Did you know that almost half of elite female athletes experience some kind of dampness *down there*? Running incontinence is way more common than you might think, but there are things you can do to dam the leak.
What’s the most important item in your long run training kit? We’re used to packing energy gels, comfortable underwear, new-but-not-too-new trainers and the perfect Spotify playlist (One Direction, anyone?), but when I ran the Brighton Marathon in 2019, I had to make sure I had room in my running belt for incontinence pads. Yes, the most vital part of my kit was my pad for when, not if, I peed myself.
Since having kids, I can’t even run for the bus without feeling that familiar and oh-so-embarrassing trickle. I’ve tried pads, tampons and incontinence pants (unsightly and uncomfortable adult nappies, basically.) You name it, I’ve tried it.
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Anyone who has ever queued for the ladies at the start of a race will know I’m not alone. Studies show that one in three women are affected by stress urinary incontinence (SUI) regardless of whether they’ve had children.
While the most common risk factors are childbirth and menopause, SUI is a massive issue that affects all ages. A 2021 study showed that 45.1% of female elite athletes experience urinary incontinence, compared to just 14.7% of men.
Despite this, there’s very little targeted information for younger women. I don’t want to wear pants designed for elderly people, and I’m sick of having to wear black leggings all the time. But before I hang up my trainers for good, I tracked down some experts to debunk the myths and get some advice.
Why are so many fit women at risk of incontinence?
Here’s the science bit. Intimate health expert Dr Shirin Lakhani explains: “Stress incontinence is leakage that occurs when your bladder is put under pressure – when you’re sneezing, coughing or exercising. It’s usually the result of weakened or damaged pelvic floor muscles. These are the muscles lying across the base of your pelvis, keeping the pelvic organs in place.”
Unfortunately, running is right at the top of the list of high-risk exercises for leakage due to the gravitational pressure it exerts on the pelvic area. Pelvic health physiotherapist Jennie Hughes tells Stylist: “SUI affects women who complete high-intensity exercise, lift heavy weights and run. When too much pressure is exerted on the pelvic floor, the muscles don’t have the strength, flexibility or reaction time to support the pressure, resulting in urine escaping.”
Although the issue is widespread, there’s huge stigma surrounding SUI. Most women don’t talk about it, and many women will simply stop running rather than reach out for help.
UK Athletics running coach Rachael Bruford tells me: “Women are embarrassed to mention their leaking. You can run with someone for years, talking about all kinds of things, and one day you’ll mention your own experience and they’ll admit it happens to them too. It’s a much bigger issue than we realise.”
Fitness coach Kirsty Victoria agrees: “Many women think that they’re the only ones suffering with incontinence. They’ll joke in a social setting about peeing themselves, but really, women are anxious about the full extent of their problem being known.”
But burying your head in the sand really isn’t going to help here. And as Bruford says: “If you’re not seeking help to manage your symptoms, running can make things worse.”
How to protect your pelvic floor when running
All is not lost, though. The experts are unanimous that while SUI is common, it’s not normal and it can be improved.
As we’re all built slightly differently, there’s no one-size-fits-all solution. So, the first step is always to seek professional advice from a GP or women’s pelvic health physio. I’ve learned that it’s not as simple as just doing those pelvic squeezes.
A physio will assess the cause and severity of leaking and eliminate other factors such as prolapse. Hughes explains: “When treating SUI, we must consider the whole core cylinder. We look at the abdominal and back muscles to check they’re functioning and moving correctly, as well as bowel health and ensuring the diaphragm is working in sync with the pelvic floor. Then we can progressively increase the pressure on the pelvic floor with gradual exercises, making sure each stage is “leak free” before moving on.”
We’re all aware of the importance of regular pelvic floor exercises (kegels), but just like any other exercise, they must be performed correctly to be effective. Your physio will show you how to do them and provide a personalised plan, while the NHS Squeezy app (£2.99, App Store) is handy for reminding you when it’s time to squeeze as well as timing you.
Short-term solutions to leaking
Clearly, the results of kegels and physio won’t be immediate. In the meantime, there are a range of short-term solutions you can try.
Women’s running coach Hannah Rayner advises that small, occasional leaks can be minimised by using an incontinence pessary, such as Contam, Contiform and Contrelle. These are inserted like a tampon and provide support to the neck of the bladder sphincter to reduce leakage. Don’t be tempted to use a regular tampon, though, as this can cause problems over prolonged periods.
Rayner also recommends Modibodi period pants as comfortable and absorbent, and Bruford mentions shorts that can offer some support. But they both stress that it’s vital to understand your incontinence and have a long-term plan in place.
Your running form might even be contributing to the problem
Switching to mid-foot striking
Victoria explains: “Heel striking is very concussive to the pelvic floor, so try striking with your mid-foot instead. Breathing through your nose also puts less pressure on your pelvic floor, but this can take a bit of re-training.
“Lastly, consider your posture when you run. Are you tilting forward or hyperextending your back? Running with a neutral spine alignment keeps your ribs stacked over your pelvis, giving a stronger posture.”
Strengthening the core
Good posture and a strong core reduce abdominal pressure and improve leakage, but there’s some good news here: trainers caution against traditional crunches, which increase pelvic pressure, and suggest dynamic or static plank exercises instead.
Don’t try to drink less
Once you’ve done this groundwork, try going for a run and see what happens. But don’t think skipping water stations will help. Hughes advises: “It’s important to stay well hydrated. Often women with SUI reduce their water intake, but water helps keep tissues hydrated, helps with constipation (straining has a huge impact on SUI) and keeps our pelvic floor nice and strong.”
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It’s clear that the route to pee-free running is long and winding, but this isn’t something we should be suffering in shame and silence. Talking about your symptoms is crucial, as only by being open and honest will we remove the stigma and make progress. Peeing and running don’t have to go hand in hand. Get seen, get sorted, get running!
For more women’s health pieces, visit the Strong Women Training Club.
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