“What fresh hell is this?” Runner’s World said, as Liz B. pondered this question five months postpartum while jogging four miles on a cold December evening.
The 36-year-old physical therapist from central Ohio leaked urine 2.7 miles into her route. Pelvic floor dysfunction affects 25 million adult Americans, with research showing 1 in 3 women and 1 in 6 men experience it in their lifetime.
High-impact physical activity exacerbates these issues because the pelvic floor repeatedly absorbs impact and dampens vibrations during running, according to Julie W. Wiebe, a Los Angeles physical therapist who specializes in returning women to fitness after injury and pregnancy. “Running creates an added challenge to your pelvic floor beyond the movements of everyday activities,” explained Carrie Pagliano, a pelvic floor specialist based in Arlington, Virginia.
“Once I had my baby, my pace slowed to a 10:30 mile, and if I ran under a 9:00, I’d pee my pants a little,” Liz told Runner’s World. Liz developed pelvic organ prolapse following a difficult labor, a condition where weak muscles allow organs like the bladder or uterus to drop.
Men also face severe pelvic floor complications from endurance training. Gordon Garner drove himself to the emergency room an hour after completing a 20-mile training run in Dallas when he lost the ability to urinate and experienced excruciating pain.
“I was in a world of pain when they put the catheter in,” Garner told Runner’s World after doctors ruled out kidney stones. Multiple misdiagnoses preceded an accurate assessment from a physical therapist who diagnosed a hypertonic pelvic floor, meaning the muscles were continuously contracting and refused to relax.
Garner scaled back his running, focused on stretching and breath-control exercises, and ran 40 miles in a 24-hour period in 2023 to celebrate his 40th birthday.
Colleen Quigley, a 2016 Olympian and steeplechase specialist, spent five years seeking relief from recurring foot, lower back, and hip pain after seeing more than 50 different experts.
An expert discovered that a jaw-stretching exercise designed to relieve tension simultaneously cleared the pelvic tension test results. “Jaw tension and pelvic floor tension have a relationship, it’s essentially both ends of the alimentary tract,” Wiebe told Runner’s World.
Liz ultimately worked with a therapist to establish a strength-training routine, allowing her to race her ninth marathon twenty months postpartum without leakage.
Kegels do not resolve every issue, especially for runners suffering from a hypertonic or overactive pelvic floor that cannot relax. Research highlighted in a 2021 Cureus Medical Journal meta-analysis determined that urinary incontinence can occur even in individuals with high pelvic floor strength.
Experts are only beginning to understand the impact of pelvic floor health on male athletes.
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