is straight ahead of you
Hold your dowel for support as you alternate a shifting forward into a deep knee lunge and sitting back toward your left heel as you straighten the right leg
As you lunge, simultaneously resist the lunge so you’re not just collapsing into it
As you sit back just go as far back as feels right without rounding your back; move slowly and deliberately
Bring your right foot out to the side, to 2:00, and repeat the movements four times
Move your right foot to 3:00 and repeat the movements again, four times
Now bring your right foot back to 2:00 and hold your dowel overhead
Tuck your pelvis under you as you exhale to lunge deeper
Add a side bend to the right, pulling the dowel apart
Add rotation, turning your chest to the right, then slowly come back to center.
Use your right leg to press up out of the lunge and repeat six more times
Walk around the room after those six times feel the difference and repeat on the other side

Dynamic Squatting Sequence for Runners

This sequence is a way to slowly increase your pelvic floor responsiveness if you already have some leakage while running or symptoms of pelvic organ prolapse, even if they’re very mild. It’s great for anyone trying to avoid those issues as well. Here’s a video if you prefer.

Perform 10 reps x 3 sets. Practice the first exercise for a few weeks until you feel comfortable, then progress to the second, third, and fourth.

1. Slow squat to quick heel raise:

Slowly lower into a shallow squat, then quickly move into a standing heel raise. Allow the arms to swing upwards with momentum. Slowly lower back down again. This movement is slow on the way down, quick on the way up. Holding on to something for balance is fine.

2. Slow heel raise to quick squat:

From a standing position, slowly come into a heel raise. Quickly drop into a squat–it does not need to be a deep squat. Slowly up, quickly down.

3. Staggered squat:

Step one leg back into a slight lunge. From there, perform a single leg heel raise on the front foot, driving the back knee forward and up. Step back into the lunge; no need for it to be a deep lunge; focus on the heel raise

4. Loaded staggered squat:

Build on the previous exercise by holding a weight in hand– you can start with as few as 2-3 pounds.

Incorporating Pelvic Floor Exercises into Your Running Routine

The best way to incorporate pelvic floor exercises into your routine is to figure out what works best for your schedule and what you can do with some consistency. If you are a regular runner, you probably have a fairly solid exercise routine, so adding 5 or 10 minutes at the beginning or end of your run might be the most effective way to go. Instead of focusing only on stretching your running muscles, add a few different movements like the ones above to help vary the load that is given to your pelvic floor. If you don’t have a running routine and tend to be more spontaneous or only run a few days a week, you may wish to set aside 15 to 30 minutes twice a week to do core and pelvic floor-focused exercises, like in my program Restore Your Core®.

Summing up

If you’re a runner, you need to make sure that you’re attending to your pelvic floor health. The forces that running exerts on your body are positive in many ways–increased cardiovascular health, a sense of well-being, less likelihood of developing some diseases. However, those same forces take a toll on your body. If you’re experiencing any kind of pelvic pain, low back pain, hip pain, or difficulty with any bodily functions related to your pelvic organs, running is likely playing some part in those issues. Seek help from your healthcare provider when you first begin noticing those symptoms–sure, a little leaking if you’ve been coughing for two weeks is ok. But leaking every time you go out for a run is not. Just because many other runners might complain about the same symptoms does not mean that those symptoms need to be your normal. I hope that you feel empowered to take ownership of your body and your pelvic health, so that you can keep running for many years to come. My private Facebook group is a great place to find some of that community.

FAQ: Pelvic Floor Health for Runners

1. What are the best low-impact exercises to complement running for pelvic floor health?

Swimming: Offers a full-body workout with minimal impact on the pelvic floor.
Cycling: Provides cardiovascular benefits without the jarring impact of running.
Yoga and Pilates: Enhances flexibility and strengthens the core and pelvic floor muscles.
Walking: A gentle alternative to running that still offers cardiovascular benefits.
Cross-country skiing: A low-impact full-body workout that challenges your core, boosts cardiovascular health and stamina, and enhances balance, coordination, and mobility.

2. Are there specific running shoes that help reduce the impact on the pelvic floor?

While no shoe is designed explicitly for pelvic floor protection, cushioned running shoes with good shock absorption can help reduce the overall impact on the body, including the pelvic floor. Ideally, your body will be able to run using a zero-drop running shoe with a wide footbed. The amount of cushioning you’ll need depends on your body. Consulting with a specialist for gait analysis may help you find the right shoe.

3. Is it safe to continue running if I have mild pelvic floor discomfort?

It depends on the severity and cause of the discomfort. If the discomfort is mild and doesn’t worsen with running, you may continue but monitor your symptoms closely. Consult a healthcare professional (e.g., a pelvic floor physical therapist) to ensure that running won’t exacerbate the condition. Consider incorporating low-impact exercises and pelvic floor exercises to support your recovery.

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

Core strength is crucial for stabilizing the pelvis and supporting the pelvic floor during running. A strong and functional core helps distribute the forces exerted during running, reducing the strain on the pelvic floor muscles. Good core strength helps manage intra-abdominal pressure, which can prevent excessive downward force on the pelvic floor. Weak core muscles can lead to compensatory patterns that place additional stress on the pelvic floor, potentially worsening or contributing to pelvic floor disorders.

5. How can I modify my running form to reduce stress on the pelvic floor?

Shorten your stride: A shorter stride can reduce the impact on your pelvic floor.
Increase your cadence: Aim for a higher step frequency (around 170-180 steps per minute) to minimize ground impact forces.
Train your core to engage reflexively: Your core muscles will be engaged throughout your run to provide better support for your pelvic floor.
Maintain a neutral pelvis: Avoid excessive forward or backward tilting of the pelvis, which can place additional stress on the pelvic floor.

6. How often should I incorporate pelvic floor exercises into my running routine?

Ideally, pelvic floor exercises should be done daily, especially if you have symptoms of pelvic floor dysfunction. Consistency is key: regular pelvic floor exercises can help prevent and manage pelvic floor issues related to running.

How Running and Pelvic Floor Health Are Interconnected: What Every Runner Should Know

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