Your Pelvic Floor and Sports
“Does anyone else pee their pants when they run?”
The answer is yes - and trust me- you are not alone. Why is this happening? You have got to be so dehydrated by the time you get through the entire swim, the whole bike, and now onto the run; so why am I peeing my pants? Peeing of the pants during activity such as running is called Stress Urinary Incontinence (SUI) and this is very common. My first incidence of SUI was when I was 16 during a high school cross country meet. Thankfully, it was a race during the night, so only the poor girl running right behind me noticed. After I had let all the urine out of my bladder, I was able to then literally sprint the last mile of the race to the finish line, fueled solely by pure embarrassment.
At the bottom of our pelvic girdle lies a layer of muscles known as the Pelvic Floor Muscles (PFM). The PFM have slow twitch and fast twitch muscle fibers just like every other muscle in the body. These muscles work in conjunction with our lower abdominal muscles. Oftentimes, us stellar triathletes have a really strong core, but a not so strong pelvic floor. When there is this muscle imbalance, our core can usually take us through that last leg of the triathlon or the last mile of the running race, but our PFM may fatigue out. Most of us triathletes also have a lot of slow twitch muscle fibers, but not as many fast twitch fibers. So when we have that pounding force on our pelvic floor, or that stress on our pelvic floor, our fast twitch fibers are not coordinating quickly enough to close off the urinary outlet (the urethral sphincter), leading to peeing our pants. Once the flood gates open, it’s very difficult to control the flow and close the sphincter. I had a few more incidents of complete bladder voiding during the runs of my collegiate triathlon races, and I could not wait to get to the finish line so I could find a water cup and pour it all over my body to try and ‘hide’ the pee. Occasionally, my ego would protect me and I would have a sense of pride and think, ‘well I crushed that race, so what if I peed my pants?!’ Well the answer to that is you can still be the stud triathlete you are, AND also not pee your pants!
The answer? Pelvic Floor Physical Therapy. Yes, you can go to PT for your vagina. Pelvic health specialists can assess the strength and coordination of your pelvic floor muscles and figure out why you’re having urinary leakage. The therapist will then give you a set of exercises to start out with and you will progress from there. SUI is one of the easiest diagnoses I treat and my patients usually start seeing improvement within a few weeks, IF you do everything I ask. It’s ‘Vagic’ baby.
So you may be wondering, what do I do?! Unfortunately the answer is a little more complicated than just to start doing kegels. This is because if your pelvic floor is hypertonic, or the muscles are too tight, doing kegels will actually make the problem worse. If your pelvic floor muscles are hypotonic, or too stretched out, then kegels will help. Whether your muscles are presenting as too tight or too stretched out, they can still be very weak and not coordinate appropriately.
Here are some helpful tips to get you started. If you don’t see results in a few weeks, I would highly recommend seeking out your local pelvic floor physical therapist for further assistance! Happy Training!
How to figure out if your muscles are too tight or too stretched out
Hypertonic (tight muscles): do you have any vaginal pain? Is it painful to have intercourse or insert a tampon? (The vagician can help with this too, but that’s another topic we can address later!) Have you had any physical or sexual trauma in your life? Does the thought of any vaginal penetration kind of make you cringe in fear due to pain? Do you feel like you have to push to urinate or strain for bowel movements? If you answer yes to any of these questions you may be on the hypertonic side.
Hypotonic (stretched out muscles): Do you have NO pain with vaginal penetration, intercourse, and tampon usage? Have you had babies and been able to resume penetrative sexual intercourse with no pain? Does sexual intercourse seem less sensitive than before? If you answer yes to these questions you may be on the hypotonic side.
My muscles are too tight! Help!
So, if your muscles are too tight, they can still be weak. Imagine if your fist was scrunched into a ball, your hand isn’t going to be very functional. Same concept with your pelvic floor.
Take a pillow and fold it in half and sit on it like you sit on a bike saddle. Straddle that baby. Do you feel your perineum (the area between the vaginal opening and the anus) touching the pillow? Good. Now imagine your perineum as an elevator. Right now you're at the lobby level. Imagine you are trying to stop the flow of urine; you should start to feel your perineum lift off of the pillow. The elevator is going up. You’re doing a kegel! Great! Now, let it go and come back down to the lobby level. Next, try and relax those muscles as best as possible and do a very gentle push with the perineum into the pillow. I call this the basement level. Hold at the basement for 5 seconds, and then return to the lobby. Repeat this step 10x, 2x a day, every day.
Taking baths, stretching your adductors, hamstrings, hip flexors, and gluteal muscles will also help. Take some time to yourself to rest and relax. I know you’re training hard and working several hours a week and/or being a fantastic mother to your kids, as most of us triathletes do. Stress will increase tension in your pelvic floor, so relaxation is a key component to stretching out those muscles. I highly encourage meditation at least 5 minutes a day, which you can do while doing your pillow exercise!
After a week or two of this, start practicing your kegels throughout your day. Practice while you're driving or standing in line at the grocery store. Remember to go up the elevator and back down the elevator and give yourself at least 5 seconds of rest before going back up the elevator to do another kegel. Try to get in 30 kegels per day. Practice a mix of 1 second kegel holds and 5 second kegel holds. Do some in the morning, some during the day, and the rest at night.
My muscles are very stretched out. What do I do?
Imagine you are sitting at the dinner table with your favorite celebrity and your tampon starts to slip out. So you subtly try to kind of suck the tampon back into your vagina. Go ahead, practice this. Got it? Make sure you are not squeezing your butt muscles or contracting your core and only focusing on those muscles right around where that imaginary tampon is. You can also insert your thumb (make sure your hands are clean, cause you know, covid and stuff) and try to suck your thumb up and in. You should feel the muscles start to lift up and hug your thumb. Practice doing 1 second holds and then challenge yourself with a 5 second hold. After every kegel, make sure you relax for at least 5 seconds before doing another kegel.
You are a kegel master now! For the next few weeks you will want to start doing these kegels or PFM contractions every single day. Repetition is key here. So try your best to do 25 reps of the 1 second hold, and 25 reps of the 5 second hold. Practice in sitting while you're driving or standing while in line at the grocery store. Sprinkle them throughout your day (pun slightly intended).
Progress your exercises
Okay so you've been doing these exercises for a couple weeks now. Some of you may be noticing improvement and some may not yet. Don’t panic.
Start practicing doing kegels everywhere. Take a jump rope and contract your pelvic floor and see how many jumps in a row you can do before you start to notice leakage. Challenge yourself to 10 second kegel holds. Continue to mix up the 1 second holds and the longer 5-10 second holds. Shoot for 60 kegels total each day, half of them being the fast reps and half being the endurance holds.
At this point you should start to see some improvement with running and leakage. If you aren’t after 4 weeks, seek out your local pelvic floor physical therapist and they will be able to customize your treatment program for you.
Live dry, live happy. That’s the Power of Vagic.
Dr. Laura x