The Runner’s Guide To Pelvic Floor Pain

Running is a high-impact activity and though it has countless benefits, it can also be hard on the body. From musculoskeletal skeletal injuries to digestive distress, there are quite a few common struggles runners face.

Pelvic floor pain also plagues many runners. While it might not be as comfortable to talk about with your running friends as shin splints or plantar fasciitis, if you’re dealing with pelvic floor pain or dysfunction on your runs, you’re not alone.

This kind of pain and dysfunction during running is particularly prevalent in postpartum women, although it can affect any runner of either sex. Fortunately, while there is usually no “quick fix” for pelvic floor dysfunction, there are some steps you can take to prevent and mitigate issues while running.

Keep reading for our runner’s guide to pelvic floor pain and start working your way back to comfort and ease in your running stride.

What is the Pelvic Floor

The pelvic floor refers to a group of muscles that span the bottom of the pelvis in a hammock-like arrangement. The pelvic floor muscles together support your bladder, bowel, and uterus. They hold the pelvic organs in place and allow you to control the flow of urine and the excretion of feces and gas.

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The pelvic floor muscles form the bottom of your core muscles. They are sometimes grouped in with deep core muscles and can be strengthened through exercises like kegels and deep breathing.

How Does Running Affect the Pelvic Floor?

The pelvic floor is an integral part of your core, forming the base of that system of muscles. Therefore, it plays a role in every phase of your running stride. When your foot lands, the pelvic floor contracts and shortens (concentric contraction) to cradle and support the load of your abdominal cavity and pelvic organs. As you push off and are in the flight phase of running, the pelvic floor muscles lengthen (eccentric contraction).

Because running requires constant and full contraction of the pelvic floor muscles, having full range of motion and adequate strength is vital to prevent pelvic floor pain and dysfunction.

What is Pelvic Floor Pain in Runners?

Pelvic floor pain in runners can vary in presentation from vague discomfort to sharp pain, and in location from anywhere in the lower abdomen, to bladder pain, to anal pain. Some runners also experience referred pain in the hips, butt, or hamstrings.

Pain is thought to occur as a result of the jostling, impact, and load of running on the muscles of the pelvic floor, which can develop trigger points. Trigger points then cause pain and/or neurogenic symptoms just as the sudden need to pee or a feeling of GI distress. 

Interestingly, the pain while running can stem from trigger points, weakness, or dysfunction in the pelvic floor muscles themselves or can be  referred from surrounding muscles, ligaments, bones, and connective tissues. For example, runners with tight adductors (the muscles on the inner thighs) may experience pain in the pelvic floor when running.

Signs of Pelvic Floor Dysfunction in Runners

Pain is just one sign of pelvic floor dysfunction. Even if you don’t have pain while running, you may still have an issue. The common signs and symptoms of pelvic floor dysfunction in runners include the following:

Pelvic Floor Pain

Pain is one of the most common signs of pelvic floor dysfunction in runners. As mentioned, runners can experience pain as more of a cramping, GI-distress sort of pain or sharper pain in the crotch, or anything in between.

Urinary and/or Fecal Urgency

If you find yourself needing to plan your running routes around bathrooms to ensure you’ll be able to finish the run dry, you might be dealing with pelvic floor dysfunction. 

Moreover, if the need to go comes on suddenly, and if you don’t end up voiding much when you actually find a port-a-potty to dash into, you’re experiencing urgency while running.

Running can cause urgency because it stimulates active myofascial trigger points in your pelvic floor muscles, which cause neurogenic bladder symptoms. In other words, running activates your pelvic floor muscles in a way that tricks your brain into sending signals that you have to pee.

Urinary and/or Fecal Incontinence

A tell-tale sign that your pelvic floor muscles aren’t working properly is leaking urine, feces, or flatulence while you run. Whether your running shorts are damp with just a few dribbles of pee or soaked through, leakage is a sign that your pelvic floor muscles are weak. 

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Studies show that about 41 percent of female athletes have experienced urinary incontinence during exercise. 

Pressure or Heaviness

Some runners note a feeling of pressure or heaviness in the lower abdomen or pelvis when they run. This uncomfortable sensation can be a warning sign of pelvic organ prolapse, which refers to the downward migration of one or more pelvic organs such as the uterus, bladder, or rectum. 

Running can increase the risk of pelvic organ prolapse because it significantly increases intra-abdominal pressure. In order to safely accommodate the rise in intra-abdominal, your pelvic floor muscles, ligaments, fascia, and other connective tissues must be strong and robust. 

If your pelvic floor muscles are weak, overtime, they can fail and your pelvic organs can prolapse.

Core Instability and Weakness

Many runners think of the core as just the abs and obliques, but the core actually extends from the diaphragm all the way down to the pelvic floor in a 360-degree arrangement. 

Runners who experience core instability and weakness, particularly in the lower core, should address the pelvic floor in their core exercise routine.

Risk Factors for Runners

Risk factors for experiencing pelvic floor pain while running include the following:

1. Pregnancy. Pregnancy hormones and the weight of the uterus during pregnancy can overstretch and weaken the pelvic floor muscles.
2. Childbirth. Vaginal delivery increases the risk of pelvic floor dysfunction because the muscles can get significantly stretched or experience other trauma and injury during delivery.
3. Menopause. As hormone levels drop, pelvic floor muscles can become weaker and less responsive to voluntary control.
4. Running. Unfortunately, running itself increases the risk of pelvic floor pain, as the impact and stress transferred to the pelvic floor muscles causes the formation of trigger points and can weaken the muscles.

How to Reduce Stress While Running

Exercises like kegels and deep core stabilizing exercises strengthen your pelvic floor muscles. And there are a few things you can do to reduce the stress on the pelvic floor while running:

• Run on softer surfaces like grass and trails
• Shorten your stride length
• Reduce your mileage
• Slow down
• Wear cushioned running shoes 
• Avoid downhills wherever possible

Finally, low-impact cross-training can reduce the pain while you work on building up strength in weak pelvic floor muscles.

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