5 Pelvic Floor Facts Every Runner Needs to Know

It’s hard to tell a runner to take it easy. Most of us love running so much that we’ll push through shin splints, knee pain, even a hamstring strain just to make sure we get in our workout. Unfortunately, we'll also put up with pelvic floor dysfunction — including bladder and bowel leaks, pelvic pain, and more — by stocking up on black tights to hide wet spots, or planning our route around public bathrooms to get out in front of the “runner’s trots.”

Alas, just like ignoring aches and pains will often lead to serious injuries that force you to take a break from the trails, ignoring pelvic floor symptoms can bring on more symptoms and even sabotage your running goals. The following cheatsheet will give you the pelvic floor basics and let you know when it's time to see a pelvic floor physical therapist.

1. The pelvic floor is part of your core

Your pelvic floor is the group of muscles, ligaments, and tissues that form a hammock of support at the base of the pelvis. It consists of several layers that act as a foundation for the pelvic organs — including the bladder, uterus, and rectum — and provide stability to the pelvic ring.

The pelvic floor works synergistically, and in coordination with your abdominal muscles and hip muscles to play a key role in the following:

• Maintaining bowel and bladder function
• Supporting sexual health and function
• Providing stability to the low back and pelvis during movement
• Blood flow and circulation to the pelvic area
• Supporting your breath and regulation of intra abdominal pressure

2. Running challenges your pelvic floor

When compared to walking, your pelvic floor muscles have to work harder (and smarter) when you run, because:

• Your lower body takes on more impact with every stride. Also known as ground reaction force (GRF), each time you land the force of landing travels up your legs and forces your pelvic floor muscles to stabilize more to support your pelvic joints and organs. The ground reaction force can vary based on your running style and how fast you run.
• The demand for lower body balance is greater when you run. As you run, you are basically leaping from one foot to the next, which requires you to land on — and then propel off of — one single foot at a time. That’s a lot of multitasking for your pelvic floor, as well as the rest of your core.

Research shows that when you run, your pelvic floor:

• Involuntarily and reflexively contracts just before and during each of the moments our feet hit the ground. (If you have incontinence, the speed of these contractions can vary).
• The faster you run, the harder your pelvic floor works.

3. Bladder leaks are not the only sign of pelvic floor dysfunction

If you tune in to what is going on in your body during or after your run, there may be some specific symptoms which could actually be your pelvic floor telling you that something is off. The following are symptoms of pelvic floor dysfunction:

Common symptoms to note during, or after your run:

• Bladder or bowel leaks
• A sudden need to pee or poop that can be hard to control (aka urgency)
• Feeling like you need to pee/poop even though you just went (aka frequency)
• Pelvic heaviness/feeling like your vagina might be falling out
• Low back, tailbone, pubic bone, or pelvic pain

Other symptoms you may experience (when you aren’t running):

• Difficulty or pain when you pee
• Constipation/straining to poop
• Pain with vaginal penetration (sex, inserting a tampon)
• Sexual dysfunction (weak, delayed, or painful orgasm)

4. Have Symptoms? You Don't HAve to Stop Running

You wouldn’t likely quit running just because you have knee pain — with proper rehab you can continue running for years to come. Well, the same is true if you have symptoms of pelvic floor dysfunction.

Pelvic floor physical therapy is a highly effective treatment option for improving the strength, endurance, flexibility, and neuromuscular control of the pelvic floor muscles. Along with a comprehensive running rehabilitation program physical therapy will help you get back to your running goals.

That said, if you're having symptoms of pelvic floor muscle dysfunction you may have to modify your training program until your symptoms improve. A pelvic physical therapist will work with you to best do this.

5. Kegels are not the only (or best) way to improve pelvic floor symptoms

Kegels, also known as pelvic floor muscle exercises, are a highly effective way to strengthen weak and underactive pelvic floor muscles. But not everyone who has pelvic floor muscle dysfunction, needs strengthening. Those who have overactive and tight pelvic floor muscles may benefit from focusing more on restoring the flexibility and neuromuscular control of their pelvic floor muscles in order to improve their pelvic symptoms and return to running. (How do you tell which is true for you? See a checklist here.)

But there's much more to think about that how you exercise your pelvic floor. Here are some other strategies that a pelvic floor physical therapist might recommend, depending on your unique situation:

• Adjusting your training program. By adjusting the volume and frequency of running, you can improve the muscle recovery time, and minimize symptoms.
• Running uphill or on an incline. Walk when you get to the downhill part. This can reduce the GRFs that are absorbed by your pelvic floor muscles and ease symptoms.
• Optimizing your running form. Research shows that your foot strike pattern (whether you land on your heels, midfoot, or forefoot when you run) can reduce the GRFs of each stride. Landing on your forefoot or midfoot when running may impact your pelvic floor the least, but adjusting your running form without guidance may leave you at risk or other injury, so make sure you consult with a physical therapist or training running coach.
• Increasing your cadence. Cadence is the number of strides per minute. While not necessarily true for everyone, research shows that sometimes increasing your cadence can reduce your pelvic floor symptoms. Check with your pelvic PT to help you understand if this tip will work for you.
• Investing in new shoes. While a thorough biomechanical assessment is best to determine which specific running shoes are best for you, properly fit running shoes can improve running form and muscle efficiency, and reduce GRFs. When you find your best fit, it is typically recommended to snag a new pair every 300-500 miles as this is when the material is thought to start failing and be less effective.

Running is a fantastic exercise, but it's crucial to understand the impact on your pelvic floor. Strengthening exercises, proper form, and listening to your body are key to maintaining a healthy pelvic floor.

Don't let pelvic floor issues hold you back — check in with a pelvic floor physical therapist at Origin for an evaluation today. Your PT will evaluate your symptoms and pelvic floor muscle function, and assess everything in the context of your running form so that you can get back on track, ASAP.