Nov 10

Are you running with incontinence?

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Sorry to say this, but… please don’t!

It isn’t easy to be told that you should stop doing something that is so intrinsic to your physical and mental wellbeing. Many women we meet, see running as an amazing release and a core part of looking after their mind and body. But please remember, that although you should stop running whilst you are struggling with incontinence, it doesn’t have to be forever.

What to do if you are struggling with incontinence

There is so much you can do to ensure that your pelvic floor is supporting you effectively. Sometimes it just requires a few weeks of focusing on other types of exercise to encourage your core to support you more productively. Once you know that a few simple movements are easily do-able, you can go back to doing what you love – without the wet pants!

Running heavily impacts your core. Each time your heel strikes, a huge load moves through your body and, if your pelvic floor is struggling, this really needs to be addressed.

Einstein gave the definition of insanity as “doing the same thing over and over again and expecting different results”. And, forgive us for saying this, but we see a lot of people who fall into this bracket!

Many women think that incontinence will get better as their children grow up, but this is rarely the case. If anything, our pelvic floor health tends to decline with age. As we hit menopause and oestrogen levels drop, pelvic floor trouble becomes prevalent, in fact over 50% of women over 50 have a degree of prolapse.

Increasing your understanding of the way you use your body and growing your knowledge of what you can do to help it, can only be a positive thing.

If you would like more guidance of what is and isn’t advisable in this area, the ‘Returning to Running Postnatal Guidelines’ are an excellent starting point. These guidelines were written by two women’s health physios who were frustrated by the frankly abysmal postnatal guidance that was previously available, and they are applicable to all women, whatever age your baby is.

Here are some important recommendations from these guidelines:

  • Individualised care is important, if you can visit a women’s health physio it is highly recommended. Rather than generalised advice, you will be able to understand exactly what is happening in your pelvic floor.
  • It is not advisable to run before 3-months postnatal under any circumstances, and if you are experiencing any symptoms of pelvic floor dysfunction then you shouldn’t be running at all, no matter how old your baby is.
  • Symptoms of pelvic floor dysfunction can include urinary/faecal incontinence, urinary /faecal urgency, heaviness, pressure, bulging or dragging in the pelvic area, pain during intercourse, obstructive defecation, bulging of the abdominal wall, abdominal separation and lower back pain.

When it comes to pelvic floor health, you should always err on the side of caution as any stresses to this area can have lasting a impact on the way your body functions.

* Other risk factors for returning to running include hypermobility, breastfeeding, previous pelvic floor conditions or issues/pain in the pelvis and lower back, obesity, a caesarean birth or perennial scarring and vaginal bleeding that isn’t related to your menstrual cycle.

Our top tips on getting yourself ‘running ready’

1. Sleep

It is difficult to say this to parents, as sleep is at such a premium for everyone, but please be kind to yourself and, if you are sleep deprived, do not feel under any pressure to get back to exercise. Sleep is absolutely vital to allow your body to recover from both physical and psychological stress. There is a clear link between increased injury risk and sleep deprivation in athletes (Milewski et al. 2014). Sleep deprivation lowers your general health and increases stress levels as well as impairing maximal muscle strength (Biggins et al. 2017, Knowles et al. 2018). If you aren’t getting 7-9 hours a night, it is more than okay not to be pushing yourself physically.

2. Fitness

Your fitness needs to be considered as low fitness levels will make running more difficult. It is really important to ensure you have a safe and appropriate build up to exercise. Our Centred Mums in Motion online pilates classes are all about building up your fitness in a safe and individualised way. The structure of our classes depends on your birth experience, the way your body works and the pace at which you are able to progress. Everyone is different and there is no hurry!

3. Breathing

It is important to establish a good breathing strategy to allow your core to work in the most effective way. In order for your body to function as its best, there needs to be synergy between your diaphragm, abdominals and pelvic floor. You should build up to pushing your breath by starting at a slow pace that allows you to have a conversation while running.

4. Psychological status

If you are having problems with your mental health, exercise can be a great way to support yourself. But, if your body isn’t quite ready to add running into the equation, it is worth being aware of other coping strategies. Relaxation, mindfulness and lower impact exercise like Pilates are great ways to look after your mental state. Speaking to a therapist or counsellor, can also make a real difference.

5. Supportive clothing

A 2019 study showed that supportive underwear could be almost as effective as pelvic floor muscle training – although this wasn’t in relation to high impact exercise, it is definitely worth considering whether you can gain extra support from your pants! A professionally fitted sports bra will also give you increased support and ensure that your breathing is not restricted by your

clothing. It is important to make sure that your leggings are not over-tight around the waist and causing extra pressure by bearing down on your pelvic floor.

6. Supportive footwear

It is common for shoe size to change during pregnancy, so you may find that you no longer have a good fit in your pre-pregnancy running shoes. You can get your gait analysed to ensure you have the support you need from your footwear.

7. Breastfeeding

Whilst breastfeeding shouldn’t put you off returning to running, it is worth taking your breastfeeding status into consideration when planning to exercise. It is important to ensure that you are making your pelvic floor health a priority and that means staying educated about the risks. Breastfeeding keeps your hormones from returning to their pre-pregnancy state, meaning lower levels of oestrogen and the possibility of increased relaxin levels. The overall hormone levels when breastfeeding, and up to 3 months after weaning, can increase the risk of developing an injury or dysfunction, including prolapse or pelvic floor dysfunction.

8. Scar mobilisation

No matter what kind of birth you had, if you have any scarring – either due to a caesarean, episiotomy or tearing – it is really useful to consider scar mobilisation to prevent the potential pain and restriction that scarring can cause. Everything in your body is connected and changes in the tissue around your scar can impact the function of tissues and structures throughout your whole body. Following a caesarean birth; your digestive, urinary and reproductive systems can all be impacted by your scar. (Comesaña et al. 2017). Scar mobilisation or scar massage can reduce inflammation and fibrosis; and improve tissue remodelling. (Benjamin et al. 2008; Bouffard et al. 2008). We regularly refer clients to www.scarworktherapy.com and have only ever had fantastic feedback about their effect on a caesarean scar.

9. DRA

Specialist pelvic health physios agree that it is important to regain functional control of your lower abdominal wall before you start running. It is vital to be able to control the pressure created in the abdominals (IAP) before you add any extra load due to the impact this could have on the pelvic floor. Although not widely researched, abdominal separation should definitely be considered due to potential risk of pelvic floor dysfunction. When exercising, you need to be able to maintain your ability to control IAP and avoid doming in the abdominals.

10. Weight

If you are overweight, this can also increase the load on your pelvic floor. If you have a BMI >30, you are considered at a higher risk of pelvic floor related symptoms (Pomian 2016), and it is advisable to opt for low impact exercise, to help reduce the load on your pelvic floor. Due to pelvic floor impact, and the increased risk of musculoskeletal injury (Nielsen et al. 2013), it is recommended that weight management is addressed before you return to running. There are many ways to address your weight before you begin running, and you will never regret taking good care of your pelvic floor.

The Returning to Running Guidelines have set a series of markers to assess whether you are fit to return to this high impact exercise. These should be able to be done without pain, dragging, heaviness or incontinence before you return to running.

  • Walking for 30 minutes
  • Single leg balance for 10 seconds
  • Single leg squat – 10 repetitions each side
  • Jogging on the spot for 1 minute
  • Forward bounds – 10 repetitions
  • Hop in place – 10 repetitions each leg
  • Single leg ‘running man’: with bent knee and opposite arm and hip flexion/extension – 10 repetitions each side

To build up strength for running it is also a good idea to be able to do 20 reps of the following exercises:

  • Single leg calf raise
  • Single leg bridge
  • Single leg sit to stand
  • Side lying abduction

As mentioned above, building up to running is extremely important. We highly recommend using a tool like the Couch to 5k app to allow you to build up slowly and ensure you are not experiencing any negative effects from your running programme.

We strongly encourage you to see a Pelvic Health Physio for more support if you feel you need it, or if you are experiencing ANY of the symptoms mentioned in this blog.

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