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Why Do I Pee When I Run? Here’s How To Stop Urinary Leaks While Running

Don’t stop running because of urinary incontinence. Here’s how to fix leakage while on the run. Spoiler alert: it’s not just Kegels.

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If running makes you feel self-conscious due to urinary leakage, you are not alone. In fact, 47 percent of women who exercise regularly struggle with urinary incontinence. Stress Urinary Incontinence (SUI)  is urine leakage with during activity. Kegels, a common pelvic floor exercise, are a first-line exercise for those with stress incontinence. Kegels are performed by contracting the pelvic floor in an upward direction as if stopping urine flow. While they are an important pelvic floor exercise, resolving urinary incontinence during high-impact activity like running goes way beyond kegels. 

Here’s how to stop peeing while running and urinary incontinence.

Four common modifiable stress urinary incontinence contributors include: 

  1. Sacroiliac joint imbalance
  2. Inner thigh and pelvic floor trigger points
  3. Contracting the abdominal muscles without co-contracting the pelvic floor
  4. Muscle fatigue, especially in fast-twitch muscle fibers used while running 

These underlying issues guide a pelvic floor stability cross-training program to decrease the leak.

Step 1: Exercises for the sacroiliac joint imbalance – perform before you run

Your sacroiliac (SI) joints are the link between your low back and pelvis. You have two of them: a right, and a left. When the right and left SI joint are unequal, one leg behaves as if it is longer than the other. When one leg functions as if it is longer than the other, force from walking and running moves up through the right and left halves of the pelvic floor unequally. Over time, this contributes to pelvic floor dysfunction. 

You can improve your SI joint alignment pre-run with a three-exercise sequence that takes less than three minutes. 

Exercise 1: Adductor ball squeeze

  1. Lie on your back with your feet on the floor and knees bent approximately 90 degrees.
  2. Place a squishy ball, such as a kid’s playground ball, between your knees. 
  3. Engage your core to flatten your low back toward the ground.
  4. Use your inner thigh muscles to gently squeeze your knees into the ball. 
  5. Hold the squeeze for 30 seconds. 

If you hear or feel a pop sound/sensation in the front of the pelvis, do not be concerned (even if it creates a momentary sharp discomfort). When the front of the pelvis (pubic symphysis) is out of line, the adductor ball exercise often re-aligns it. 

If you do not have a squishy ball, use a foam roller, yoga block, or folded pillow instead. 

Exercise 2: Tabletop legs isometric

  1. Lie on your back with your hips, knees, and ankles each at 90 degrees; this is called the tabletop leg position. If this position strains your low back, you support your feet on a chair, stability ball, or the wall. 
  2. Tighten your core to flatten your back toward the floor. 
  3. Perform a kegel by pulling your pelvic floor up toward your head.
  4. Place your left fingertips on the top of your left thigh. Place your right fingertips on the back of your right thigh. 
  5. Maintain your core and pelvic floor engagement and keep your legs completely still as you apply very gentle pressure from your fingertips into the areas that they are touching on your thighs. It is as if your fingers are trying to push the legs out of position, but the core and legs push back. This creates an isometric contraction, meaning, the muscles work without big movements. 
  6. Hold for 30 seconds, then repeat on the other side. 

Resist the temptation to push too hard with your hands. This exercise only works for pelvic rebalancing when it is performed gently. 

Exercise 3: Twisted flamingo isometric

  1. Lie on your back, then bend your left knee to hook your left foot behind your right knee. 
  2. Try to keep your shoulder blades flat on the ground as you bring your left knee across your body. Do allow the pelvis to rotate.
  3. Place your right hand on the outside of your left thigh. 
  4. If this position feels like an intense stretch, stop here. Breathe and stretch for 30 seconds. If you are ready for more, continue with the next step. 
  5. Contract your core and your left deep buttocks muscles to gently push your outer left thigh up into your right hand. Keep the pressure between the hand and thigh gentle. 
  6. Hold for 30 seconds, then repeat the exercise with the right knee crossed for the other side.  

Like the tabletop legs isometric, this exercise is isometric too. If the right and left sides feel unequal, that is O.K.; work within the range you have on any given day. It takes some women several months to equalize the right and left sides. 

Step 2:  Inner thigh and pelvic floor trigger point release – perform before you run

Imagine a knot tied in a stretchy piece of fabric. When you stretch the fabric, the knot doesn’t stretch. When you let go and watch the stretched fabric recoil, the knot doesn’t recoil. Your body’s muscles and fascia act the same. Knots (also called trigger points) neither stretch, nor contract. Yet running is a sequence of stretching and contracting muscles. This sequence of pelvic floor stretching and contracting keeps abdominal contents properly buoyant, as opposed to pressing down on urinary structures. 

Inner thigh and pelvic floor muscles commonly develop trigger points when they are asked to perform large amounts of work, such as in running. Releasing the trigger points pre-run prepares the muscles to dynamically support the pelvic floor.  You can release the trigger points with two exercises in less than two minutes. 

Exercise 1: Sit on a half foam roller

  1. Put a half foam roller on a chair. The round side should be up, and the flat side should be down. 
  2. Put your pelvic floor directly on top of the roller as you sit upon it. If you do not have a half roller, you can sit upon a whole roller or a medicine ball placed on the ground.
  3. Allow your pelvic floor to relax as it is being released by the object you are sitting on.
  4. Sit and breathe for 30-60 seconds. 

Exercise 2: Inner thigh roller release 

  1. Put a foam roller on the floor.
  2. Lie face down and position one inner thigh on top of the roller.
  3. Roll back and forth until you find a tender spot in the inner thigh muscles.
  4. Once you find a tender spot, hold still for 30-60 seconds, allowing the tension to melt as you breathe.
  5. Repeat on the other side. 

You could alternatively use a roller stick on the inner thighs, slowly rolling up and down the inner thigh for 30-60 seconds. You may discover you have multiple trigger point spots, and they may shift from day to day. This is normal. Focus on one to three spots per day.

Step 3:  6-Minute cross-training routine level 1

The trunk makes up just over 50 percent of our body’s weight. As we run, the abdominal contents bounce up and down upon the urinary bladder; this forces the abdominals and pelvic floor to respond by contracting. They don’t just stay contracted, but rather act more like a trampoline, alternating between various stages of contraction and relaxation. Even though both the abdominal and pelvic floor muscles contract, they don’t necessarily contract at the same time. The desired simultaneous contraction is called co-contraction, and it can be trained with six exercises in six minutes. 

Exercise 1: Ball squeeze bridge

  1. Lie on your back with your feet on the floor and knees bent approximately 90 degrees.
  2. Place a squishy ball, such as a kid’s playground ball, between your knees. 
  3. Press your upper arms into the ground to help the backside of your core engage. 
  4. Engage your core, pelvic floor, and inner thigh muscles to squeeze your knees into the ball. 
  5. Without letting go of the ball, squeeze the glutes. Use the glutes to lift the hips any amount off the floor. If your low back arches, or your hamstrings cramp, you have gone too high. 
  6. Hold at the top of the motion for two seconds, then lower down until the pelvis is resting on the mat in the starting position. 
  7. Re-engage the core, pelvic floor,  inner thighs, and glutes to perform the next repetition. 
  8. Repeat the process for 10 repetitions, always resetting the muscle engagement at the beginning of every repetition. 

Exercise 2: Glute band bridge

  1. Follow the instructions from the ball squeeze bridge, but use your deep hip rotators to gently push out into the band before you bridge, as opposed to using your inner thighs to squeeze a ball. 
  2. Repeat the process for 10 repetitions, always resetting the muscle engagement at the beginning of every repetition. 

Exercise 3: High plank knee to opposite elbow

  1. Begin in a plank on your hands. Actively push the palms and fingertips into the floor to stop the shoulder blades from winging; the shoulder blade muscles are part of your core support too!
  2. Keep your back flat as you do a kegel and pull your belly button toward the spine.
  3. Bring your right knee toward your left elbow. Get as close as you can while maintaining the plank position. Hold the end position for two seconds, then return to the starting plank position. 
  4. Re-engage the shoulder blade muscles by pushing more into the floor, then repeat on the other side. 
  5. With every repetition repeat the conscious muscle re-engagement. Repeat for 10 total repetitions (five per side), alternating sides. 

Exercise 4: Kneeling chop

  1. Begin kneeling on the right knee, with the left foot forward. Keep your ears over your shoulders, shoulders over your hips, and hips over your supporting knee to maintain tall posture throughout the exercise. 
  2. Hold a light ball or dumbbell (no more than 10 pounds) with both hands in front of your right hip. 
  3. Perform a kegel. At the same time contract your core and buttocks muscles. Keep all of these muscles tight throughout the motion. 
  4. Keep your hips facing forward as you rotate your chest, shoulders, head, and the ball toward the high left diagonal. 
  5. Keep the pelvic floor, core, and glutes engaged as you return the ball to the start position.
  6. Re-engage the key muscles as you initiate every repetition.
  7. Perform 10 repetitions, then give the other side a turn. 

Exercise 5: Plié squat

  1. Hold a medicine ball, dumbbell, or kettlebell between your hands at chest level. Start with a weight no more than 10 percent of your body weight. 
  2. Place your feet slightly wider than squat stance; turn your feet out to the ten o’clock and two o’clock positions in preparation for a plié squat. You can find the right amount of foot rotation by watching your knee. Throughout the plié squat, your kneecap should stay in line with your second toe. If your knee falls inward of your second toe, adjust your feet to make them more parallel. 
  3. Perform a kegel and maintain the kegel throughout the plié squat. 
  4. As you lower into the plié squat, imagine your sits bones and knees being pulled in opposite directions like taffy. Keep your heels on the ground as you lower to the point that you know you can successfully get back up. 
  5. Initiate the ascending phase by further pulling upward in your kegel muscles and imagining your sits bones coming back toward the center of the pelvic floor. 
  6. Re-engage the pelvic floor at the start of every repetition to perform 10 repetitions. 

Exercise 6: Medicine ball monster walk 

  1. Hold a medicine ball, dumbbell, or kettlebell between your hands at chest level. Start with a weight no more than 10 percent of your body weight. 
  2. Place a lightweight stretchy band around your thighs just above your knees. 
  3. Engage your core, kegel muscles, and deep gluteal muscles (external rotators) to gently press your outer thighs into the band. Your knees and toes should both be facing forward. Your knees and hips should be flexed approximately 30 degrees. 
  4. Perform 10 side steps to the right, then 10 side steps to the left. Throughout the entire motion, there should be some degree of tension in both your band and key muscles. 
  5. Repeat the exercise for one more set to each side in more of a squat position. 

Consistency leads to quicker results, so try to perform the pelvic floor cross-training routine at least two days/week. If time allows, perform the routine daily. 

Step 4: 6-Minute cross-training routine level two

Teaching muscles slow controlled contraction is the first step. Once you can perform the level one cross training routine without urinary incontinence, progress to level two. Level two focuses on the fast-twitch muscle fibers required for running. 

Level two exercises build on level one exercises with one slight upgrade: speed! Follow the instructions below to incorporate pelvic floor – abdominal co-contraction speed into each exercise. 

Exercise 1: Ball squeeze bridge with pulse

Perform the ball squeeze bridge with one addition: At the top of the bridge, gently pulse the knees into the ball 10 times during each repetition. 

Exercise 2: Glute band bridge with pulse

Perform the ball squeeze bridge with one addition: At the top of the bridge, gently pulse the knees outward into the band 10 times during each repetition. 

Exercise 3: Cross-knee mountain climber

Perform the high plank knee to the opposite elbow quickly as if performing a mountain climber. 

Exercise 4: Fast kneeling chop

Keep your back safe by holding a very lightweight, such as a kid’s playground ball or yoga block, for the fast version. Perform the kneeling chop with a fast upward motion, then a slight pause, then a fast downward motion. 

Exercise 5: Jumping plié squat

Perform the plié squat, then accelerate toward the ascent to perform a small jump at the top of each repetition. 

Exercise 7: Banded shuffle 

Perform each version of the monster walk quickly, adding a little bounce to transform the movement into a shuffle instead of walking steps. 

The rate of progression from level one to two is highly variable. Some women work diligently on phase one for several months, while others progress to phase two within a few days. Since each woman has a unique anatomy and an individual history, no single factor predicts progression speed. Like the level one pelvic floor program, level two delivers faster results if performed most days of the week. 

Beyond Kegels – Other Ways To Strengthen Your Pelvic Floor For Running

Your cross-training efforts don’t stop when your run starts. As you run, position your pelvic floor for success. When fatigued, runners often compensate by overstriding or tipping their pelvis forward into an anterior tilt. Both of these compensations contribute to pelvic floor dysfunction

Pelvic anterior tilt disengages the pelvic floor and core muscles that you have worked so hard to train. Instead of allowing the tip, think about pulling your abdominals upward to decrease the tilt as you fatigue. 

Like marathon training, results are not instant. Pelvic floor cross training and conscious running technique are practiced consistently over time for a gradual leak reduction. If, after 3 months of consistent practice, you still experience the same amount of urinary incontinence with running, consider consulting with a Physical Therapist who specializes in pelvic floor health for a more individualized assessment and approach. 

Finally, before you leave this article, bookmark it, share it, or save it so you know how to cross-train your pelvic floor every day. 


Dr. Meredith Butulis, DPT, PT, CSCS is a licensed sport and orthopedic physical therapist, certified exercise physiologist, strength and conditioning coach, personal trainer and yoga/Pilates instructor practicing since 1998. She is the creator of the ISSA Fitness Comeback Coaching Certification, author of the Mobility | Stability Equation Series & Stop Joint Wear and Tear books, and host of The Fitness Comeback Coaching podcast.


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