No one (over the age of 12) really wants to talk about what happens behind bathroom doors. So when you pee a little (or a lot) while exercising, it's embarrassing.
Leaking, also known as urinary stress incontinence is, at most, whispered about in the context of mom groups. And at worst, it's either tolerated or considered grounds for avoiding healthy activities that can trigger it.
That special underwear has been developed to absorb bladder leaks is evidence of just how common a problem it is. And while both pregnancy and childbirth can be triggers, it's not just a mom problem. One study found that 45% of female athletes experienced some symptoms — and 76% of those surveyed hadn't given birth.
So what causes it — and what, other than donning a pair of ultra absorbent undies, can a person do? Heather A. Dunfee, a physical therapist in the Mayo Clinic Healthy Living Program and certified Pregnancy and Postpartum Corrective Exercise Specialist, sheds some light on the issue.
"Many people think leaking while running is just caused by a weak pelvic floor and they need to do more Kegels to strengthen it," says Dunfee. "That could play a role, but it's usually about a flawed system versus a single muscle issue."
The pelvic floor is one part of the muscle system that makes up your "deep core," Dunfee explains. Think of it as the bottom of a canister that provides stability and support for your internal organs and urinary and bowel function. The top of the canister is your diaphragm, and around the sides are abdominal muscles.
Ideally when you breathe in, your diaphragm and pelvic floor both relax downward and your ribs and belly expand outward. When you breathe out, they naturally draw up and in. That healthy range of motion is important because it helps to absorb impact and manage pressure. If you grip your abs or squeeze your pelvic floor to try to prevent leaking, you can actually make it worse, warns Dunfee.
If you do have weakness in your pelvic floor, doing lots of Kegel exercises alone isn't the answer. Practicing how to coordinate your breathing with a Kegel contraction can help: Inhale, relax and expand, then exhale, contract and lift the pelvic floor while drawing in the abs.
For runners, good alignment can help your core to better absorb impact, preventing leaks. For example, a slight forward lean helps to put your deep core "canister" in the best alignment to do its job. Think about stacking your rib cage over your pelvis, something that comes naturally when running uphill.
More tips from Dunfee:
- Eyes at the horizon. Look out about 20 feet ahead with your neck long, chin gently tucked.
- Don't overstride. Think about propelling yourself from your glutes rather than pulling through your hip flexors in the fronts of your thighs. You should land with your foot underneath you.
- No chicken wings. Swing arms forward and back rather than side to side.
- Land like a 'whisper.' If you hear pounding, see what you can do to soften your steps. Landing in the middle or front of your foot instead of your heel reduces the force by about half.
"The pelvic floor is a helper muscle, and it loves to take over and help stabilize the body when your hips or glute muscles aren't doing their job," says Dunfee. But the pelvic floor will easily fatigue and stop working correctly.
If weakness in these areas is a problem, exercises such as squats, lunges, dead lifts, bridges and hip thrusts can all help. For runners, focus on single-leg exercises whenever you can since running is a single-leg dynamic activity.
Once you get a feel for the correct breathing pattern and alignment, it can take time to build up your endurance. Rather than keep running no matter what, try alternating running and walking (walk when you notice you're not maintaining the right form or breathing).
For a more intense workout that won't derail your progress, try running up hills and walking down. "Hills are great because they force the body into a position of rib cage over pelvis and untucks the bum," says Dunfee. Walking downhill is a good option, though, since it's high impact.
There are lots of possible reasons your pelvic floor might not be functioning the right way, and surprisingly overly tight muscles are actually more common than weakness, Dunfee says. A pelvic floor physical therapist has special training in pinpointing the cause of this type of dysfunction and can tailor a program that can help.