Laura Jawad standing in front of the Columbia River before the start of the Columbia River Gorge Half Marathon.

When it comes to running and your pelvic floor, leave your brain out of it.

The beautiful Columbia Gorge Half-Marathon had been on my bucket list for ages. And, finally ready to run the distance again- I was plagued by a new concern-

How many Honey Buckets would I find along the course?

Because although I was running 13.1 miles, a year after the birth of my daughter, I wasn’t running 13.1 miles confidently. I was still experiencing heaviness related to my bladder prolapse and I was still experiencing urinary urgency.

During this time, I was going to pelvic floor physical therapy. That’s never been a hard sell for me- I love physical therapy. But I remember struggling with the advice of my provider, which was along the lines of this:

Let your bladder feel like it’s going to fall out. Because, it won’t. And by holding a kegel, holding your pelvic floor muscles high and tight, you’re contributing to the problem.

Letting go is hard.

Especially when it has to do with your pelvic organs.

But if you want to get back to running comfortably and confidently and if you want to heal your pelvic floor, you’ve got to learn to release your hold.

Here’s What I Want You To Know About Running And Your Pelvic Floor:

You don’t have to “activate” your pelvic floor while you’re running.

Don’t think about it.

Don’t try to control it.

Do not try to kegel while you’re running.

What Should Your Pelvic Floor Do While You Run?

When you’re running, your pelvic floor should respond reflexively.

That means, your pelvic floor should to contract and relax appropriately WITHOUT YOUR CONSCIOUS CONTROL.

Along with the rest of your deep core, your pelvic floor is responding to pressure generated by your breath AND it’s responding to ground impact forces generated by each foot-strike.

It’s managing input from above AND from below to keep your pelvic organs supported, your torso stable and your panties dry.

That’s a very big job.

You’ve got to trust your pelvic floor to reflexively manage ground impact forces and changes in your intra-abdominal pressure. If your conscious brain tries to get involved, your pelvic floor won’t do it’s job as effectively.

How Does Running Affect The Pelvic Floor?

The entire time you’re running, your pelvic floor is contracted more than it would be if you were just casually standing around.

Infographic illustrating pelvic floor activation at rest while lying down versus standing.

During each foot strike, the pelvic floor contracts a little more. It goes through a mini contract-relax cycle between each foot strike (1).

Infographic illustrating the cyclical contraction and relaxation of the pelvic floor during each step while running.

And this is on top of a contract-relax cycle driven by your breathing (2),

When you run, your foot strikes the ground 4-8 times per breath (3). So there are mini-contract relax cycles layered on top of a longer contract relax cycle.

Infographic illustrating pelvic floor muscle activity at rest lying down, standing and while running.

That’s complicated, right?

When you run, it would be impossible to try and cue your pelvic floor in sync with your gait (–> you can’t breathe that fast).

Heck, you can’t think that fast.

So I’ll say it again: don’t try to micromanage your pelvic floor.

Pelvic Floor Activity During Strength Training Versus Running

Here’s where it gets a little confusing for some folks when we think about pelvic floor and running:

Ideally, you built up to running with 12-16 weeks of strength training. During that time, you used the Connection Breath and an “exhale on exertion” strategy to retrain good, reflexive pelvic floor function.

You got used to cueing your pelvic floor during exertion or impact and now that you’re running, you’re trying to do the same thing.

But, here’s the twist:

Once you start running again, you don’t want to think about your pelvic floor at all.

If you hold a kegel while you run, you’re going to impose a lot of extra strain on your pelvic floor. And you’re potentially setting yourself up for pelvic floor injury down the line.

Picture a tree bending and swaying in the wind. If it lacked that flexibility, it would crack under the force of the wind.

Get where I’m going?

No kegels while you run.


Signs of Pelvic Floor Dysfunction in Runners

This is a great time to take a little interlude to talk about what’s “normal” and “not normal” when it comes to pelvic floor function.

What’s “normal” is when your pelvic floor works behind the scenes to perfectly counterbalance all of the forces that it receives and you feel strong, comfortable and dry.

What’s less desirable is when you feel downward pressure into your pelvic floor, you’ve got pelvic pain, you feel urinary urgency or you leak urine (or anything else).

Infographic describing signs and symptoms of pelvic floor dysfunction in runners.

What Do You Do If You’re Having Pelvic Floor Symptoms When You Run?

What if you pee a little?

What if you feel heaviness or discomfort?

Well, too often, people’s inclination is to hold a kegel throughout their run- but I assure you, this will make the problem worse, not better.

So if you’re experiencing symptoms while running, here are a few things you can try:

1) Relax.

Release the kegel if you’ve been holding a kegel (might sound like a broken record here).

2) Insert walking breaks into your run.

When you return to run, you should begin with a walk-run program. If you find that you’re experiencing symptoms, increase the walks and/or shorten the run intervals.

3) WHEN are your symptoms occurring?

Immediately or later in the run? That can help you determine whether or not your symptoms are caused by a pressure management problem or from fatigue of your pelvic muscles (poor endurance).

If you’re fatiguing later in your run, determine your symptom threshold. If you find you have symptoms beginning at 10 minutes, 15 minutes etc., keep your runs below that threshold and gradually increase the length of your run.

4) WHERE are your symptoms occurring?

Uphills? Downhills? Bias your running route towards terrain that is less aggravating.

5) How much worse are your symptoms during/after a run?

You don’t necessarily have to wait until you’re entirely symptom free, but you do want to make sure that your runs aren’t making things worse.

Carrie Pagliano, a pelvic floor physical therapist who specializes in returning to run after pregnancy, suggests that a tolerable symptom margin is 1-2 points on a 10 point scale. So, if your symptoms start out as a 1 or 2 out of 10 in severity, they shouldn’t get any worse than 3 or 4 out of 10 during your run. And they should resolve to your baseline with rest.

If you are starting with more severe symptoms, or your symptoms really ramp up during activity, I’d forgo running until checking with a pelvic floor therapist. Which leads to:

6) Check in with a pelvic floor therapist.

Pelvic floor physical therapists are the medical professionals most qualified to assess your pelvic floor muscles. They’re trained to help you manage urinary incontinence (leaking), pelvic organ prolapse or pelvic pain. They can determine if you have weak pelvic floor muscles or an overactive pelvic floor and they can provide an appropriate treatment plan.

7) Work with a running form coach to evaluate your running form.

The way you hinge at your hips, rotate through your torso, or orient your rib cage can have a big impact on how your body manages pressure and how you experience pelvic floor sensation. It’s hard to self-assess your own running form. This is a great place to ask for help.

Pelvic Floor Exercises For Runners

While you run, your pelvic floor is managing impact and pressure as it contracts AND as it lengthens.

So one of the best things you can do to become comfortable releasing your pelvic floor during your runs, is to get comfortable loading it when it’s lengthened.

The Connection Breath and an “exhale on exertion” strategy train your pelvic floor to manage load while it contracts. That’s a good start, but how do you train your pelvic floor to manage load and impact while lengthened (i.e. when it’s “relaxed”)?

To advance your pelvic floor exercises and prepare for more dynamic exercise (e.g. running), try experimenting with some of these strategies:

1) Inhale on exertion

Once you are able to contract or lift your pelvic floor during the hard part of an exercise, practice inhaling and RELAXING your pelvic floor during exertion.

2) Exhale on impact

If you can inhale on exertion during static exercises, re-introduce impact exercises. You can introduce impact with exercises like drop landings and jump downs. Exhale as you land, contracting your pelvic floor to manage impact.

3) Inhale on impact

After “exhale on impact” comes “inhale on impact”. Practice the same exercises while inhaling and relaxing your pelvic floor to manage impact.

4) Practice breathing through dynamic exercises

If you’re able to exhale AND inhale on impact with no symptoms (pelvic floor heaviness, pain or leaking), move on to dynamic exercises. These are exercises during which you can’t really cue your breath. The movements are too fast to synchronize to your breath.

For example, try pogo jumps or toe taps. You’ll hit the floor several times during each breath cycle.

Vary your breathing strategy during bilateral exercises like squats, drop landings and box jumps. But also experiement with them during unilateral exercises that better mimic gait.

For a more thorough discussion, visit Advanced Pelvic Floor Exercises For Postpartum Athletes.

Key Takeaway

When it comes to your pelvic floor and running, less is more. Ideally you’ve done the rehab, retraining and strength training to build a solid foundation so that your pelvic floor can do its job on autopilot.

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Redmond, WA-based Seattle birth doula Laura Jawad, headshot

My mission is to make sure that having a baby is not a reason why you can’t do all the things.

I offer customized, online pregnancy and postpartum personal training to folks locally (Seattle-area, Bellevue, Redmond, Kirkland) and beyond.

Laura Jawad holds a PhD and a personal training certification (NASM). She’s a Certified Prenatal & Postnatal Coach, Pregnancy & Postpartum Athleticism Coach, and Pregnancy and Postpartum Corrective Exercise Specialist. You can check out the rest of her alphabet soup here.

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