10 tips for preventing leaks during long-distance runs

April is a big month for runners in many senses – not only is it traditionally when our London marathon is held but that post-Easter chocolate-induced resolution to get fit, lose weight and get ready for summer boosts us to get moving.

Running provides a relatively cheap way to get active and for many it provides more than physical activity – delivering an escape from the everyday and much needed headspace to cope with the demands of our busy lives.

Sounds great doesn’t it…but how does your pelvic floor feel about it? 

Studies into the effect of marathon running on our pelvic floor are relatively few but studies range between saying just over 30% of non-professional female marathon runners experience stress urinary incontinence (SUI)[1]and 50%[2]of active women.  So at least 1 in every 3 female runners, if not every 1 in 2 will experience pelvic floor issues at some point.  Eeek!

When women experience incontinence they reduce their activity levels, around half resort to using pads and many are simply unaware of available treatment2

Isn’t it just women who’ve had babies that get stress incontinence you may wonder?

Well no.  Women who haven’t had children and even elite athletes may also encounter SUI.  The amount & type of training you do has a direct effect on potential pelvic floor dysfunction with high impact activity having an almost 5-fold impact on incontinence symptoms[3].

It’s not reserved for older women either, as SUI in early life is a strong predictor for incontinence in later life[4].

So incontinence does not discriminate – between women who have & have not had children, between recreational runners & elite athletes, between young and old.

What does that mean for your running practice?

Running is not the ideal activity for those with any form of pelvic floor dysfunction – in fact it is notsomething I’d advocate without female health physiotherapy assessment & treatment, range of alternative supporting treatments & a graduated return to running programme.

Why?

Running is a high-impact sport – the degree of impact depends on a number of factors including your gait, foot pattern on impact, speed of running[5], terrain, duration & more.

The pelvic floor feels the force of that impact on EVERY step; and for those with existing pelvic floor issues, running has potential to make things worse.

Whilst I wouldn’t advocate or endorse running with pelvic floor issues, I appreciate that for some, not running is an inconceivable idea. 

So here are my tips to attempt to manage the impact on your pelvic floor:

  1.  Seek the support and advice of a female health physiotherapist.

Where dysfunction exists it’s important to understand the type and scale of issue affecting You and treat it specifically.  It’s not always just about lift & squeeze.  

A female health physio can support your understanding using biofeedback and advise on suitability of at-home support trainers such as Elvie or pessaries/continence devices to support your pelvic floor during your run.

  1. Include other forms of training in your plan to support your desire to run.

Programmes such as those offered by Holistic Core Restore® coaches such as myself[6], coach you to manage the pressure within your abdomen for everyday occurences such as coughs, laughs and sneezes as well as building your core & floor strength and fitness for movement.

3. Invest in supportive footwear

If your trainers have been around for more than a year, it’s worth investing in care for your feet and pelvic floor. Talking to specialist running shoe specialists can ensure a good fit with the right support

4.  Choose appropriate clothing:

such as EVB shorts (evbsport.com) which will keep you feeling comfortable and supported during your run

5.  Vary the terrain you run on:

Opt for surfaces with a little more give (such as grass) wherever possible

6.  Build your distances gradually

Those running longer distances may notice that it’s towards the end of their run that “issues” start to occur1. Work to where your energy levels (and pelvic floor) are on any particular day and stop if it doesn’t feel right for You.

7.  Listen to your body

A medal for completing a run is pretty shallow if your confidence has been robbed by the incontinence it has caused.  Be aware of when symptoms occur and back off from there to manage your training without symptoms.

8.  It's not just about your pelvic floor

Support your pelvic floor through your nutrition and lifestyle –alignment, constipation, hydration & body weight all have an effect.

9.  Get sufficient good quality sleep

If you’re not sleeping well then your pelvic floor isn’t getting chance to recover either. Check in with your energy levels (and pelvic floor) at the start of every activity session.

10.  Increase your body awareness

Are you holding your breath for different daily tasks? We can’t treat the pelvic floor in isolation, it needs to be a cohesive part of the whole body, working in tandem with the diaphragm, abdominal wall and alignment.

 

Special considerations for pregnant and post-natal athletes

Pregnancy and post-natal periods are times of exceptional change and pressure on our pelvic floor.  Post-natal period extends far beyond the 6 weeks post-birth that most assume it to be.  Your body takes at least a year to recover from pregnancy and childbirth. 

All of the above applies during these periods but additionally, consideration and care needs to be given to the changing status of your body and pelvic floor during these times.  So whilst some MAY be able to safely return to running without long-term effects within 6 months of childbirth, other people may require much longer.

 

Lisa Gimenez-Codd is a female health & Holistic Core Restore® Coach specialising in supporting women through mindset, movement and nutrition from motherhood to menopause.

[1]Abitteboul et al – Urinary incontinence in non-professional female marathon runners (2015)

[2]Brennand et al – urinary leakage during exercise:problematic activities, adaptive behaviours and interest in treatment for physically active Canadian women (2018)

[3]de Mattos Lourenco et al – Urinary incontinence in female athletes: a systematic review. (2018)

[4]Bo (K) & Sundgot-Borgen Are former female elite athletes more likely to experience urinary incontinence later in life than non-athletes?(2010)

[5]Luginbuehl et al -  Pelvic floor muscle electromyography during different running speeds : an exploratory and reliability study (2016)

[6] https://www.holisticcorerestore.com

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