Stress Urinary Incontinence in Runners and Physiotherapy Management

Stress Urinary Incontinence in Runners and Physiotherapy Management

Running can be a liberating workout, but for some people, it’s interrupted by unexpected bladder leaks known as Stress Urinary Incontinence (SUI). SUI is prevalent among runners and is frequently caused by weakness in pelvic floor muscles.

Fortunately, our blog will shed light on how physiotherapy management is instrumental in overcoming this condition with the right strategies and techniques. Ready to conquer SUI and reclaim your run? Let’s go deeper into understanding and managing stress urinary incontinence in runners better!

Key Takeaways

  • Stress urinary incontinence (SUI) is a common condition experienced by runners, characterized by involuntary urine leakage during physical activity.
  • Weak pelvic floor muscles and increased intra-abdominal pressure are major factors in runners’ SUI.
  • Physiotherapy management plays a crucial role in treating SUI in runners, with pelvic floor muscle training being a key component of the treatment.
  • Other therapeutic modalities such as biofeedback, electrical stimulation, vaginal cones or weights, bladder training, and lifestyle modifications can also be used in physiotherapy management for pelvic floor dysfunction causing SUI in runners.
  • Challenges in managing SUI include identifying the exact cause of the condition, low adherence to exercises, coordination among healthcare professionals involved, and financial limitations for treatment options.
Understanding Stress Urinary Incontinence In Runners

Understanding stress urinary incontinence in Runners

Stress urinary incontinence in runners is a condition characterized by involuntary urine leakage during physical activity, caused by factors such as weak pelvic floor muscles and increased intraabdominal pressure.

Definition and causes

Stress urinary incontinence is a medical condition marked by unintentional urine leakage during physical activities such as running. This happens primarily due to the inappropriate levels of intraabdominal pressure that impairs bladder control, leading to an involuntary loss of urine.

In runners, repetitive impact and pelvic movement can trigger these leakages. The primary culprit behind this issue is the weakness or dysfunction in pelvic floor muscles responsible for supporting organs like the bladder and maintaining continence.

The root cause goes deeper – hypermobility of the bladder neck, and urethra often triggers these episodes in runners with stress urinary incontinence. Additionally, weight plays a pivotal role, with excessive body weight increasing abdominal pressure leading to stress on the pelvic floor muscles, thereby inducing symptoms of this disorder.

Hence, weight reduction can significantly improve or completely resolve stress urinary incontinence symptoms.

How it affects runners

Stress urinary incontinence can have a significant impact on runners, both physically and emotionally. When running, the repetitive impact forces put pressure on the pelvic floor muscles, which can result in bladder leaks during exercise.

This not only affects performance but also causes embarrassment and a loss of confidence for many male and female athletes. Studies have shown that female runners are especially prone to stress urinary incontinence due to their anatomy and the effects of hormone fluctuations.

However, it’s important to note that male runners can also experience this condition. Fortunately, with proper physiotherapy management, including pelvic floor muscle training and other therapeutic modalities, runners can effectively address stress urinary incontinence in women and men and regain control over their bodies.

Preventive measures

To prevent stress urinary incontinence while running, it’s important to take certain precautions. Here are some preventive measures you can implement:

  1. Maintain a healthy weight: Excess weight puts extra pressure on the pelvic floor muscles, increasing the risk of stress urinary incontinence. Losing weight and staying within a healthy BMI range can help alleviate symptoms and reduce stress incontinence.
  2. Strengthen your pelvic floor muscles: Regular pelvic floor exercises like Kegels and pelvic floor muscle strength training can help improve the pelvic floor muscles that support the bladder and control urine flow. Aim for at least three sets of ten repetitions per day of pelvic floor exercises.
  3. Gradually increase exercise intensity: Avoid sudden spikes in your running routine, as intense physical activity can strain the pelvic floor muscles. Gradually increase your pace and distance to allow your body to adapt.
  4. Low-impact exercises: Replace high-impact exercises like jogging and aerobics with strengthening exercises such as Pilates to strengthen your core muscles and alleviate stress incontinence.
  5. Practice good posture and breathing techniques: Maintaining a proper posture during running helps distribute forces evenly throughout the body, reducing strain on the pelvic floor muscles. Focus on diaphragmatic breathing techniques to enhance core stability.
  6. Bladder training: Following a schedule for toileting can help reduce the number or severity of urge incontinence episodes. Empty your bladder before starting any exercise session to minimize the risk of accidents.
  7. Well-fitted shoes and moisture-wicking clothing: Choose comfortable and well-fitted shoes and moisture-wicking clothing to keep you dry and comfortable during your run.
  8. Optimize hydration: Stay hydrated but be mindful of excessive fluid intake before running sessions to reduce bladder pressure. 
  9. Avoid bladder irritants: Limit the consumption of bladder irritants such as caffeinated drinks, citrus fruits, spicy foods, chocolate, milk, and carbonated beverages before running.
  10. Utilize menstrual products designed for active women: Choose menstrual pads or tampons specifically made for active individuals to provide better protection against leaks during exercise.
Physiotherapy Management For Runners With Stress Urinary Incontinence

Physiotherapy management for runners with stress urinary incontinence

Physiotherapy is essential for managing stress urinary incontinence in runners, with pelvic floor muscle training being a crucial component of the treatment. One important component of physiotherapy treatment includes pelvic floor muscle training.

What is pelvic floor muscle training?

Pelvic floor muscle training (PFMT) is a series of exercises designed to strengthen the pelvic floor muscles. These muscles support the bladder, bowel, and uterus (in women) or prostate (in men) and play a crucial role in maintaining urinary and fecal continence and sexual function.
PFMT involves repeating one or more sets of voluntary contractions of the pelvic muscles. By increasing muscle volume, PFMT elevates the pelvic floor and the pelvic organs, closes the levator hiatus, reduces the pubovesical length, and elevates the resting position of the bladder.

Importance of pelvic floor muscle training

Pelvic floor muscle training is essential to physiotherapy management for runners with stress urinary incontinence, as these muscles are crucial in supporting the pelvic organs and maintaining bladder control.

By strengthening the pelvic floor muscles, runners can improve their ability to handle intra-abdominal pressure during physical activities, reducing the risk of bladder leaks. Studies have shown that regular pelvic floor exercises can significantly alleviate symptoms of stress urinary incontinence.

It’s important to note that pelvic floor muscle training is a non-invasive and conservative treatment option, making it a preferred choice before considering more invasive interventions such as surgery for pelvic floor dysfunction.

Rehabilitation techniques used for stress urinary incontinence in runners.

Rehabilitation techniques can play a crucial role in physiotherapy managing stress urinary incontinence in runners. Here are some effective techniques that can help improve bladder control and reduce leakage episodes:

  1. Pelvic floor muscle exercises: Strengthening the pelvic floor muscles is essential for supporting the bladder and improving urinary control. This can be achieved through a series of exercises where you identify, contract and relax the muscles responsible for controlling urine flow.
  2. Biofeedback: Biofeedback is a technique that helps individuals become more aware of their pelvic floor muscles and learn how to control them effectively. It involves using sensors or visual cues to provide feedback on muscle activity, allowing runners to understand and engage their pelvic floor muscles better.
  3. Electrical stimulation: Electrical stimulation involves using low-level electrical currents to stimulate the pelvic floor muscles, helping to strengthen them and improve their function. This technique can particularly benefit individuals with difficulty identifying and activating their muscles voluntarily.
  4. Vaginal cones or weights: These devices are inserted into the vagina and require active contraction of the pelvic floor muscles to hold them in place, providing resistance training for the muscles
  5. Behavioural training: Behavioral training focuses on retraining the bladder by establishing regular voiding schedules and gradually increasing the time between bathroom visits. This helps to increase bladder capacity and reduce urgency symptoms, ultimately improving urinary control.
  6. Lifestyle modifications: Making certain lifestyle changes can also contribute to managing stress urinary incontinence. These may include maintaining a healthy weight, avoiding bladder irritants like caffeine and alcohol, practicing good hydration habits, and adopting proper techniques during physical activities such as running.
Barriers to successful physiotherapy outcomes for stress urinary incontinence

Barriers to successful physiotherapy outcomes for stress urinary incontinence

Several challenges are faced in managing stress urinary incontinence through physiotherapy, but these obstacles can be overcome with the right approach and dedication. Read on to learn about the barriers and how to navigate them and successfully achieve positive outcomes for your condition.

Challenges faced in managing stress urinary incontinence

Managing stress urinary incontinence can sometimes present challenges for both runners and physiotherapists. One of the main difficulties is identifying the exact cause of the condition, as it can be multifactorial and may require a comprehensive assessment.

Additionally, some athletes may feel embarrassed or reluctant to discuss their symptoms, further complicating diagnosis and treatment. Moreover, adherence to pelvic floor muscle training exercises can be challenging for runners due to time constraints or lack of motivation.

Another challenge is that stress urinary incontinence management often requires a multidisciplinary approach involving collaboration between physiotherapists, urologists, and other healthcare professionals.

This coordination can sometimes be difficult to achieve given these specialists’ different schedules and availability. Lastly, there may also be financial limitations for individuals seeking treatment options such as physiotherapy and surgery.

Overcoming obstacles

Overcoming the challenges involves raising awareness about stress urinary incontinence among runners and providing education on its management options. Encouraging open communication between athletes and healthcare providers is crucial to implement accurate diagnosis and effective treatment plans.

Furthermore, utilizing innovative approaches such as telehealth consultations or online resources can help improve access to specialized care, especially for those facing financial constraints or limited availability of services.

To successfully manage stress urinary incontinence, here are some important points to consider:

  1. Consistency: Sticking to a regular physiotherapy routine can be challenging for many runners. However, consistent self-practice is crucial for strengthening the pelvic floor muscles and improving bladder control.
  2. Time constraints: Runners often have busy schedules, making finding time for pelvic floor exercises difficult. It’s important to prioritize self-care and dedicate time daily for pelvic floor muscle training.
  3. Motivation: Maintaining motivation can be tough when progress may take time to become noticeable. Remember that perseverance is key; every small step towards better bladder control counts.
  4. Lack of knowledge: Some runners may not be aware of the role of physiotherapy in managing stress urinary incontinence or may not know how to perform specific exercises correctly. Seeking guidance from a qualified physiotherapist can help overcome this barrier.
  5. Lifestyle adjustments: Changes can be challenging for some runners who are used to certain dietary routines or who struggle with weight management. Making necessary lifestyle changes, such as adopting healthy eating habits and maintaining a healthy weight, can positively impact stress urinary incontinence symptoms. 


In conclusion, stress urinary incontinence is a common issue runners face, but it can be effectively managed through physiotherapy. By focusing on pelvic floor muscle training and utilizing other therapeutic modalities, runners can regain control over their bladder and improve their overall quality of life.

With proper guidance from trained professionals and dedication to rehabilitation techniques, stress urinary incontinence should no longer hinder runners from pursuing their passion.


1. What is stress urinary incontinence (SUI), and why does it occur in runners?

Stress urinary incontinence is the involuntary leakage of urine during physical activities or movements that place pressure on the bladder, such as running. This occurs when the muscles and tissues that support the bladder and urethra are weakened or damaged.

2. How can physiotherapy help manage stress urinary incontinence in runners?

Physiotherapy can help manage stress urinary incontinence by strengthening the pelvic floor muscles through targeted exercises, improving muscle coordination, and providing education on proper breathing techniques and body mechanics during exercise.

3. How long does it take to see improvements with physiotherapy for stress urinary incontinence?

The time it takes to see improvements with physiotherapy for stress urinary incontinence can vary depending on individual factors such as the severity of symptoms, consistency with exercises, and adherence to lifestyle modifications. Some people may start noticing improvements within a few weeks, while others may take several months of consistent effort.

4. Are there any lifestyle changes that can complement physiotherapy for managing stress urinary incontinence?

Yes, several lifestyle changes can complement physiotherapy treatment for managing stress urinary incontinence. These include maintaining a healthy weight to reduce pressure on the bladder, avoiding irritating foods and drinks that can irritate the bladder (e.g., caffeine), practicing good fluid management, and using protective pads or devices during high-impact activities like running.

Cynthia Pathipati Physiotherapist

Cynthia Pathipati – Registered Physiotherapist

Cynthia Pathipati completed her bachelor’s in physiotherapy and is a qualified Registered Physiotherapist in good standing with the College of Physiotherapists of BC with more than 15 yrs of experience.  She has Post-Graduate Credentials and Certifications as well as extensive knowledge experience in treating pelvic floor, orthopedic, neurological, vestibular and pain conditions.

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