Whether it’s a small leak or a full pee, urinating on yourself in the middle of a run is no fun. However, crossing the finish line with an empty bladder is far more common than you might think. Running is a high-impact activity that significantly increases the stress on the bladder, and even professional runners experience leakage when pushing hard in a race. This condition, known as stress urinary incontinence (SUI), can often be managed with a simple solution: training the pelvic floor.
SUI is involuntarily urine leakage (without the urge to pee) during activities that increase intra-abdominal pressure (IAP), such as coughing, laughing, sneezing, lifting or exercising. Repeated ground impact and abdominal contractions place greater demand on the pelvic floor muscles. If these muscles are untrained, they may be weak and give out, leading to unexpected urine leakage. For some individuals, particularly young women experiencing stress, untrained pelvic floor muscles can lead to excessive tension, which can also can cause leaks due to poor motor control of the sphincters.
Pelvic floor dysfunction isn’t just linked to pregnancy, childbirth or chronic constipation. A 2020 study found that urinary incontinence (UI) is most common in those over 60 (23 to 32 per cent), but noted that “in athletes, the prevalence [of urinary incontinence] is higher, especially in high-impact training and gravity sports.”
Another study from 2022 assessed 211 female and 128 male elite track and field athletes, showing a much higher prevalence in women (51.7 per cent) than men (18.8 per cent). Of the 211 female subjects, 70 struggled specifically with SUI, while the males primarily struggled with urgency-related incontinence. UI was determined to be especially frequent in middle-distance runners, alongside athletes specializing in horizontal jumps, sprints and hurdles.
So, with this added stress on their pelvic floor, do runners regularly train their pelvic floor muscles? The unfortunate answer: no. There is a noticeable gap when it comes to education around SUI and regular training involving pelvic floor muscles. There’s a clear psychological factor–finishing a race with a visible stain on the front of your shorts is tough to own. Pads and absorbent garments can be worn to absorb urine, but that’s just a temporary solution.
Do pelvic floor exercises work?
I used to be surprised by how often my teammates admitted to peeing themselves during races. At first, I thought it wasn’t normal, but I soon realized how common it is among runners at all levels–recreational, collegiate or elite level. I started wondering why I wasn’t peeing myself in a tough races–was I not pushing hard enough?
This made me realize the importance of controlling the pelvic floor muscles. Because of a serious groin injury from running, my physiotherapist prescribed pelvic floor exercises when I was just 17–and I’m convinced that skill has kept me from experiencing bladder leakage years later. Research has also shown that training the pelvic floor muscles can be up to 69 per cent effective in curing SUI.
SUI in running is a taboo topic; more education and standardized pelvic floor training should be prioritized at all levels of competition.
Pelvic floor exercises
Kegels are the simplest, yet most essential pelvic floor movement. Finding your pelvic floor muscles is the hardest part, but once you get that first step down, these exercises come easily–and you can do Kegels anytime, anywhere.
Your pelvic floor muscles are the muscles you would use to stop the flow of urine mid-stream. While sitting or lying down, contract these muscles by squeezing and lifting–you can even place your fingers firmly on the front of your lower abdomen, slightly above your pubic bone, to feel these muscles shift. Hold for three to five seconds, then relax; repeat 10 to 15 times.
Other beneficial exercises include pelvic tilts, bird-dog, bridges and squats.
Pelvic floor physiotherapy
While some general physiotherapists offer pelvic floor treatment/exercises, you may need to find a pelvic floor specialist for a more in-depth training plan.
