Jayne Nixon joins us again today to provide the second of our articles for female athletes. Jayne is a Clinical Specialist at Sevenoaks Physiotherapy and a big part of the Kent Running School. Jayne’s first article covered breast health and today she’s discussing urinary incontinence and the pelvic floor.

Incontinence is a common and often embarassing issue experienced by women from all sports. A study by Thyssen et al. (2002) found that over 50% of elite athletes had experienced urine loss during sports or daily activities and yet only 3.3% had discussed it with their doctor and only 4.6% had tried pelvic floor training. So while it can be a frequent issue for athletes it appears many may be reluctant or nervous about asking for help. This is totally understandable considering the very personal nature of the problem but it’s important to know that health professionals will be sensitive to your needs and can do a lot help.

Source: Thyssen et al. (2002)

Running is a high impact activity as we all know, and for some who hit the ground hard and with poor technique this can add to their pelvic floor issues making it easy to leak from your bladder. The physical force that is associated with landing passes through the lower limb and pelvic floor rapidly as the foot strikes the ground. The ground reaction force is felt as the abdominal contents bear down on the pelvic floor making it hard work for your bladder to control and not let go. It can stretch the pelvic floor, especially if structures of the abdominal wall are not there to support it e.g. with issues like diastasis in the recti muscles (which can happen to men as well as women!)

Fortunately there are a number of steps you can take to improve your pelvic floor support for running:

  • Perform regular daily pelvic floor exercises to optimize your pelvic floor strength and the support for your pelvic organs (including bladder, uterus and bowel). Increasing the tone and stiffness in these muscles leads them being able to with stand the downwards forces that running places on them.

How do I do pelvic floor exercises?

Pelvic floor exercises can be done anywhere and anytime. You can perform them standing, squatting or lying down but at first you may find it easier to do the exercises sitting down:

  • Sit on a chair, toilet seat or toilet lid.
  • Make sure that your feet are flat on the floor and your legs are slightly apart.
  • Lean forwards, resting your elbows on your knees.

There are two types of exercises – slow twitch and fast twitch. It is important that you do the slow twitch first and then the fast twitch each time you exercise your pelvic floor muscles.

To perform the slow twitch exercises:

  1. Close and draw up the muscles around back passage, as if you are trying to stop passing wind. Make sure that you do not contract (tighten) your buttock muscles while you do this.
  2. Now close and draw up the muscles around your urethra, as though you are trying to stop the flow of urine.
  3. Try not to hold your breath, breathe normally. Pull upwards and count how long you can hold the squeeze. If you can hold for a count of 10, then relax for a count of 10.
  4. Repeat this until you feel tired.

Over time you should be able to increase the length of time you can hold for.

To perform the fast twitch exercises:

  1. Pull up the pelvic floor muscles as before.
  2. Hold for one second and then relax.
  3. Repeat until your muscles feel tired.

Pelvic floor muscles tire easily and you may notice that it takes a lot of concentration to begin with to do these exercises correctly. If you find that the muscles ‘let go’ too quickly and that you cannot hold for long, just hold them for as long as you can. If you can only hold the contraction for a count of three, then every time you do your exercises, contract the muscles for a count of three. Gradually try to work up to four, then five and so on.

Once you feel confident in doing the exercises try doing them in other positions, such as standing or squatting. Remember to tighten your pelvic floor muscle during and after any activity that makes you leak – like rising from a chair or coughing – so that tightening becomes an automatic reaction.

While performing the exercises, it is important not to:

  • Squeeze your buttocks together
  • Bring your knees together
  • Hold your breath
  • Lift your shoulders, eyebrows or toes upwards.If you do any of these, you will not contract (tighten) your muscles correctly.

Your pelvic floor muscles also need to react quickly to sudden stresses from coughing, laughing or exercise that puts pressure on the bladder. So practise some quick contractions, drawing in the pelvic floor and holding it for just one second before relaxing. Try to achieve a strong muscle tightening with up to ten quick contractions in succession.

How often should I do my exercises?

Practise pelvic floor contractions (as explained previously) three times a day. Make sure you do the contractions properly every time. It is a good idea to have something that reminds you to do your exercises. Doing them after meals or after passing urine may help.

If you are doing these exercises to improve your bladder or bowel control, you should do them for the rest of your life. If you stop exercising, your problems may return.

Do not expect instant results!

It will take several weeks of regular exercise to regain the strength in your pelvic floor muscles.

There are various devices on the market that your physiotherapist can help you with that can support the bladder neck and reduce leakage with exercise. Seeking guidance from a Woman’s Health physio is a great place to start.

Mix up the surfaces you are running on i.e. trails and grass, as compared to cement paths or tarmac roads. More importantly change the way you hit the ground and what your strike pattern is will have the greatest effect. Run softly and quietly, more Ninja and less elephant! Shorten your stride length to bring initial contact beneath you (rather than in front) and slow down slightly.

Avoid running very fast down hill as you tend to over stride and hit the ground hard, and stop running before your pelvic floor and abdominal muscles start to fatigue, putting you at risk.

Managing your body weight so there is less weight pushing down on your pelvic floor can help. It’s often best to do a run/walk programme to start as this way your pelvic floor muscles will gradually build up to the stresses and strains you are putting in them. Look for a beginners running class to help you with this.

Make sure the control of the deep abdominals are there, and do a class every week that makes these work to support you when you are running. Doing exercise that challenges your stomach, glutes and pelvic floor is a great adjunct to running. Running itself will not improve this group of muscles.

Bear in mind that over-tightening your upper abdominals may also cause a pushing effect into the pelvic floor making you bear down on your pelvic floor putting more pressure on it. This and the complexity of pelvic floor issues means it’s often best to have guidance from a health professional which brings us to our last point…

Seek help, do not suffer in silence!

Jayne Nixon, Clinical Specialist Physiotherapist, Manor Clinic and The Running School Kent, Sevenoaks, Kent.


  1. Excellent article. Thank you Jayne and Tom for bringing this sensitive but highly important topic into the public consciousness. Funnily enough we were discussing this very topic at a netball committee meeting this morning. It’s a very common problem yet women suffer in silence and don’t realise they are not alone and that it can improve. We need to talk about it more! I shall be sharing this article with my netball club!

  2. The more we talk about incontinence, the more women will seek help. I talk about this issue with my patients as well as with my yoga / Pilates class participants when I teach. I agree with Jayne – seek help, don’t suffer in silence. For those who want more info before seeing a physical therapist, check out Julie Wiebe’s website and youtube channel for videos discussing pelvic floor exercise, etc. She even has a DVD that can explain this whole thing to those who are not able to find a qualified PT. http://www.juliewiebept.com. Thanks Jayne and Tom for posting on such an important topic!

  3. Thank you so much for posting this. I work with a ton of athletes. Many of which do crossfit as part of their conditioning and cross training. Around a year ago, a video came out making fun of incontinence. Feel free to see it yourself. https://www.youtube.com/watch?v=UKzq1upNIgU&feature=youtu.be

    From what I am seeing here, it seems that best way to fix this issue is the basic kegel exercise or strengthening of the Uddiyana Bandha [yoga technique]. Simply increasing the contraction of the lower pelvis. Please let me know if that is correct.


  4. Thank you for drawing attention to this very important issue. I am a pelvic health and orthopaedic physiotherapist, and would like to add some further encouragement for runners experiencing urinary incontinence. If performing these exercises do not solve the problem, an assessment with a pelvic health physiotherapist may be helpful. Often, there is an imbalance of the muscles of the pelvic floor such that some muscles are weak and need to be strengthened, and others are tense and would benefit from softening – balancing this out often the key to solving the problem. Also, a pelvic health physiotherapist would be able to provide more specific cues that are often developed with the patient while the physio palpates the desired muscle internally – that way, the runner will know that a particular cue is definitely activating the muscle that is being targeted.

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