Top 8 Causes of Incontinence when Running by Fiona Healy

Fiona Healy, Chartered Physiotherapist The Bump Room and Kerry Physiotherapy

About 1 in 3 women will suffer from urinary incontinence in their lifetime, with rates as high as 50% reported amongst active women. Although remarkably common, women should not accept having to wear pads and black leggings every time they go for a run or jump as normal. Help is available for you if you are experiencing urinary incontinence.   

Understanding the reasons why leaking occurs is the first step to help manage the symptoms of urinary incontinence. Some women may have one main contributing factor to their incontinence while another may have many factors. While you might think all incontinence is the same there are many factors influencing continence. Some are simple to address on your own; while with many others, guidance from a women’s health physiotherapist is essential to get the best results.   

Here are some of the top causes:  

1. Weak pelvic floor muscles  

Pelvic floor muscles that are not being exercised regularly get deconditioned and therefore less available to react to the impact running generates in the body; this in turn can cause leaking.  

The NICE guidelines recommend that all women perform a set of 10 slow pelvic floor muscle contractions and 10 fast contractions, three times a day.   

This sounds easy but many women are not sure if they are doing the pelvic floor muscles correctly and some even do the opposite, bearing down on their pelvic floor when trying to do the pelvic floor exercises. An individual assessment with a women’s heath physiotherapist can ensure you are doing your pelvic floor muscles correctly and help you develop strategies to ensure you are consistent with your pelvic floor muscle training. Consistence is key when doing pelvic floor muscle training.  

2. Overactive pelvic floor muscles   

Most women have heard of pelvic floor muscle weakness, but did you know sometimes the pelvic floor muscles can be “switched on” all the time and overactive? This sounds like it is a good thing but when you are running your pelvic floor muscle needs to lengthen just before your heel strikes the ground and then contract to support your bladder as you push off. A muscle that is held tight all the time cannot lengthen and will not be available to prevent leaking on running.  

A women’s health physiotherapist can help you reconnect you to your pelvic floor muscles and diaphragm again. Co-ordinating breathing with movement of the pelvic floor allows your system to respond more effectively to the demands of running.  

3. Sucking in your tummy muscles  

A constantly drawn in, tight waist forces pressure down internally, overwhelming the pelvic floor. When you suck in your tummy muscles on running (or just in your daily activities), you increase the demands on your pelvic floor  

Learning to consciously release and soften your waist (after years of sucking it in) is perhaps the most difficult of all habits to change but can make a huge difference to your pelvic floor muscle performance. Breathing and co-ordination exercises under the guidance of a physiotherapist will help you change this habit and reduce the pressure down on your pelvic floor muscles as you run.  

4. Hormones  

For some women their symptoms of urinary incontinence increase around the time of their period, and this can be due to hormonal shifts in your body. Working on your pelvic floor muscle strength can help to minimise the effects of the hormonal cycle on your incontinence.  

5. Excess weight  

Unfortunately, as women, we carry weight around our tummy. When we run any extra pounds create more force down on our pelvic floor muscles increasing the risk of leaking urine. Losing weight has been shown to reduce urinary incontinence.   

Increasing your walking pace and distance is a great place to start with losing weight and improving your bodies capacity for running. Speak to a physiotherapist to get a specific programme tailored to your fitness and needs.  

6. Constipation or Bloating  

Constipation is a major contributing factor to pelvic floor muscle dysfunction. Chronic straining from constipation can lead to weakening of the pelvic floor muscles. The rectum is very close to the bladder. When the rectum is overfull (due to constipation), it can press on the bladder, reducing the amount of urine the bladder can hold. This may cause you to leak urine or make you feel as if you to need to pass urine right away or frequently  

Monitoring your fluid, fibre, exercise and adopting the correct toileting position will help but, in some cases, constipation can be caused by the pelvic floor muscles not relaxing properly. When we open our bowels the pelvic floor muscles need to lengthen to allow a bowel motion to occur. A tight/non-relaxing muscle can create obstruction to opening your bowels. A women’s health physiotherapist is specifically trained in the assessment of the pelvic floor and is best placed to help you manage a non-relaxing pelvic floor.  

7. Fatigue  

For many women incontinence only occurs after a period running (eg: after 1km). Running generates forces of over 2.5 times your body weight. The repetitive forces overtime can cause incontinence, due to pelvic floor muscle fatigue or even decreased endurance of the leg muscles, which in turn will change your running technique (increasing ground reaction forces and pressure through your body). Your body could benefit from a specific whole body strengthening and endurance programme designed by your chartered physiotherapist to increase your body and pelvic floor’s capacity for running.  

Sometimes your body is just too tired. Maybe you have not got enough sleep recently? This heavily impacts your pelvic floor muscle performance and even your whole body’s ability to cope with the increased demand of running.   

8. You have a post birth injury   

Some women can experience a birth injury during childbirth. This could mean they may need support for the pelvic floor to maintain continence while running. There are many options available including the EVB support short and various types of pessaries, but you would require an individual assessment with a women’s health physiotherapist will evaluate what support if any could benefit your body.  

Common does not mean normal!! If you are experiencing symptoms of urinary incontinence, the best thing you can do to help yourself is book an appointment with a women’s health physiotherapist to assess which factors are contributing to your symptoms and create a plan to get you back enjoying running again. Remember, it is never too late to work on improving your pelvic floor muscles.  

To find a chartered physiotherapist near you visit www.iscp.ie/find-a-physio. A Chartered Physiotherapist is a university graduate with hospital-based training who has comprehensive knowledge of how the body works, along with specialist training in the diagnosis and treatment of muscle and joint pain. When you choose a physiotherapist, you’ll enjoy the peace of mind of knowing that they are a part of Ireland’s only professional body within its field. For more information visit www.iscp.ie