Women’s health physiotherapist Kym Toller shares the challenges her client Jessica faced with her return to running and high impact exercise after childbirth, and some tips to manage the common condition of stress urinary incontinence
Running and incontinence. It’s not often that you find these two words in a sentence together, but this was my client Jessica’s new reality, and it started when she resumed running post-childbirth.
Jessica didn’t rush back into exercise or running postpartum. In fact, she felt like she had recovered well from childbirth. She had started to find more time and had energy to commit to a new routine and she wanted to set herself a new challenge. While Jessica was aware of potential injuries from a return to running such as sore muscles, inflamed tendons or irritable joints, she never imagined that she would “leak”.
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At first Jessica was able to brush it aside and manage her symptoms with timed toilet stops, reduced fluid intake, or even a pad. Over time, however, her symptoms worsened and she knew she needed to do something about it. But she didn’t know where to start or who to see—and also felt a deep sense of embarrassment and shame.
What is stress urinary incontinence?
Stress urinary incontinence (SUI) is the involuntary loss of urine during exertion or physical activity. It’s an extremely common complaint for many women. Up to 30 percent of women can suffer from SUI and it's not confined to the postnatal population. Young, nulliparous women (those who have not given birth to a child) can also suffer.
SUI can happen during high impact activities such as running or jumping, but also with a cough or a sneeze. The condition can seriously affect a woman's quality of life and can lead to psychological and social problems.
Unfortunately, the majority of women just put up with the symptoms of SUI and accept it as a “mummy complaint” or part of “getting old”. However professional help is available and there are quality evidence-based treatment options for the condition.
Like many individuals, Jessica’s first port of call, however, was Dr Google. After some research, she decided that Kegel exercises were a good place to start. These seemed straightforward and easy, plus didn’t require any extra equipment. However, she quickly became bored with their repetitive and tedious nature. Additionally, the online information was confusing and she didn’t know how many repetitions to do or the time frame for improvement. She eventually gave up and consoled herself with the knowledge that they weren’t really helping anyway. Someone suggested trying yoga and pilates and although those exercises felt good, they didn’t help Jessica with her symptoms.
What the professionals say
Women’s health physiotherapists are well versed in treating SUI. Research suggests that the majority of women with SUI, up to 75 percent, will respond to supervised Pelvic Floor Muscle (PFM) training exercises.
Understanding and executing a proper pelvic floor contraction is essential in any SUI rehab and may be a reason why a home programme fails. Research has shown that the exercises need to be performed consistently for 12 weeks. There is also emerging research about which part of the pelvic floor muscles is engaged in order to give enough support to the urethra (the tube through which urine passes) and so learning this early in your journey means all the effort you put in is much more likely to pay off.
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PFM training for SUI in runners also needs to be progressed from a lying down position to functional upright postures, and with varying speed, breathing patterns and weights. For some women PFM is not sufficient and they may benefit from consideration of a continence pessary, supportive underwear or a surgical procedure.
When Jessica finally decided to address her symptoms with a professional, I assessed her pelvic floor through an internal examination and showed her how to do a Kegel correctly, which is crucial for the success of PFM training, and an individualised programme allowed her to progress her exercises gradually over time. The rehabilitation was centred around Jessica’s return-to-running goal, and the targeted training and functional approach made all the difference to her SUI, allowing her to progress and successfully and confidently return to impact activities.
Like all challenges, attention and maintenance are key for prevention. “I underestimated both the mental and physical toll of SUI,” says Jessica. “But I’m so glad that I reached out and got the professional help I needed. I only wish I had done so sooner.”
Tips for managing SUI and returning to running postnatally
- For self assessment of your pelvic floor muscles, you should be able to feel a lift upwards of your perineal area with your hand when you contract these muscles
- Consult an expert to ensure you are working your pelvic floor muscles correctly and to design a personalised programme that matches your goals
- Pelvic floor exercises should be performed consistently over at least a 12-week period
- As part of a return to running postnatal programme, rehabilitation exercises don’t end with pelvic floor muscle training, but should also address core, pelvic, hip and leg muscle strength and control. The proper coordination and strength of these systems is essential in the successful build back to impact activities and running
- To help manage stress urinary incontinence, drink small water volumes consistently. Drinking too much too quickly can rapidly stretch the bladder causing the sudden urge to urinate and then potentially leak
- Supportive compression pants can help provide external support to pelvic floor muscles—think sports tape on the skin
- Try short uphill runs or a forward lean when you run. This slight postural change can support the anterior pelvic floor and bladder
- Use apps, such as Squeezy or Tat Pelvic Floor Exercises, to remind you that it’s time to do your PFM training
Front & Female’s Women’s Health With Evolve series is a collaboration with Joint Dynamics Evolve, Hong Kong’s first multidisciplinary women’s health clinic with services spanning physiotherapy, osteopathy, rehabilitation, personal training, nutrition and psychology. The series addresses all aspects of female health to support women at various life stages and open up the conversation around women's health topics, from the awkward to the unknown.