Running is a great cardiovascular activity and kudos to you if you are a long-distance runner (uhm, yeah you won't catch me doing anything more than a 10k!) However, did you know that running is a repetitive exercise that places continuous pressure on your pelvic floor? Pressure that if your body isn't ready for such high and repetitive impact, your pelvic floor will suffer. In physical therapy we often use the analogy as the pelvic floor being compared to as a hammock. When you lie back on a hammock there is some give but the material does refrain you from falling or sagging all the way through. I, however, prefer to compare the pelvic floor to a trampoline. When you stand or sit on a trampoline it does give way some (but not to the extent of a hammock) and additionally, if you jump on the trampoline there is some give but then it bounces back. Likewise, a strong pelvic floor will be able to "bounce back" with every pounding stride of your run. On the other hand, a weak or overly tight pelvic floor will give way and you may experience symptoms such as pain, leaking, or pressure.
Pain - can be caused from overly tightened (one or both sides) pelvic floor, scar tissue from an episiotomy or tearing, constipation, pressure, muscle spasms, and may also refer or cause pain in the lower back and sacroiliac joint.
Leaking - one of the major responsibilities of the pelvic floor is to keep urine or feces from coming out when you're not ready for them to come out. People automatically assume a cause for this is a weak pelvic floor and try doing kegels only to get frustrated they aren't improving or even worsen. While a weak pelvic floor can cause incontinence, often times instead of weakness being the culprit, it's due to overly tightened muscles in the pelvic floor. A muscle that is tight (or in the "on" position) all the time, does not get a chance to rest therefore it fatigues. A tired muscle will not be able to do it's job when you randomly sneeze, laugh with your friends, catch a cold and find yourself coughing or start training or running.
Pressure - feeling pressure through the vagina, urethra, or rectum as if your organs are slipping may be due to prolapse. There are different degrees of severity but certainly if you feel any pressure while running STOP as you do not want to make these symptoms worse. The cause is a weakened pelvic floor due to pregnancy, delivery of a large baby, difficult or prolonged labor which may have caused trauma, being overweight, constipation (constant straining), and repeated heavy lifting.
Can I do anything to prevent these things from happening?
There are certainly ways to prevent or at the very least lessen the severity of symptoms. If you are pregnant, I encourage all of my patients to maintain or adopt a pregnancy safe fitness routine. A good exercise program for an expecting mother will contain pelvic floor strengthening as well as relaxation in preparation for birth. In addition to getting exercise clearance from your OBGYN I encourage an assessment performed by a pelvic floor physical therapist specialist. Physical therapists are the musculoskeletal gurus and that includes the muscles of the pelvic floor! Some other tips to avoid issues when returning to running include:
staying hydrated and eating plenty of fiber filled foods (this will help avoid any constipation issues), keeping your weight gain within your doctors recommendation when pregnant, improving your posture, and avoid lifting moderate to heavy items as this will increase pressure to the pelvic floor.
Those who delivered vaginally are more at risk for pelvic floor pain, incontinence, and prolapse BUT a woman who delivered via cesarean can also experience these symptoms. On the same note, you don't have to be recently postpartum to have these issues. Your kids my be teenagers or beyond and could still be experiencing some or all of these problems. Just know that it is NEVER too late to get help and even though some of these symptoms are common they are not normal! Find yourself a good women's health (or pelvic floor) physical therapist and they can get you back in your running shoes with a healthy, happy pelvic floor.
