The Pro’s Guide to Managing Leaking Urine While Running

Understanding urine leakage in runners

The primary type of urine leakage affecting runners is stress urinary incontinence–the involuntary leaking of urine when the pelvic floor experiences a heavy load and is unable to manage it. This leaking can happen due to coughing, sneezing, jumping, etc., but is of higher prevalence in female athletes, especially in high-impact sports such as volleyball, running, and weightlifting.

Other types of urinary incontinence are:

• Urge incontinence: involuntary leaking of urine accompanied by a strong sense of urgency, usually due to overactivity of the tissue that composes much of the bladder (the detrusor). 
• Overflow incontinence: leakage of urine because the bladder is too full, and can be caused by a blockage of the bladder outlet or a lack of tone in the detrusor. 
• Functional incontinence: environmental or physical barriers to toileting that lead to incontinence. 

The science behind urine leakage and running

Because running requires a higher impact than walking, there are many elements that can have a larger impact on the body as a whole and the pelvic floor specifically. 

The running gait cycle consists of the following phases: 

1. Loading: a shock absorption phase from when the foot lands on the heel to a midfoot/flat position
2. Midstance: the shift from shock absorption to forward movement (propulsion), when the forefoot is in contact with the ground
3. Propulsion: toe-off, pushing the body forward
4. Initial swing/Float phase 1: after toe-off, the phase where the foot begins to swing back, with both feet off the ground
5. Terminal swing/Float phase 2: completion of the movement, with the opposite foot preparing to land.

The single-leg impact nature of running requires the runner to manage both balance and force, to a much greater extent than with walking. The pelvic floor must also support the increased forces of running. High-impact activities, in general, exacerbate urine leakage by placing loads on the pelvic floor that exceed what the pelvic floor muscles are capable of withstanding. Athletes who participate in high-impact sports tend to have overactive pelvic floor muscles, often in response to the demands the sport places on the body. Part of the function of the pelvic floor muscles is to manage intra-abdominal pressure in conjunction with the rest of the core system. When an event, such as a run or a weightlifting PR, causes an increase in intra-abdominal pressure, leaking can occur.

A further contributing factor to leaking during running, in particular, may be an overall alignment of the body. If a runner leans backward while running instead of leaning slightly forward, the pelvis is unable to adequately support the weight of the torso as the runner moves. The foot lands too far ahead of the center of mass, and the force of impact is much higher than if the foot lands below the center of mass. This restriction of movement in the pelvis also affects the upper body and core; a lack of pelvic stability may inhibit a runner’s access to an effective contralateral arm swing, and may also affect their ability to engage their core, diaphragm, and pelvic floor effectively.

Screening and identifying at-risk clients

Ideally, your intake process should include a few questions directly addressing pelvic floor function, such as the following:

• Have you ever leaked urine while running, or felt an uncontrollable urge to urinate while running?
• Have you given birth? If so, what was your birthing and recovery process like?
• Do you find that your underwear or shorts are damp with urine after a run?
• Do you often feel like you have “tight hips”?
• Do you have any issues such as constipation or difficulty emptying your bladder?
• Do you experience pain during or after intercourse?

Of course, not every pro in every situation can be so direct, but we can make it easier for our clients to talk about these issues by modeling direct, shame-free, compassionate language. Let’s normalize conversations about bodily functions when we’re working with people’s bodies. If your client is reluctant to discuss these kinds of questions, you can also look for the following as you assess them:

• What’s their posture like as they run? Do they lean forward or backward? Is one hip dropping more than the other? Do they have good upper body control?
• Where are the parts of their body that do seem to be routinely tight or problematic? 
• How do they describe their routines around running? Listen for stories about needing to make a lot of pit stops, wear incontinence pads, or change clothes during training or races.
• What other activities do they engage in? Are there particular activities they avoid (e.g., jumping on trampolines), and why?

Once you have a sense of whether your client is leaking and why, it’s time to work on some strategies. It is always a good idea to refer your client to a pelvic health specialist for any diagnosis or strategies (such as internal pelvic muscle release) that may be out of your scope of practice. But there’s plenty you can work on right away.