Stress incontinence in women runners: the issue nobody talks about

Many women runners suffer the embarrassment of stress urinary incontinence or bladder leakage when they run, and are too embarrassed to discuss it with either their doctors or their friends. The problem affects women of all ages, and may or may not be related to childbirth. For some women, sanitary products provide some security, but for others the risk of embarrassment may discourage them from running, at least with other people. So what can female runners do about stress incontinence? 

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We spoke to Stephanie Reynolds, a core exercise specialist and certified yoga teacher in Peterborough, Ont. In response to a high demand for expertise in pelvic floor health, Reynolds opened The Willow Studio, a yoga, fitness and Pilates studio that specializes in this area, earlier this year. She recommends pelvic floor physiotherapy for any woman dealing with stress incontinence. A pelvic floor physiotherapist is a physiotherapist with additional training in pelvic floor health, and can diagnose and treat related issues, including stress incontinence.

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“A lot of women brush it off when they leak, or think it’s just a normal part of childbirth or aging,” says Reynolds, “but there is something that can be done about it.” While pelvic floor health is a huge subject, simple stress incontinence without urgency (i.e. bladder leaks when running, or even sneezing or coughing, not accompanied by the sudden urge to pee) is usually caused by weak pelvic floor muscles. A weak pelvic floor may result from childbirth, though the issue affects many women who have never given birth, and in some women it appears only after menopause. 

With stress incontinence, usually the pelvic floor can be strengthened by doing exercises like Kegels. (Kegels are done by contracting and holding the pelvic floor muscles, as if trying not to pee, and then relaxing them. They can be done anywhere, with complete discretion. Kegels are often recommended to pregnant women to reduce the risk of developing stress incontinence after childbirth.)

When stress incontinence is accompanied by other symptoms such as sudden urgency, the cause and treatment may be different. Sometimes the pelvic floor muscles are actually too tight, and exercises are combined with breathwork to help relax them. Sometimes the internal organs are prolapsed. If the exercises recommended by the pelvic floor physio don’t produce the desired result, in some cases, surgery to instal an artificial mesh sling (to hold the internal organs in place) is the best option.

Reynolds explained that, while not exactly new in Canada, pelvic floor physiotherapy is less common here than in Europe, though there are pelvic floor physios in most Canadian cities. Like regular physiotherapy, pelvic floor physiotherapy is not covered by most provincial health plans. (It may be covered by private insurance, though in some cases a doctor’s referral is necessary in order to claim benefits.)

You should be able to search your provincial college of physiotherapists online to find one with pelvic floor health specialization in your area.