Prevent Leaking While Running: Pelvic Floor Solutions
Stress urinary incontinence, or leaking with exercise such as running or jumping, or even with laughing, coughing, or sneezing, has often been marketed as a normal badge of motherhood. If you have a baby, you are going to pee when you sneeze.
Common fixes include accepting that this is part of motherhood, wearing black leggings for workouts, or using a pad. These are not fixes. They are ways of ignoring the issue.
Leaking urine while you exercise or sneeze is not something to be embarrassed about because it can be common. Research suggests that a significant percentage of women experience urinary leakage with exercise after birth. There are a number of changes that occur during pregnancy and in the postpartum period that can increase or decrease the likelihood of leaking.
In this post, we will break down what you can do to prevent leaking while running and other forms of high-impact exercise, and how to overcome it if you are currently experiencing it. It is not something to be ashamed of, but it is also not something you need to live with.
Understanding Stress Urinary Incontinence
First, it is important to understand what stress urinary incontinence actually is and why it may be happening.
Stress urinary incontinence occurs when you leak urine with increased stress on the system. This can happen during high-impact activities like running or jumping, or during activities that increase pressure within the abdominal cavity such as lifting heavy weights, sneezing, or laughing.
Leaking can occur if the pelvic floor is not able to effectively close around the urethral sphincter during these moments of increased demand. However, this is not always purely a strength issue. In many cases, it is a coordination issue.
The pelvic floor is meant to be dynamic and responsive to movement and pressure changes. If you are constantly clenching your pelvic floor in an attempt to prevent leaking, it can reduce its ability to respond appropriately when you actually need it to. The pelvic floor should be able to lengthen and contract based on the demands placed on it.
Because of this, the solution can be more complex than simply doing more Kegels or trying to hold tension all day.
The Pelvic Floor is Responsive and Anticipatory
The pelvic floor is part of your deep core system. This system includes the diaphragm at the top, the multifidus along the spine, the transverse abdominis and internal obliques around the sides and front, and the pelvic floor at the bottom.
This deep core system is anticipatory, meaning it prepares for movement that it predicts is about to happen.
When you are running or jumping, the pelvic floor works together with the rest of the core to prepare for the impact of each stride or landing. This requires coordination with the entire system. It does not function in isolation.
This system is also responsible for pressure management. It regulates pressure within the thoracic and abdominal cavities to support breathing and stabilize the spine and torso. The entire body anchors on this core canister for stability, which means it is essential that this system is functioning well.
There are two key ways to think about how the pelvic floor functions within this system to manage pressure and prevent leaking.
1) Pelvic Floor Lengthening with Inhalation
The pelvic floor lengthens during inhalation as part of pressure management.
When you inhale, the diaphragm flattens and moves downward, which increases pressure in the abdominal cavity. The pelvic floor responds by lengthening and eccentrically loading.
This lengthening is necessary because it allows the pelvic floor to gather elastic energy that contributes to a stronger contraction during exhalation.
If the pelvic floor does not lengthen effectively, the contraction will be weaker.
A helpful analogy is a rubber band. If you stretch a rubber band fully and then release it, it will snap back with more force. If you only stretch it halfway, the recoil is weaker.
The same concept applies to the pelvic floor. If you are constantly clenching and preventing it from lengthening, you reduce its ability to generate force when you need it, such as during running or high-impact activity.
2) Pelvic Floor Changes with Stance and Movemen
The pelvic floor also changes tension based on which leg you are standing on or landing on during running.
The pelvic floor attaches to the pelvis, so changes in pelvic position directly impact pelvic floor tension.
When you are in a stance position, the leg that is on the ground is your stance leg. The pelvis on that side moves into internal rotation and adduction to stabilize. This results in changes in pelvic floor tension, including shortening of the anterior pelvic floor on that side and changes in the posterior pelvic floor on the opposite side.
This shifting helps support closure around the urethra, which is located toward the front of the pelvic floor.
As you switch legs during running, the pelvic floor should alternate tension in a diagonal pattern.
If there is uneven tension in the pelvic floor, which is commonly seen as increased tension in the right anterior pelvic floor and left posterior pelvic floor, it can limit the ability to shift tension effectively with each stride. This can contribute to leaking.
Improving Pelvic Floor Balance
One of the first steps is improving pelvic floor balance.
This includes releasing areas of excessive tension and strengthening the muscles that help position the pelvis more effectively.
This may include:
- Offloading the right anterior pelvic floor
- Releasing the left posterior pelvic floor, and potentially the entire posterior pelvic floor
- Strengthening the right glute and quad to support external rotation and abduction
- Strengthening the left inner thigh and hamstring to support internal rotation and adduction
In our mobility flow, we walk through movements that support this balance.
We start with back expansion breathing to release the posterior pelvic floor and reduce excessive spinal extension. If you are consistently in an extended position, it can increase tension in the posterior pelvic floor and lengthen the anterior pelvic floor. If the anterior pelvic floor is overly lengthened, it can be harder to contract and close around the urethra.
We then move into anterior pelvic floor release work with lateral hip shifts and adductor rock backs. These movements help reduce overactivity in the right groin and inner thigh, which can contribute to excessive tension in the right anterior pelvic floor. If this area cannot relax, it may fatigue more quickly and contribute to leaking or discomfort.
From there, we progress into upright positions to release both the posterior and anterior pelvic floor in standing positions, which translates more directly to running. This includes standing hip shifts to feel a stretch in the deep glute and posterior pelvic floor, followed by lateral hip shifts to target the anterior pelvic floor.
Finding balance in the pelvic floor improves its ability to function effectively during movement.
The Role of Hip Strength
The pelvic floor is often the victim, not the primary problem.
The hips play a significant role in supporting pelvic floor function. If the surrounding musculature is not doing its job, the pelvic floor may compensate.
The hip needs to be able to move effectively in multiple directions:
- Extension, which is reaching the leg back
- Flexion, which is bringing the knee toward the chest
- Abduction, which is moving the leg away from midline
- Adduction, which is bringing the leg toward midline
- External rotation, where the knee moves outward and the ankle moves inward
- Internal rotation, where the knee moves inward and the ankle moves outward
In addition to hip movement, the pelvis itself needs to be able to internally and externally rotate over the femur.
If you include exercises that target each of these movements, you can improve the strength and coordination of the hip musculature to better support the pelvic floor.
Sagittal plane movements such as squats, lunges, and deadlifts target hip flexion and extension. Hinge movements are especially important for targeting the hamstrings.
Frontal plane movements such as lateral band walks and adduction work target side-to-side stability, which is essential for single-leg activities like running.
Rotational movements include both open-chain and closed-chain variations. Open-chain movements involve the femur moving on the pelvis, such as during the swing phase of running. Closed-chain movements involve the pelvis moving on the femur, such as during the stance phase.
You need both.
When these movement patterns are trained effectively, the surrounding musculature supports the pelvic floor so it does not have to compensate.
This is why our prenatal, postpartum, and Beyond Postpartum programs include all of these movement patterns. Our programs are known for their accessory work and for helping people feel better in their bodies because of it.
Running Mechanics That Impact Leaking
How you run can directly support or challenge your pelvic floor.
Your rib cage position matters. If you are running in a more extended position, it increases pressure on the anterior pelvic floor and lengthens it excessively. This makes it harder for the pelvic floor to contract effectively. Finding a more neutral position, where your rib cage is stacked over your pelvis, can improve how pressure is distributed.
Rotation also matters. Running is a rotational activity. If you limit rotation, such as when running with a stroller, you may reduce rotation through the rib cage and pelvis. This can impact how the pelvic floor shifts tension between strides.
You can think about bringing your hand toward the opposite shoulder and then toward the same-side hip to encourage rotation, making sure that your arm swings both forward and backward.
Stride length also plays a role. A very short stride can increase vertical oscillation, which increases pressure on the pelvic floor. Increasing your stride length can help reduce this excessive bouncing. Running faster can also naturally increase stride length, and if you are not able to sustain faster running, you can use run-walk intervals to build up your capacity.
Additional Strategies to Prevent Leaking
If you notice leaking with coughing or sneezing, you can try adjusting your stance by placing one foot slightly behind the other, which can help shift pelvic floor tension and improve pressure management.
You can also try external support by applying gentle pressure to the perineum with your hand or a soft object.
If you are experiencing persistent leaking or a feeling of heaviness, it is important to rule out medical concerns such as a urinary tract infection or other conditions related to the bladder or urethra.
Working with a pelvic floor physical therapist or occupational therapist can be extremely helpful for individualized assessment and support. If your sessions are only focused on passive treatment or isolated Kegels without addressing movement and coordination, it may be worth finding a provider who takes a more comprehensive approach.
You can find a pelvic floor therapist through pelvicrehab.com or work with our physical therapy team virtually or in person at hayleykavapt.com.
You Do Not Have to Live With Leaking
Leaking may be common, but it is not something you need to accept as your normal.
When you address pelvic floor coordination, pressure management, hip strength, and running mechanics together, you can significantly improve how your body responds to impact and load.
If you are looking for guidance, our prenatal, postpartum, and Beyond Postpartum programs are designed to support this full system. We do not just focus on isolated pelvic floor exercises. We train your body as a whole so that your pelvic floor can function the way it was designed to.