I refer patients to certain blogs over and over during their treatment session and so have created this Articles section for patients to access easily. If you are passionate about running, we have set up a Running Clinic where women, men and adolescents can be assessed by our physios and improvements to style and technique made. Jane Cannan who worked for me for six years, wrote this blog on our running clinic. I have always loved Jane’s passion for running which is clearly evident in this article.
Jane finishing her first marathon
The transition to motherhood made me a runner and I know I’m not alone. Something about the simplicity of putting one foot in front of the other while alone with my thoughts, that has served to calm my mind from the scrambling, juggling act of raising children. So when I come across a woman who is giving up running because they experience bladder or bowel leaks, my heart breaks and if this comes up in a physio consultation, I launch into problem-solving mode. Because, in many cases, it doesn’t have to be this way and there are a number of different reasons why it could be happening. In this blog I will explore the factors that contribute to bladder and bowel leaks and prolapse during running.
Regardless of the reason for leaks, my Number One message is to stop trying to maintain a pelvic floor hold while you are running. If leaks are due to a lack of strength or endurance, then trying to maintain a squeeze in these muscles will only lead to a sooner point of failure. Stand up now and gently contract your glutes (many of you will at some stage been told or considered whether your glutes are too weak), now maintain that gentle squeeze while you jog on the spot. It doesn’t feel very good does it?
For starters, you end up squeezing your butt harder than before, so you can still feel it, you end up changing what the rest of your leg muscles are doing, and if you kept that up for anything longer than a few seconds, you would probably get mighty sore in your butt cheeks! If you’ve ever tried that strategy to stop a bladder leak or a feeling of pelvic heaviness, I would hazard a guess that it didn’t work anyway. So please stop, it doesn’t make bio-mechanical sense, it doesn’t work and in actual fact, it can only make things worse.
If this is you and you want to break the habit, start by slowing down, trying a shorter run interval and focus on breathing. Draw the air deep into the lower parts of your lungs at the bottom of your rib cage. If you are over holding your tummy muscles, you need to let them go to let your ribs widen to bring the air in. Panic and rising fear have a nasty way of ruining a good run. You fatigue quicker, start feeling niggles, niggles become more intense and you start to wonder if you should listen to your ‘helpful’ aunt who tells you that running is going to ruin your knees/back/feet/life.
Breathing not only helps the endurance of your pelvic floor, it is your tool to help curb the rising panic and fear. If you panic that you are going to leak (or get any unwanted symptom for that matter) and you stifle your breath, you will more than likely:
- Tighten your pelvic floor
- Tell your brain that you are under threat and need some protecting, so it will likely be that you further tighten your tummy and pelvic floor
- Your performance will feel worse than usual because you tried to do some cardiovascular exercise without breathing!
Many women after delivering a baby vaginally, will feel that their pelvic floor muscles aren’t what they were before and they are right…can we take a moment to give ourselves a pat on the back for listening to our bodies and hearing that something has changed! The most significant change once the tissues have all healed is that pelvic floor timing is forever altered. Where before, the pelvic floor muscles would automatically engage before an activity of effort (cough, sneeze, bend over, lift something, jump, run etc), now the activity occurs before the brain and the pelvic floor has time to prepare for it. To improve this timing, we deliberately practise pre-contracting the PF muscles at the right time and during the right activities.
If you’re trying to improve your overarm throwing, you don’t just keep going through the action without releasing the ball, because without practising that fine timing, you could not expect to get better at hitting a target. In this case your arm will have enough strength and endurance to perform the action, but your lack of practice in timing the ball release will inevitably make your ability to coordinate a throw unsuccessful.
Every time I blow my nose or do glute strength activities, I make the timing count. Start with complete tummy and pelvic floor rest; prepare for the event (eg,nose blow, single leg bridge etc) by engaging your pelvic floor and lower abdominals; maintain that feeling throughout the event, task or movement (keep breathing if it’s a bridge or other exercise); then let it completely rest (relax) once the activity is over. In running, the moment when your foot strikes the ground, your glutes should act to absorb the impact and during this glute activation your pelvic floor should engage to support the downward jolt of your pelvic organs. But like all good technique, it requires deliberate and successful practice to make automatic (good motor training). So, if you’ve had a vaginal delivery and you want to run dry, please practice good pelvic floor timing in a variety of day-to-day activities, as well as in your gym sessions.
As much as I love running, it is not for everyone. There are certain pelvic circumstances for which running poses a great risk of pelvic organ prolapse. This is why at Sue Croft Physiotherapy we take care in our assessment so we can help you to know your level of risk.
- Hiatus size – the gap in the muscles through which your urethra, vagina and rectum pass through. The bigger the size, the higher the risk of the bladder, uterus or bowel prolapsing through that gap.
- Childbirth history – size of baby, progress through labour and amount of assistance (such as instrument deliveries especially forceps) may impact the degree of muscle damage.
- Cervix descent on strain – this is a measure that we can re-assess over time to see if your chosen physical activity is causing structural problems.
- Prolapse – a measure of the degree of pelvic organ descent, which we can monitor over time and assess for suitability for supportive devices such as pessaries which can be great at giving support and protecting existing prolapse.
The last piece of the jigsaw puzzle is a look at bladder function and habits. Certain circumstances can increase the risk of urinary leaks mid or post run. Going back to what I talked about in terms of pelvic floor endurance earlier, habits that lead to extra muscle requirements can pose an issue. Consider if you spent a significant portion of your day keeping your heels off the ground, then it would come as no surprise when during a run later that evening your feet and calf muscles don’t cope very well.
A similar thing happens in people who over-hold their bladders. The normal bladder capacity is between 350-500mls. Some women have a habit of deferring bladder urge for far longer than they should, leaving their bladder to overstretch and get heavier and heavier. For starters, the pelvic floor has to now work under a higher load for a prolonged period of time which will impact endurance. In addition to this, the muscle of the bladder doesn’t respond well to overstretch and you can lose the awareness of fullness and incomplete emptying (notorious in teachers, nurses and hairdressers).
Another bladder factor that can increase the chance of urinary leakage is having an overactive bladder. This is one that makes deferring urges more difficult and the intensity of urgency harder to control. In contrast to the first bladder issue, this is characterised by an inability to reach a full bladder and more frequent trips to the toilet. Bladder training and using urge control techniques are the way to bladder control and your women’s health physio can guide you through this process.
So there you have it folks, the puzzle that runs through my head when I meet a woman wanting to run without prolapse risk or leaks…I love puzzles almost as much as I love running.