TO PEE OR NOT TO PEE:
A RUNNERS GUIDE TO URINARY INCONTINENCE
By Sherrie Palm
I have to wonder how many women take up an exercise regimen like jogging or marathon running and then give it up because urinary incontinence sends them sideways. I’ve had intentions for some time of putting together an article about the impact urinary incontinence has to women who are runners and joggers, but when two women I know who are marathon runners told me within a short time frame that they had concerns about handling leakage issues during upcoming runs, I knew I had to get the lead out and address these concerns. We health advocates are a bunch of pro-active, self-help go-getters who want to get every bit of zing out of life that we can. Fitness clubs are filled with women who want to feel great so they can get the best bang for the buck out of their time on earth. We want to not only be able to remain active, we also want to feel great while we do so. Running is an aspect of fitness that many individuals partake in; marathon running and jogging are two forms that are extremely popular.
Running in any form makes people feel free, it’s just you and the pavement and nature’s elements. If you want to completely escape, you simply leave your cell phone at home and no one can reach you; you are liberated for a pocket of time from everything that overwhelms you in your daily routine. Running can make you feel healthy and vigorous and alive. The median age for women marathon runners is 2009 is 35, a prime age for POP symptoms to start occurring. In 2009, 93% of women who entered the Nike Women’s marathon finished the race. The half-marathon currently has the largest female percentage (57%) of any US road race. But there is an aspect of running that is of particular concern to women. Women runners who experience urinary incontinence often shy away from participating in running activities when their incontinence reaches a level that they feel might be recognizable. It is important for these women to become familiar with the signs and symptoms of pelvic organ prolapse; urinary incontinence is the most common symptom of POP.
Runners typically have concerns about their feet or joints; the repetitive pounding can be hard on these areas and it is pretty much common knowledge that there is potential for injury if you don’t wear good supportive running shoes. But what is not common knowledge for women is the impact running has to the contents of their pelvic cavities. A very significant aspect of POP is the impact (no pun intended!) that marathon running and jogging have to the organs and structures within women’s pelvic cavities. Most women are not aware that pelvic organ prolapse exists much less have concerns about the impact running may have to their pelvic structures. Since the organs in the pelvic cavity are jarred continuously in a downward motion over an extended period of time during marathon running or jogging, female runners are predisposing themselves to pelvic organ prolapse issues. Urinary leakage is most common symptom of POP and can be a huge cause of distress for many women runners, but that is not the only reason women should support their internal structures.
There are five types of POP and there is potential for more than cystocele (bladder) issues. The pc muscle is like a trampoline that supports all of the structures in the female pelvic cavity. When that starts to weaken, everything above it is left without the proper support to maintain normal position. The end result of repetitive pounding is that organs shift in a downward direction and often start pushing into the vaginal canal. Women may start to experience urinary leakage as well as other symptoms of POP such as a sensation of “their insides falling out”, rectal/vaginal/back/pelvic pain, abdominal bloating, constipation, and rectal or vaginal pressure.
That statistics for prevalence of urinary incontinence in women run from 40-75% depending on what source you quote. 7-10% of women have severe UI. The question at hand is how many female runners have POP and don’t realize it? How many female runners initially tolerate minor urinary leakage issues and do nothing to address the cause? How many female runners find their incontinence issues have increased since they took up running? How many female runners eventually give up running because they simply cannot risk anyone discovering they have UI?
The good news is that women with UI have options to treat and eliminate UI issues. Once a woman takes the necessary steps to find out the cause of her UI, she can utilize support devices and treatments. Treatment options like a pessary or Incostress can support the bladder and create immediate relief from incontinence. Some treatment options can improve the leakage issues that come with a cystocele; nonsurgical options like learning the correct Kegel method, utilizing core strengthening exercises like Pilates or Pfilates, support garments, hormone replacement therapy for menopausal women to improve muscle tissue strength and integrity. For those women who want a permanent fix, there are surgical repair options.
For women who run, whether it is a 26 mile marathon or a 1 mile jog, recognition of the impact running has to the core is vital. Women need to know about POP. ALL women. We need to know what we can do to control urinary incontinence. We need to know they we recapture control of this aspect of our bodies so we can continue to access the feeling of freedom that running brings.