My Overactive Pelvic Floor Almost Derailed My Training. Here’s How I Got Ahead of the Symptoms With Expert Help.
Jinxing is real. Just last week, I touted how I’ve been breezing through my workouts. But this week, I’m speed-dialing a pelvic floor specialist.
I’m not experiencing an injury per se, as I’m not suffering pain that interferes with my runs, but the increase in my mileage has led to an experience I wish my body wasn’t familiar with: urinary retention. When I sit down on a toilet to pee, I’m only able to empty my bladder halfway—unless I force the rest out, which is a poor solution because “power peeing” strains pelvic floor muscles instead of relaxing them.
Once the pelvic floor muscles stop operating properly, other issues can arise, interfering with bowel movements and gas passing, causing bloating, or, for example, the very common urine leakage.
I experienced this issue two years ago when I significantly upped my mileage, and while the first time around I couldn’t connect it to running with certainty, now I’m more confident there is a link. Is running the culprit, though?
“The body is meant to run; it’s meant to jump; it’s meant to lift and all the things,” says Jennifer Perna, PT, DPT, a founder of Vivid, women’s health clinics in Bucks County, Pennsylvania. “The issue is when the capacity of your body can’t sustain the task; the task is too high of a demand for what your body is capable of doing right now —doesn’t mean forever, just at this moment in time.”
Due to being such a high-impact activity, running can exacerbate underlying issues. “Your pelvic floor is not meant to stabilize you; your pelvic floor is meant to keep you fit,” Perna says. “There’s probably a compensation happening somewhere—maybe your glutes; it could even be all the way down to your feet—where those muscles are not doing their job. And so your pelvic floor is reflexively trying to grip to give your body some stability as you’re running, and then your pelvic floor can’t let go because it’s almost in spasm at that point because you’ve stressed it so much.”
With these spasms, my pelvic floor is overactive, causing urine retention, but the issue can go either way; the pelvic floor muscles can be too tight (hypertonic), too weak (hypotonic), or uncoordinated. “Running is one of the things where the pendulum can swing either direction,” Perna says. On the opposite end of my issue is muscle weakness, which can lead to urine leakage from the pressure of the feet striking the ground that the body cannot counterbalance. While leaking is definitely common, it’s not normal and should also be treated.
Any of these problems, though, often originates elsewhere in your body. When other muscles don’t do what they’re supposed to, it’s the pelvic floor that picks up the slack. “A lot of times, what we’ll actually find is that patients who have foot weakness, calf weakness, glute weakness, or core weakness end up overloading their pelvic floor so much during the run that they hit this threshold and their pelvic floor just gives way—and that’s when they start leaking or developing pain,” Perna says.
Now That the Problem Is Here, What Do I Do?
Being in the middle of a training block where my weekly mileage is still rising, there is no way to reduce the impact my pelvic floor is experiencing. All the more, I have to focus on what I can do when I am done running.
“The first thing is we want to make sure that we have an appropriate relaxation slash down-regulation protocol after your run,” Perna says. Doing relaxation exercises right after a workout, when you put all that pressure on your pelvic floor, is the most effective way, she adds.
- Perna recommends doing yoga poses, like happy baby, child’s pose, and pigeon—with the last pose, the focus should be on the hip of your front leg, which is closer to your pelvic floor at that moment, rather than the back leg and hip.
- Working on diaphragmatic breathing is always a good idea, but especially when trying to help the pelvic floor relax; it involves engaging the abdominal muscles and diaphragm rather than your chest, allowing your pelvic floor to let go of tension and lengthen.
- Last is the thing I personally struggle to implement the most, but understand as vital for my body. “Strength training is just as important as running,” Perna says. “Especially the single-leg work, the lifting of the weights, those are all so important because they’re working the compensatory muscles that your pelvic floor is compensating for.” Perna recommends including squats, lunges, and hinges in the routine. “They’re wonderful for runners because they’re going to work on the leg muscles so that when you go to run, those muscles are still really strong so that your pelvic floor doesn’t have to do all the work.”
While practicing these habits is generally beneficial for anyone, they may not counterbalance the damage completely. If symptoms continue, you may need more personalized help. “If that doesn’t work, then you need to see a specialist for sure,” Perna says.
Should I Change How I Run?
Since some of the damage happens on the run itself, I wondered if there is anything I should be mindful of during the run itself to support my pelvic floor better, but Perna quickly dismantled that thought.
“You can’t squeeze your pelvic floor as you’re running,” she says. “If you’re noticing that either you’re getting pain in your body or you’re feeling just something is off, take a break, step to the side, try to do maybe a couple standing fire hydrants where you bend your knee and push it into a wall—find a telephone pole, push your knee out into the telephone pole, do a couple second holds, maybe five on each side.” After that, try to return to running and see if the symptoms lessen. “A lot of times I see that it’s just disengagement with the right muscles: they just start getting tired, and so your body starts getting lazy, and it goes to the habits that it knows—your body knows to turn on the pelvic floor. So we just have to tell your body, ‘let’s try something different.’”
As Perna mentioned, the problems your pelvic floor ends up dealing with can stem from the weakness of other muscles, so if there is anything you should focus on while running, it’s your form and potential misalignment. Runner’s World recently published The Runner’s World Guide to Running Form, which includes tips and real-life examples of runners whose form may be interfering not only with their potential but also lead to injuries.
Can I Prevent the Issue From Happening?
All of us—and women especially—may be exacerbating pelvic floor issues with day-to-day habits we may not think twice about. Here are some things Perna says to keep in mind that could contribute to future issues:
- Sucking your belly in: When you do that, you give the belly or pelvic floor nowhere to go but out, and you start losing control of the muscles as a result.
- Waiting to pee: Holding it and not going to the bathroom for too long can strain the pelvic floor muscles and make them overactive.
- Peeing too often: A lot of just-in-case peeing without a natural urge strains and weakens your pelvic floor muscles as well.
- Hovering over a toilet: While sometimes inevitable, like in public restrooms, it doesn’t allow your pelvic floor to relax all the way.
- Not drinking enough water: Liquids help ensure our bowels and bladders move waste properly through the body.
- Stress: Your pelvic floor is the first muscle that kicks in when you’re stressed, so don’t underestimate good mental health hygiene.
Could It Be ... the Shoes?
One of the questions Perna asked me—which came as a surprise—was whether I had recently started wearing new running shoes. “If these symptoms came on suddenly, and the only thing you changed is your shoes, don’t discount that the change may be affecting your pelvic floor,” she says. “The foot is the first thing that strikes the ground, and if that’s not giving good stability or it’s giving too much stability and you don’t have any muscle activation because your shoe is so stable, now the rest of the body has to do so much more work.”
It’s important to remember that it all depends on the person’s body: the same shoe that could cause issues for one person doesn’t necessarily have to be a problem for someone else.
Bottom Line
Because I test shoes for Runner’s World, I don’t run in the same pair consecutively, so my issue doesn’t come from my feet.
It very likely stems from my running form. During my form evaluation a few weeks back, Heather Milton, the clinical exercise physiologist, pointed out how much rotation I have in my torso and arms, which is a telltale sign of decreased hip and deep core muscle strength. My right hip also drops when I am on my left leg disproportionately more than my left hip does when I am on my right. ”Not only does that make it harder to absorb the increased impact forces from [your] overstriding but also can contribute to other injuries,” Milton said.
During this half marathon training block, I’ve been strength-training once a week, trying to find a practice I’d actually enjoy, so I could keep doing it even after the training is over.
Aren’t runners funny? It’s thanks to injuries that we often do what we know is good for us. My prerun routine has included a warmup ever since I was dealing with shin splints a few years ago; now I’ve added a postrun yoga to my actual cooldown; in between, I’m finally committing to the strength training I should have been doing all along. Hopefully, all that will make my pelvic floor happier.
Pavlína Černá, an RRCA-certified run coach and cycling enthusiast, has been with Runner’s World, Bicycling, and Popular Mechanics since August 2021. When she doesn’t edit, she writes; when she doesn’t write, she reads or translates. In whatever time she has left, you can find her outside running, riding, or roller-skating to the beat of one of the many audiobooks on her TBL list.