Leaking and Running: to Kegel or not to Kegel?

So many women think that using a pad when they run is just “par for the course” after they have a baby. Leaking with running, coughing, sneezing and other activities with increased intra abdominal pressure is called Stress Urinary Incontinence. Studies show that pelvic floor physical therapy is the first line treatment for stress urinary incontinence. When runners leak, I almost always see it with other pain issues such as IT Band, knee, hip, back or pelvic pain. Is it related? Definitely!

You can think about the abdominal canister like a can of coke. When you step on a full can of coke with the top on-- the pressure inside the can of coke will not let you crush the can. When you step on a can of coke when the top is off-- it is easy to smash the can of coke. Can you visualize that?

We WANT the top to be on the can of coke-- that is when you run without leaking and with good stability. But, in the case of leaking with running-- the top of the can of coke is open and pressure goes out!

Let’s take this triathlete as an example: Let’s call her Sally. Sally has a decade long history of right sacroiliac joint dysfunction. She comes to me for leaking with running and for her sacroiliac joint dysfunction. I found several factors that are leading to her leaks:

1. Breath holding: she thought she was supposed to hold her breath to help her running form

2. Pelvic floor tightness: her pelvic floor muscles were short, tight and tender on the same side, the right side, as her sacroiliac joint dysfunction

3. Obturator internus: her deep hip muscle was tender on the right and overworking because her gluteus medius/ maximus was not strong enough

4. Her middle back, her thoracic spine was stiff and lacked rotation

5. Her gluteus medius and gluteus maximus were weak on that side

So, should Sally do kegels? Nope. There are several factors at play, none of which will be helped with kegels. Sally’s problem is that her diaphragm is not moving-- she thinks she should hold in her belly in a misguided attempt at improving her core stability. When Sally moves, some of her hip muscles under work and others overwork. That leads to tightness in her deep hip muscle, the obturator internus. That muscle connects to the pelvic floor, which leads to the pelvic floor is already so high and tight that there is nowhere for it to go when she needs the support when running.

By addressing her breath holding habit and rebalancing her hip muscles through manual therapy and a few corrective exercises, Sally is now running marathons and ironmans without sacroiliac joint pain OR leaking. The connections of the body are amazing and running with a pad definitely is common but not normal.