It’s time to talk about a topic some people would rather avoid, and that’s the pelvic floor! It is common to forget about the pelvic floor when we talk about core strength, so let me say this loud and proud, DO NOT ignore the pelvic floor, especially all you female distance runners. Even in our “modern” era, talking about pelvic floor dysfunctions is something really uncomfortable and even shameful to bring up and it really shouldn’t be. A healthy strong pelvic floor is really just as important as the strength of any other muscle on your body.
The muscles that make up this area support your organs and are in charge of containing or excreting contents from our bodies (1). And just like any other muscles in our body, when muscles are not activated or trained properly, over time weaknesses will develop. Pelvic floor weaknesses then begin to manifest as urine leakage, pain with intimacy, constipation, organ prolapse, and or back pain.
In a 2015 study conducted by Thyssen et al., they found that 151/291 elite female athletes and dancers (average age of 22.8 years old) experienced some sort of urine loss in general. 125/291 athletes (51%) experienced urine loss during their sport (4). Similarly, in another study conducted by Borin et al, found that there was a higher correlation between athletes and decreased pelvic floor muscle pressure and incontinence (1). This is important to note, because what this tells us, is that athletes are at a HIGHER risk for pelvic floor dysfunction simply because we are not training our pelvic floor, and we NEED to be doing so.
When it comes to running, we have to remember that running is a high impact sport. Every time our foot strikes the ground, all of our organs move up/down in our cavity and bounce onto our pelvic floor. This causes stretching of the pelvic floor muscles and the supporting tissues. Now imagine what happens when a WEAK pelvic floor is forced to try to support all the forces and movement stress that occurs during a run. Well, it gets weaker, longer, less supportive, and leads to problems. Our pelvic floor will do as much as it can with what it can but over the course of time increase pressure or stress may lead to noted leaking. Sometimes you may have heard patients, friends, team mates state something along the lines of “when I do jumping-jacks/jump/ jump-rope/sneeze/sprint/run for longs periods of time I leak a little.” For the most part, it is taken as something normal for women, especially if they have experience vaginal childbirth. This type of symptom is categorized as stress urinary incontinence and I will state that: no it is not okay, and that is NOT normal. Luckily for ladies or men who experience this, yes there is a solution and that is pelvic floor exercises.
How does this happen?
The pelvic floor form a bowl-like structure that stretches from the tailbone to the pubic bone and from one sitting bone to the other. It is also a supportive structure to the abdominals and back muscles and play a role in stabilizing and supporting the spine. Alone, when the pelvic floor contracts it lifts our internal organs and tightens the sphincters of the urethra, anus, and vagina. Relaxing of the pelvic floor allows for passage of excrements. Therefore, as you might foresee the function of the pelvic floor is supportive and sphincteric. Supportive in the sense that as you read the pelvic floors role is to support our organs, reduce the force of gravity of our contents, and reduce intra-abdominal pressure in cases such as coughing/sneezing/lifting/vomiting/straining. The sphincteric function is to compress the urethra and rectum from continence and maintain continence during high pressure of the urethra and bladder (such as during sports).
Stress urinary incontinence occurs from poor sphincteric closure (due to weakness of muscles) with increased abdominal pressure. Activities and high impact sports have been associated with a higher prevalence of developing urinary incontinence especially in women. What researcher and clinicians suspect happens is that repetitive and prolonged high impact activities leads to fatigue and overtime weakening of the pelvic floor (2).
So what things can make your pelvic floor weak?
1. Pregnancy and Childbirth
2. Injury or trauma
3. Lack of exercise
4. Too much straining on the toilet
5. Heavy lifting
7. Men: prostate cancer
There are three types of stress incontinence and they are:
Type I: leakage with strenuous activity (sports) , sneezing
Type II: leakage with moderate activity such as moderate cough, jogging
Type III: Leakage with minimal activity such as rolling over in bed.
How can you strengthen the pelvic floor?
There has been numerous studies that has demonstrated that training the pelvic floor muscles lead to a reduction in incidents in individuals that suffer from stress urinary incontinence. Therefore, strengthening is imperative for improving ability to tolerate high impact activities without incidents.
A nice way to start working on the pelvic floor is with the basics. The most basic task is to become aware of your pelvic floor and then learn how to engage it. This can be attempted by “stopping the flow of urine” midway through emptying. Doing so will not necessary strengthen the pelvic floor but it is a great way for you to get a feel and understand where those muscles are. After you have been successful with that start with doing exercises on your back.
Exercise 1: Kegels
- Lay on your back, knee bent, and feet shoulder width a part.
- Begin with your diaphragmatic breathing (inhale and expands the abdominal area and gently exhale).
- As you exhale begin by closing and drawing up the muscles around the back passage WITHOUT tightening your buttock and muscles around the urethra (front passage), as if you are trying to stop the flow of urine.
- On your next inhale relax and SLOWLY leg go.
- Repeat for about 3- 5 minutes, or until you feel tired.
- As you get better you will hold the contraction for 10 seconds—then 20 sec –
- The actual contraction will at first feel very faint and as you get better it will be more prominent.
Practice, practice, practice, and then eventually implement to your functional activities.
Once you get the hang of this, you can try to do this laying on your side or back, then proceed to standing.
Implement Kegels with your Bridges, Squats, and Core exercises.
Be very mindful of your pelvic floor as you perform your usual core exercises. Many times we focus too much on just bracing the abdominals that we end up bearing down and pushing the pelvic floor down instead of lifting.
Tips While Running:
- Make sure you use the restroom before going on your runs- you want to be empty to minimize excess bladder and intestinal pressure
- Avoid over drinking during your run, and if you drink a lot, and eel the need to urinate, then just stop and urinate
- Every mile check yourself and work on lifting for a few seconds and proceed with running.
- If you are running down hill, make and effort to lift the pelvic floor.
Remember fellow runners, developing strength is a lengthy process.
Seeing actual changes may takes a few weeks, especially during your actual runs.
Ladies want to learn more- visit your local Women's Health Physical Therapy Specialist!
Work on this daily and weekly.
Jessica Mena PT, DPT, CSCS
1. Borin LC., Nunes FR., Guirro EC. Assessment of pelvic floor muscle pressure in female athletes. American Academy of Physical Medicine and Rehabilitation. March 2013. 5(3) 189-193
2. Garcia-Sanchez E, Rubio-Arias J, Avila-Gandia V, Ramos D, Lopez-Roman J. Effectiveness of Pelvic Floor Training in Treating Urinary Incontinence in Women: A Current Review. Actas Urologicas Espanolas. 2016; 40(5).
3. Raizada V., Mittal R.K. Pelvic Floor Anatomy and Applied Physiology. Journal of Gastroenterology. Clinic North America 2008. September 37 (3) 493
4. Thyssen, H.H, Clevin O.S., Lose G. Unirary Incontinence in Elite Female Athletes and Dancers. Journal of International Urology. 2002 13:15-17