The MamasteFit Podcast Episode 153 – Leaking When You Run? Postpartum Stress Urinary Incontinence

Gina: Welcome to the MamasteFit Podcast. In this episode, we are going to be talking all about postpartum stress urinary incontinence, so essentially leaking urine or pee when you are running, jumping, or even lifting weights. We’re going to talk about some quick fixes, so things that you can do to find relief relatively quickly, in addition to some long-term fixes of things that you can do over time to help resolve this issue altogether- plus some considerations for when maybe it isn’t an orthopedic or pelvic floor issue, where you want to seek additional care with your provider. 

Welcome to the MamasteFit Podcast. Leaking pee as you run and jump and exercise is one of those things that is sometimes viewed as this badge of motherhood, or this badge of honor in motherhood where it’s just one of those things that happens, and we just are all going to laugh about it and just accept that this is our fate as moms. And it’s important to note that if you do leak urine when you exercise or really any other point, it’s not something to be ashamed of, but know that it doesn’t have to be something that you live with by any means. And I’ll occasionally see either on social media or even in real life, like IRL, where someone makes a joke about, “Oh, like I pee because of you,” I think it’s like the Kelly Clarkson, well, it’s not her song, but they’ll be like, “Mom, why do you always cross your legs when you laugh?” or, “Why can’t you jump on the trampoline with us?” and it’s like the Kelly Clarkson song of, “Because of You!”  

Roxanne: I have not seen that, but that’s hilarious. 

Gina: But she, she’s obviously not singing about that. Or folks will make like jokes about how they can’t jump on trampolines because like they pee, and they like, LOL. Or it’s, “Oh…” 

Roxanne: “Make sure you wear your black leggings!” 

Gina: “I ran this race, and…” Yeah. And so it, it becomes very normalized that this is just something that happens, and we just suffer with it. 

And again, I don’t want anyone to feel ashamed if they do have stress urinary incontinence, like it’s not something to be ashamed of. But know that it doesn’t have to be something that you suffer through either. 

Roxanne: Or just live with.  

Gina: There are things that we can do to help improve your quality of life, because having stress urinary incontinence during pregnancy or in the postpartum could potentially impact you long-term as well. So we want to make sure that we’re doing things to help support that. 

So what can cause stress urinary incontinence, or essentially leaking with like high demand activity, or even just high pressure activities? 

So this can be the typical things like running, jumping, even weightlifting, which you may not be like jumping in the middle of your squat or your deadlift, but it is really high pressure, and so depending on the amount of pressure that you’re generating, you may see you may pee a little bit, or a lot of bit, and so you may see some like high level like power lifters- or maybe not even high level athletes, but athletes that are lifting very heavy weights for themselves- I usually see it more in like the sumo squat where they’ll be like peeing on the floor a little bit. You also can have it with coughing, laughing, sneezing, so these are all things that are generating a lot of pressure within the abdominal cavity. 

And so your pelvic floor has a bunch of different functions to help prevent that, and one of them is it supports the pelvic organs and it helps with sphincter control. So it Contracts around the sphincters to keep stuff in, and then it releases to let all that stuff out. So if the pelvic floor is not strong enough to contract around and compress around the sphincters to keep them from leaking, or it’s not coordinated with the rest of the system, this is what can cause some of that peeing a little bit whenever you have these high level activities. And that by itself feels really simplistic, but understanding that the pelvic floor is not always the problem, I think is a really good place to start as well. It’s usually like the victim of other things that are not working well. And so when it comes specifically to running, when we are running, we are bounding from leg to leg, like we are jumping from one leg to the other leg, and there’s a lot of shock absorption that needs to happen with each stride that you take. So your foot lands on the floor, then we have to absorb that force through the ankle, through the calf, through the knee, all the way up through the hip, and then continuing through the upper body. And then we’re going to bound to the other leg, and we have that same kind of transfer force throughout the entire body. And so if we are noticing leaking with our running or jumping, or those high impact activities, it could be that the pelvic floor is quote unquote “weak,” but it could also be that something along that line of shock absorption is not working well, and we’re having to compensate and the pelvic floor is taking on more load than it needs to do. So you can almost think about the pelvic floor is not the problem, but the victim and essentially like we’re all on this group project and the pelvic floor is doing everything that other people are supposed to be doing. And that’s where we’re seeing the symptoms in the pelvic floor.

Roxanne: So this could be why someone may be leaking in certain activities, but not other activities because based off of the movement that they’re using, they’re compensating maybe more in other movements and not certain movements. So like you may have the ability to do running and do it appropriately, like the appropriate pressure and whatever on your legs, not utilizing the pelvic floor as like your crutch. Whereas in other movements, you may not be able to do those movements as well, so your pelvic floor is taking more of that control and unfortunately being the victim. So it could be why jumping on a trampoline, or double unders, or jump roping could be harder for people and more likely leading to leaking, whereas running, they have the strength to be able to do that without leaking. 

Gina: So that’s something that I experienced in my own postpartum, I would say like the first maybe year postpartum. So I was running marathons and feeling pretty good at nine months postpartum, like no leaking, no issues. But if I jumped on a trampoline, I would feel like heaviness and almost like I was about to pee, like I didn’t… maybe I did pee a little bit, I don’t know, I could be in denial. But the trampolines would be the thing, and like jumping with two feet would be what would cause more the symptoms for me. But I could bound from leg to leg, just fine.  

Roxanne: Single leg movement, yes. Excellent. Double leg movement, not as well.  

Gina: Two legs together, not great. 

And some of that could be related to the positioning of my pelvis and like kind of the tension within my pelvic floor based on my common patterns, where I could go from leg to leg really easily, but once, like I was more even, it was harder for me. And so I agree that different activities may cause different symptoms for you. 

So let’s talk about what, specifically with running, causes the stress urinary incontinence, or leaking while you run. The first thing, similar to what I was just talking about, is impact mechanics. So how are we landing on each foot? And then this is also going to relate to if you’re jumping, you’re doing double unders, you’re on a trampoline. What happens when you land up through the chain into the pelvic floor, and then past the pelvic floor? How does that load transfer through the body? And so when we have, when we’re jumping, when we’re landing, we are essentially trying to slow down. So we’re trying to decelerate when we land to decrease the force through our body. Now, when I typically jump, or when you typically land from foot to foot, there should be some bending that happens. So when you land, it’s not like landing on like a stiff pole, like we’re going to land and there’s going to be a bend that happens in the ankle, a bend that happens in the knee, a bend that happens in the hip, and then we’re going to extend through that leg as we land on the other foot, and then we bend in the ankle, bend in the knee, bend in the hip. And then we bound from leg to leg. And then same with jumping- if I’m jumping with both feet, when I land, there’s going to be a bend in my ankle, knee and hip. And that is helping to decelerate, so it’s attempting to decrease the impact force on the pelvic floor and the rest of the body. If I jumped with super straight legs and I didn’t have any of that bending happening in my lower body joints… 

Roxanne: It would also hurt. 

Gina: It would, one, it would be very uncomfortable, your knees would probably really hurt. But it’s going to increase the impact force as well. And not that running is like getting into a car accident, but the reason why car airbags help to decrease the force in a car accident is because it’s slowing you down. So the amount of time that it takes you to cross a distance is going to decrease the impact force. And so when I land on a foot while I’m running or while I’m jumping, if I can essentially increase the time it takes for that impact to hit my pelvic floor, it’s going to decrease the amount of force being put on the pelvic floor. 

The first is: how are we impacting, what is our impact mechanics like, as we stride from leg to leg, or while we jump? Do we have good shock absorption and good mobility through all of the joints, up the body into the pelvis? And are we compensating anywhere? So if you have really stiff ankles, that’s going to impact how the force is distributed from the foot into the lower leg. If you are not moving your knee well, or you’re keeping it super straight, or depending on where you land in your stride, we could be putting more force through the knee, which again is going to transfer up through the body. We want to have better kind of distribution of that force through the lower body before we hit the pelvic floor. So folks that have stress urinary incontinence tend to have less ankle mobility, and so there’s more kind of shock being pushed up through the body as opposed to being evenly distributed throughout the different joints than the lower body into the pelvis. 

The next thing is going to be pressure management. So how are we managing pressure within the abdominal cavity? Within the thoracic cavity? So, thoracic cavity is essentially where your lungs are; abdominal cavity is down where your pelvic floor area is. How are we managing the pressure in those two places? 

And so your pelvic floor is a part of your deep core system, so it doesn’t work in isolation, similarly to how every other muscle in your body works as a team with somebody else. Your pelvic floor is the bottom of your core canister. We have the diaphragm on top, which is going to be at the bottom of your ribcage, and this is your prime mover with like pressure management. Around the sides of the abdominal wall, we have the transverse abdominus, sometimes known as your corset abs. If you’ve done any deep core exercise type workouts, they probably say to contract your TA, or engage your TA. Sometimes the internal obliques are included within the deep core system, and then we have them multifidi along the spine. So all of these four to five muscles work together to help with postural control, so they help to keep your spine stable, to keep your positioning however you want it to be, in addition to managing pressure within the abdominal cavity and within the thoracic cavity. So when I inhale, that diaphragm should move down and flatten, which is going to increase pressure within my abdominal cavity, decreasing pressure within the thoracic cavity and this low pressure within the thoracic cavity is what is pulling the air in. Or, that’s the reason why when we inhale it’s low pressure, the air is moving to a place of low pressure. And then when I exhale, if that diaphragm is moving up, which is increasing pressure within the thoracic cavity, decreasing pressure in the abdominal cavity, and high pressure gradient within the lungs is what is pushing that air out, or pulling it out into the atmosphere. So that’s how breathing works. 

Now, if we are breathing in a dysfunctional way- so when I inhale, I’m thrusting up in my rib cage, when I exhale, I’m pushing down- this is going to impact the pressure mechanics and the pressure management within the abdominal cavity. And so, when we’re running, or when we’re jumping, or we’re doing these like high impact kind of dynamic exercises, we don’t necessarily want to be like, “okay, I inhale as I’m in the air and then I exhale as my foot lands,” ’cause that would be like our cadence is probably a little bit faster than our breathing pattern. And so what we want to focus on rather, is just how am I positioning my rib cage so that my diaphragm can move optimally? So if I have a more flared rib cage, or if I’m like really crunched down, typically it’s going to be more flared, this is going to impact the angle of my diaphragm and it’s going to impact how I can manage pressure within my abdominal cavity and how that is coordinated with the rest of the system. 

So the pelvic floor is not meant to be something that I consciously contract and relax all the time. When we are earlier postpartum, or maybe later pregnancy, we may be a little bit more conscious of it as we’re learning to reconnect, but it should eventually become something that you don’t have to think about. It should just be responsive to the system as you bound from leg to leg and as you breathe. And so if we are setting it up in a position that it can work optimally with ribcage maybe a little bit more stacked, with pelvis not necessarily tucked, but everything’s a little bit more stacked- this is going to help you manage pressure more optimally, and that’s going to help to decrease the likelihood of leaking as well. ‘Cause if there’s too much pressure and our exhalations, which is going to involve more of that muscular force, so inhales, we’re increasing pressure by moving that diaphragm down, so there’s this lengthening and energy gathering that’s happening. When I exhale, the abdominal wall, the pelvic floor, and everything is contracting in. So we have that muscular force that’s aiding with stabilization. If I have increased pressure downward, and then I add on muscular force with the exhalation, because my breathing pattern is opposite, this is going to essentially overwhelm the pelvic floor and probably cause it to leak a little bit too with activity. So we don’t necessarily want to think about, “I inhale while I’m in the air and then exhale when I land,” we do want our breathing pattern to be in the appropriate direction so that when these muscles are reflexively contracting, we’re not adding even more pressure and load internally. 

And the last thing that can contribute towards stressing urinary incontinence is your pelvic floor’s capacity. So if I am one week postpartum, my pelvic floor is probably not going to be doing a great job of withstanding that increased pressure. And I noticed it in myself, I’m sure our listeners have noticed it, I’m sure you’ve noticed it, where in my first week postpartum, or maybe even my first like month or two postpartum, anytime I had to blow my nose, I was like, “My pelvic floor is going to fall out.” And so there are some strategies that we can use to help when we have the pelvic floor is just like not there yet. Like it needs time to heal from pregnancy and from birth, regardless if you had a vaginal birth or cesarean birth. And so it’s probably not quite at its capacity at that, in that first like month or two postpartum. 

Roxanne: Yeah. 

Gina: Once we start getting to three or four months postpartum, the capacity for the pelvic floor to do a little bit more and to withstand that pressure, the tissues are getting denser, they’re healing, they’re set up in a more optimal way- then we can start handling more of that load. And that may take some time. So for me, I think I was closer to four to six months postpartum before I was like, “I feel good running,” or moderately good. I was like, “I feel like I am at a good point where I can run and not feel symptomatic. I can’t run very far yet, but I’ll get there eventually.” And now at 18 months postpartum, I really feel like I am capable of doing all the things without having to think about my pelvic floor. Like I can run, I can jump, I can sneeze, I can laugh without having to think about my pelvic floor. I can lift heavy weights! But I didn’t really feel that until, I don’t think I really felt like healed until I was like almost 18 months postpartum. I started to feel more of it probably around like the nine month to 12 month timeframe. And then now I’m like really at a point where I’m like, okay, I really feel like I can push things now with my body, that I have that capability to do so. 

And so if you’re noticing like leaking, or discomfort, or heaviness within the pelvic floor with activity, it could also be that you are just not physically ready yet. Like maybe you’re a week postpartum. Maybe you’re a month postpartum. I think with my first, I was four or five weeks postpartum and I was like, “I’m going to go for a two mile run!”  

Roxanne: Oh my gosh. I remember that.  

Gina: I don’t know why. I had done nothing else. I just thought, I was a collegiate runner, I was running ultra marathons before I gave birth or before, not before I gave birth, before I got pregnant. Surely a two mile run, which used to be like my easy shakeout run in college… 

Roxanne: I remember Gina was like, “I’m going to go for a three mile run. I’m like, “Or not.” 

Gina: Yeah, I made it like a quarter mile. 

Roxanne: Just walk to the end of your street and back!  

Gina: I made it a quarter and I was like, “Ooh. This is a horrible idea. This was a terrible idea.” 

Roxanne: And while pushing a stroller too, not like…  

Gina: No, I was just by myself.  

Roxanne: Oh, okay.  

Gina: I was by myself, thank God! My poor baby whose head is not ready to be in a stroller.  

Roxanne: That’s very true.  

Gina: So if you’re feeling symptomatic within the pelvic floor, it could just be that you are not ready for it yet, too- which can be frustrating also. 

Roxanne: Yeah. 

Gina: And so the things that can contribute towards stress urinary incontinence is one impact mechanics, and this is specifically to impact activities, so running and jumping. If you are not well coordinated through how you are transferring load into your body with each step or each bound or jump, like we have limited mobility in the ankle, the knee, the hip- this is going to increase the load onto the pelvic floor, which can cause some of that leaking. The next thing is going to be pressure management. How are you managing pressure within the abdominal cavity? So if we are essentially reverse breathing or we’re inhaling up and then exhaling down, we are going to be increasing pressure onto the pelvic floor with our exhalations, which is when those muscles reflexively contract. So we have increased pressure downward, and muscular force adding together to increase the pressure more onto the pelvic floor, which can cause leaking. And then the third thing is the pelvic floor capacity. Are you even at a point where your pelvic floor is ready for the impact? For most people, I would say at least the first month or two postpartum, you are probably not ready for any sort of jumping stuff. You could maybe incorporate a little bit, like introduce impact around the two or three month mark, but generally it’s like 12 to 16 weeks is the earliest that people usually feel ready to… generally feel ready to start running at this point. And then of course, this will vary from person to person. I like to remind our clients and our listeners that like I was a collegiate runner, like I ran competitively in college, Roxanne did, too. I was running ultra marathons before my babies were born. I was what I would consider myself a high level endurance athlete. I won a race one time! 

Roxanne: With minimal training.  

Gina: With moderate amount of training… And I did not find running comfortable during pregnancy, personally. I know that there are people out there that do feel comfortable with it, I did not find it comfortable. And then I did not find it comfortable to go for a two mile run at four to six weeks postpartum, ’cause my body did not feel good. And so I like to remind people that I consider myself a high level endurance athlete, and even though I had all of this kind of training that I was doing, I still needed time to heal. And I think sometimes people forget that, where they’re like, “No, I’ve been doing a lot.” We’re all still going through the same tissue healing timeline, at various rates, but generally, you’re probably not going to feel good at four weeks postpartum to go for a two mile run. Or prove me wrong. I don’t know. I’m, you can prove me wrong, I don’t care. 

So those are the things that are going to contribute in general to stress urinary incontinence. How are we landing? How are we transferring force with impact mechanics? How are you breathing? And then what is the capacity of your pelvic floor? Is it even ready for that impact activity? 

Are there any like medical things that could be contributing towards stress urinary incontinence, or just incontinence in general, that is maybe outside of orthopedic and movement things?  

Roxanne: Yeah, things that could cause leaking outside of, just like pelvic floor function is, one, if you have some sort of infection. So a urinary tract infection usually leads to certain symptoms of like urgency, burning when you pee, blood in your urine, anything like that. Sometimes though, like you may not notice any of those symptoms, and you still have a urinary tract infection and eventually like based on just the infection timeline, you may start to just like leak urine. And usually it is not like just a small amount though, like a lot of the time, if it is like a true infection, it’ll be larger amounts of urine that are coming out. 

If there’s some sort of like neurological disorder as well, or neurologic injury that is like an injury within the spine that is related to the bladder, then that could also lead to incontinence. So if you’re noticing like pain with urination, or like when you have incontinence, it is like a large amount, those could be things that you could reach out to your provider for. 

And even like stress urinary incontinence, bring it up with your provider at like your postpartum visit, ’cause then they can then recommend, “Oh yeah, maybe let’s put in a referral for pelvic floor pt, or send you to a urogynecologist to make sure that it’s not like anything else.” Rule out some medical things, and then also work on your pelvic floor. But also know that like when you come to see us at your postpartum visit between four to eight weeks postpartum, it is again, within that timeline where your pelvic floor is still healing. So if you’re noticing like, “Oh yeah, when I laugh or sneeze, I’m still leaking at this point.” Yes, that is a little bit more common in that window of time, but that doesn’t mean that we can’t still send you to pelvic floor PT to start that rehab process, and it may resolve. 

Sometimes with prolapse symptoms, I do notice that people may not feel like the urge to pee as often. Either they’ll feel heaviness or like the urge to pee isn’t there until, “Oh, like I really need to pee.” Like people will go like a lot more time between peeing, which usually we should pee every four hours or so. Four to six hours. If you go 12 hours, like that’s a really long time, and most likely, like the cues to your body are like off. And it could just be like mechanics of like where your bladder is sitting and like the urethra. So if you’re not peeing very often, this also increases that risk of developing a urinary tract infection, which could then lead to leaking. So it’s like which one is causing the other? Is it just you have a urinary tract infection at a poor time and you’re postpartum healing? Or could it be like other things that are also causing it?  

Gina: So let’s break down some quick fixes that we can do to help to improve the symptoms of stress urinary incontinence. 

So if you are experiencing leaking or like almost like this urge to pee with jumping or running, there’s a number of things that we can do. So if you are experiencing with jumping specifically, so you’re doing double unders, you’re jumping on a trampoline, the first thing that you can do is we can first think about ribcage position. So are you a little bit more extended and arching in your back with your rib cage? Sometimes just bringing the rib cage down so it’s more stacked can really help to improve pressure management and the amount of pressure being put down onto the pelvic floor. So when we are in a more flared rib position or that more arched position, this can put more pressure to the front half of the pelvic floor where the bladder sits. And so in this more arched position, it can increase pressure to the front and cause more of that leaking, or pressure, or feeling like you need to pee. And so the first thing is just going to be to bring that rib cage down. 

The second thing that you can do is you can find more of a staggered stance. And so we have normal asymmetry within our pelvic floor, where there’s maybe a little bit more tension to the right anterior portion of the pelvic floor and the left posterior. So a lot of us tend to favor a little bit more weight in our right leg, which then causes us to nonstance in our left. And so we have this kind of normal positioning, or normal asymmetry within our pelvis, so right hip tends to sit more back and left hip tends to sit more forward in an open hip position. And so when we are jumping or doing double unders and you’re experiencing like heaviness or leaking, if we find a staggered stance with left foot back and right foot forward, sometimes this can help to relieve symptoms pretty quickly. And this was a strategy that I utilized in my like first six months postpartum whenever I was on a trampoline, or even when I felt like I needed to sneeze or blow my nose, I would find more of a staggered stance. This staggered stance position changes the tension within the pelvic floor, and so it brings a little bit more length to the front half of the right side and the left posterior pocket, and shortens the other two, and so this could help with pelvic floor balance and help you better manage the pressure. This can also help to improve pelvic floor capacity because if those two portions of the pelvic floor, that right anterior and left posterior are maybe really overactive, they could be very fatigued. And so by finding the staggered stance, this is helping to improve the capability of the pelvic floor. And so you can do that whenever you’re jumping, or when you ever have to blow your nose, if you’re laughing, sometimes that slight stance change can really help. 

In addition to that early postpartum timeframe, if you are feeling any sort of symptoms when you are like sneezing or laughing or coughing, you can also externally splint, either with your hand or with a soft object, against the perineum- and sometimes that external pressure can help to improve pelvic floor capacity by giving it a little bit of extra support. 

Now we’re not going to be able to just maintain a staggered stance as we’re running though. Like I can’t just hold that position as I bounce up and down the road, like I want to be able to bound from leg to leg. So maybe you a little bit more symptomatic with one leg versus the other. But things that we can consider when we are running again is can we bring that rib cage down because running is a very forward momentum movement, we may emphasize a little bit more arching or like thrusting the ribs forward in our back. And so if we can bring that rib cage down and have more of a forward lean with our entire torso, this can sometimes help to decrease those symptoms as well. 

We can also focus on more of a forward motion with our run, as opposed to an up and down. So when we have a very bouncy stride, this sometimes can increase the force onto the pelvic floor and cause more of those symptoms as well. So as opposed to bouncing up and down with your run, think about moving forward and sometimes that forward lean can be something that’s really helpful with decreasing kind of the vertical oscillation of your run- so how bouncy you’re with the run. Sometimes increasing your stride cadence can also be helpful and they have a number of different, like monotone, different like beep things that you can get like for apps and stuff where you can increase the cadence of your stride, which can also help to decrease the force with on the pelvic floor. When we have a faster stride, it typically is going to decrease the amount of balancing that you have and increase that forward propulsion. And so think about your rib cage positioning, we want to increase our stride cadence, so how fast you go from leg to leg, and then we want to decrease the amount of balancing that you have with your stride, and those can all be things that help to decrease the likelihood of leaking as well. 

Another thing that you can focus on with running to help improve pelvic floor capacity, how you manage pressure, how the impact forces are, is to think about your rib cage positioning in addition to not flaring the ribs, but also the rotation of it. And so if you want to think away from the pelvic floor, like hyper-focusing on it is not always super helpful, we can think about: how is my upper body moving with my stride? So really emphasizing kind of the arm rotation where we’re finding more of a twist in the spine, finding more extension- so bringing that hand more towards the hip- is going to help to improve your stride as well. So the way that your arms move and your rib cage moves is going to impact how your legs and your hips move. And so we can think about, do I have a good arm swing? Am I twisting in my upper body? And those can also help to improve symptoms as well. 

So some quick fixes that we can do to help decrease leaking while running is to think about your rib cage positioning- so bringing that rib cage down, focusing more on a forward lean from the hips as opposed to thrusting in that rib cage. Think about your arm swing and making sure that we’re actually rotating in the upper body, so we should twist from side to side as we run. We want to think about our stride cadence, so can we have quicker steps as we run? And then we want to think about how bouncy we are. And so sometimes just running faster can be really helpful. 

And so because running faster can sometimes help to decrease the symptoms of stress urinary continence, that may not be a pace that feels attainable to you or sustainable to you. And so we can also incorporate more like walk run intervals. So you could run for a minute and then walk for 30 seconds, or run for two minutes and walk for 30 seconds- and this can be a great strategy to get back into running, so that we don’t exceed that pelvic floor capacity. So we’re going to a point where we’re starting to feel a little fatigued and then giving our body an opportunity to rest and recover and then coming back into it. And so that’s a really great way to get back into running as well, especially if you feel more symptomatic. 

But now let’s talk about some long-term solutions if you’re experiencing leaking. And so one of the things that could impact stress urinary incontinence is the impact mechanics- so how are we landing from foot to foot? And that is going to require strength throughout that leg and good mobility throughout the ankle, the knee, and the hip. And so first we can start down with that ankle and improving the mobility of it. So can you like flex and extend your ankle? Can you rotate it from side to side? And we could do things like calf raises, where we’re strengthening the calf musculature in addition to tibial raises, so on the front side of the legs, thinking about bringing the toes towards your shin. Can we have like good range of motion with both of those? And there are ways to load those as well, so with the tibial raises, you can have a band around your foot and you’re lifted up as the other side stays down. We can hold onto weights as we do calf raises. So being able to start there with a lower leg can really help to improve those impact mechanics. 

And then we’re going to be thinking about single leg stability. How well can you do movement on one leg? And so we can start with more staggered stance positions such as a B stance squat, or a staggered stance RDL, and then progress towards it being a single leg movement, such as a single leg deadlift, or a single leg squat down to a box. And so we want to improve how strong a leg is on one side, starting with more supportive variations, and then coming to more like single leg standing positions. And this is going to help to improve that single leg stability so you can bound from leg to leg. 

We also want to think about the different kind of directions that your hip musculature and your knees and your ankles need to move through. So with your hip musculature, we want to be able to find hip flexion- so bringing the knee towards the chest; hip extension, so extending the leg out behind you; we want to be able to find hip abduction, so bringing the leg away from midline; adduction, bringing the legs together; and then we want to be able to find internal and external hip and pelvic rotation. So the difference between those two, is hip rotation is how does the femur or your leg move on your pelvis- which is going to be relevant to when you’re in your non stance position. So how does my knee rotate during the swing phase- ’cause we want like a little bit more external rotation at one point, and a little bit more internal rotation at another point. While pelvic rotation was, how does the pelvis move on the femur, which is relevant to the stance phase. So when I put weight into my leg, how is my pelvis changing position on that fixed femur? So we need a little bit of both. 

And so when we think about all of these different movements that my hip and my pelvis needs to move through to support running, this is going to give you a ton of accessory work that we need to incorporate. So more of those squats and deadlifts are going to incorporate more of that hip extension. Really any sort of marches where we’re bringing the knee towards the chest, either with a mini band or without, is going to help with hip flexion. Bringing the legs out to the side or bringing them together with that hip standing abduction or adduction is going to help with that hip abduction and adduction, sometimes even hip, internal and external rotation. And then movements where we’re rotating the pelvis on the femur that are closed chain, so that foot is down on the floor, is going to help to improve pelvic mobility internally to externally. And so that’s a lot of movements that we can incorporate just for single leg stability, and that by itself can feel really overwhelming. 

But the key is that we don’t start with the running, we start with the strengthening aspect. We start with how can we manage pressure? How do we then strengthen to improve pelvic floor capacity? And then, how do we incorporate impact mechanics to help improve how we transfer force through our body? And this is going to be a very patient and slow process. And so the first month postpartum, we’re just focusing on connecting with our core and pelvic floor, figuring out where it is again postpartum, just doing the initial healing after giving birth. And then we’re going to come into a point where we can start incorporating strength, either both legs together, some single leg, or staggered stance stuff to improve pelvic floor capacity- and these are just like little steps that we’re taking. After about another month or so of that, maybe we start to introduce some impact to focus on impact mechanics, and then we make it to a point where we’re adding in that running with our run walk intervals of I run for 30 seconds, I walk for 30 seconds, and then over time increasing the running interval to where maybe you don’t need to do those walking intervals anymore. But it can take some time. It’s a very patient and slow process. If you do want to get back to more of the endurance or cardio stuff, but you don’t feel quite ready for running, there are low impact activities that you can do, like the stationary bike, the elliptical, the rower- that can all help to improve your cardiovascular capacity without the impact aspect of it. 

And so that was probably a lot. There’s a lot of information out there on what we can do to help to improve stress urinary incontinence. It can feel very demoralizing. You might feel like a little bit ashamed if it’s happening to you. Just know that it can be a really common occurrence during pregnancy and the postpartum. Sometimes it even happens before you’ve ever been pregnant, it’s not like exclusive to mothers by any means. It’s not something to be ashamed of, but know that there’s a lot that we can do to help resolve it. Some of the best people that you can work with to find some like individualized solutions for you is going to be pelvic floor physical therapy or pelvic floor occupational therapy. You can work with your provider to help you find a pro, find a PT if you are not sure who to go to. And also to see if there’s anything else going on that maybe is contributing towards the stress urinary incontinence, or the incontinence just in general for you. It’s not something to be ashamed of, but there’s a lot of stuff that we can do to help resolve it, so it doesn’t have to be something that you suffer through. 

And so in review, the things that can contribute towards stress urinary incontinence, specific to running and jumping and maybe even lifting heavy weights, is going to be: what is your impact mechanics? How are you landing from leg to leg? That is either distributing force evenly throughout your body, or increasing a lot of force onto the pelvic floor? Things we can do to improve impact mechanics is one, going to be the mobility of the ankle, of the hip, and then improving that strength of the single leg. So how strong are your calves? The front of your shin? How strong are your quads, your hamstring, and all of the hip musculature? ‘Cause when one of those muscles is weaker or maybe not working well with the rest of the system, it can cause the pelvic floor to compensate or not be able to work as well. 

The second thing that can contribute towards stress urinary incontinence is going to be pressure management. So how are you breathing, and in what direction are you pushing pressure or pulling pressure away? And how is that muscular activation being added on? And so if we’re running with a really thrusted rib cage, or rib cage is flared upwards, you’re arching more in your back, this is going to put more pressure onto the front half of the pelvic floor where the bladder is, and make it harder for the anterior pelvic floor to contract and come around that sphincter towards the front. And so that can contribute towards more of that leaking. So if we can bring that rib cage down, we can improve rib cage mobility, this is going to improve pressure mechanics and help you breathe better while also improving your pelvic floor function. 

And then the last thing is going to be pelvic for capacity. Sometimes we just need to heal. We just need our pelvic forward to have some time to heal, to get denser, to get stronger, to coordinate again after giving birth. So going for a run and like a week postpartum, typically not appropriate. 

But we can look at other factors as well that may be contributing towards stress urinary incontinence or just incontinence in general. Did you have any birth trauma to the urethra? Are we dealing with any prolapse symptoms? Do you have more symptomatic prolapse that may be seeing a urogynecologist to be fitted for a pessary can be really, like really beneficial for you? Do we have a UTI or any other infections that could be impacting the bladder and the urethra? And so sometimes it’s a little bit more than just how are we landing? There could be other things going on as well. And so working closely with your provider to ensure there’s nothing else going on can be incredibly beneficial also. 

Now if you do want to get back to running and you’re not sure what all of these little exercises that you should be doing are, we do have our postpartum Return to Running program, which is going to just gently guide you through this whole process. The first month postpartum, we have our free early postpartum recovery course that’s just mobility, gentle breathing, gentle core exercises to help you reconnect with your core and pelvic floor. And then we move through our foundations portion, which is going to be those movements that are helping you to reconnect while adding a little bit of load, improving thoracic mobility, improving pressure mechanics, and how you are breathing. And then it progresses into our running program, where we incorporate those plyometrics to reintroduce impact. We have our run walk intervals to help you get back to that cardiovascular fitness, to improve pelvic floor capacity without overwhelming the system, in addition to all of the strength training- because if there’s anything that I have found to be super beneficial for me as a runner is to have the strength training aspect of my programming as well. 

And so if you need some support with returning to running after birth, we would love to be a part of your recovery with our postpartum return to fitness programs and our postpartum return to running program. And again, if you are dealing with stress urinary incontinence, it’s nothing to be ashamed of. It is something that is really common, but it doesn’t have to be your normal. There’s a lot that we could do so that we can feel better in our bodies and improve our quality of life.