If you’re a new Mom that loves running but struggling with leaking, pressure “down there” or pain, you are not alone.
Too many Moms go to their 6 week checkup after having their baby and are given the OK to return to exercise without any guidance.
Runners hear this and they are ecstatic to hit the trails.
However, regardless if you had a c-section or vaginal delivery, your body still needs time to recover before you can just jump back into your exercise routine.
I work with Runners after they’ve had their babies and I get it, running is their outlet, a way to burn off stress and feel better. It’s hard to tell a Runner not to run!
Even though the doctor gives you the OK to run again, there may be signs during or after your run that your Postpartum body is trying to tell you that says you are not quite ready…
Peeing while running, feeling pressure “down there” or any kind of pain during or after a run can be avoided. You don’t have to put up with it.
Let’s talk about the things every Postpartum Runner needs to know…
Just because you are given the green light at your 6 week check up to return to exercise, doesn’t mean you are automatically good to go.
This is the missing gap in Postpartum Recovery, in most cases no real guidance is given or encouraged.
You carried a baby for 9 months, your belly muscles were stretched and your pelvic floor carried the weight of the baby.
Not to mention if you had a c-section or a vaginal tear during delivery, there may be some pain involved which can interfere with the recovery process.
Addressing any pain issues first, then developing a baseline of core and pelvic floor strength before you hit the trails will help give you the stability you need to avoid symptoms.
This leads us to our next category….
Leaking isn’t normal, it’s a sign.
Too many times Moms tell me that they’ve heard from a friend or doctor that “leaking is normal” after having babies.
It can be common to occur in the postpartum days, but in no ways should it be acceptable to just live with.
Leaking can occur for number of reasons during running….pelvic floor weakness, pelvic floor “tightness” or trying to keep the pelvic floor muscles “on” while running, decreased pelvic floor coordination, holding our breath, clenching our abdominals
Research has shown that our pelvic floors are pretty smart. While running the pelvic floor knows when it needs to contract on its own, so we should not be trying to do a continuous pelvic floor contraction while running to avoid leaks.
Learning how to both relax and contract the pelvic floor is a good place to start. Incorporating this with postpartum pre running exercises such as lunges and split squats can help carry over when Moms return to running.
Looking at other things such as posture and form while running can help give clues as what else might be contributing to unwanted pressure through the core and pelvic floor, which can result in leakage.
For example keeping the abdominals engaged or clenched while running can move pressure in our body downwards toward the pelvic floor resulting in leakage.
One breastfeeding Mom told me that since her breasts are full with milk, she has to wear 2 or 3 sports bras, and runs with her chest up and stomach clenched to avoid the heaviness. This could definitely become a trigger for leakage during running. Trying to run if possible right after pumping or when the breasts are not as full can help.
You Need to Strengthen the Core and Pelvic Floor to Safely Return to Running Postpartum
Most athletes who are recovering from an injury are given guidance, time and specific exercises to return to their sport.
However after having major abdominal surgery as with a c-section, or a vaginal delivery where there may be tearing involved, Moms are not given the same privilege.
This is where starting slow with connection exercises between the abdominals and pelvic floor is so important to build some baseline strength before adding more demand to the body as with running.
Once the baseline strength is there, then adding things like jump squats along with other plyometric exercises help train the pelvic floor to start accepting load.
With that being said, if you are one of the lucky ones that start running after given the green light from the doctor without symptoms initially, it is still a good idea to work on the baseline strength so as your running endurance improves, your body will be able to keep up with it.
However keep in mind that our tendons love estrogen, and while breastfeeding our estrogen levels will remain low. This is another reason to return slowly to exercise to help decrease risk of injury.
I normally encourage a walk/run program after developing some baseline strength. This is helpful to know when you are ready to increase distance, frequency and or speed.
For example start with 1.5 minute walk, then 30 seconds light jog, repeat for 10-15 minutes. Once there are no symptoms for a few trials, then increase to a 2 minute walk, 1 minute jog, gradually increasing the run time with less walking time.
If you run for 15 minutes and experience leakage after 12 minutes, then reduce the running time back to 10 minutes. Stay here while continuing to work on your baseline floor and core strength.
Pain While Running Postpartum Should Not Be Tolerated
The concept of no pain no gain is a no go when it comes to postpartum recovery.
If you are experiencing back pain, hip pain, knee pain etc, while running, it’s important to address the underlying reason for the pain.
Back or hip pain can start during Pregnancy. The weight of the baby can pull our abdomen forward, making us clench our butt muscles to help gain stability.
Hormones in Pregnancy can affect the joints, resulting in hip instability and pain, making Moms “waddle” a bit when walking.
Then after birth Moms are not getting enough sleep, which could set them up for injuries during exercise as well.
Add to that Moms lifting baby off the floor, or lifting other toddlers, the pain just doesn’t get a break.
So addressing the pain first, will make the surrounding muscles function better to allow a safe return to running.
Prolapse is Another Consideration Running Postpartum.
Prolapse is when the bladder, uterus and or rectum have shifted a bit after delivery into the vaginal canal. Symptoms can include a feeling of heaviness or pressure along the vagina or unable to insert a tampon all the way as with a bladder prolapse or cystocele. Other symptoms can include painful intercourse as with a uterine prolapse, and unable to completely empty while having a bowel movement as with a rectocele
While caution is given on progression with exercises with a prolapse, we should never discourage a Mom from exercising at all.
Research has shown that 1 in 2 women decrease or give up exercises because of pelvic floor issues.
The last thing we want to do is discourage Mom’s from exercise which can affect their overall well-being, mental health and fitness level.
In fact if you ever see another health care that tells you never to squat, lift, etc again because you have a prolapse, please seek another opinion!
As Moms we have to lift, carry, hold babies in a carrier, all the things and we have to learn how to manage a prolapse vs not moving at all.
We just have to learn the strategies to help minimize the intra-abdominal pressure that causes the symptoms of a prolapse to occur or worsen.
This is where strengthening the pelvic floor and core before doing any kind of impact such as with running is really essential.
Learning other strategies such as avoiding holding our breath when picking up objects such as the stroller, avoid clenching our stomach out of habit or when carrying the baby in a carrier, and including fiber rich foods to help us avoid constipation can help manage a prolapse.
Work with a Pelvic Floor Physical Therapist Postpartum
Bridging the gap between having a baby and returning back to the sports or activities you enjoy postpartum can be a challenge.
Moms focus so much on the baby that their own needs just go to the back burner.
While I do think there is some awareness out there about the importance of postpartum recovery, it is still not considered a standard of care.
The American College of Obstetricians and Gynecologists (ACOG) emphasizes the importance of the “fourth trimester” following childbirth. They promote a comprehensive assessment be performed within 12 weeks postpartum, focusing on physical, social and psychological well-being. https://www.obgproject.com/2022/04/25/acog-revises-redefines-postpartum-visit/
Some Moms are advocating for themselves and seeking out guidance with online courses or with one on one help with a Pelvic Floor Physical Therapist.
A Pelvic Floor Physical Therapist can help give you specific guidance based on individual symptoms and goals with returning back to exercise.
A Pelvic Floor Physical Therapist can address things like back or hip pain, diastasis recti issues, specific muscle weakness or tightness, c-section scar tissue and pain, vaginal tearing that may result in painful intercourse, symptoms of prolapse and leakage with day to day activities and exercise.
Online courses are becoming more popular and I get it, Moms don’t always have the time or money to see a Pelvic Floor PT.
However I always recommend that Moms see a Pelvic Floor Physical Therapist at least once after having a baby, to see what needs to be addressed and get a game plan for moving forward.
Here Are Some Tips to Avoid Pelvic Floor Issues While Running
- Do not remain upright and rigid, lean forward in a “ski jump” position from the ankles (not the hips)
- Untuck your butt (no clinching the butt cheeks)
- Breathe while running making sure the chest and belly breathe together (don’t inhale from the upper chest or from the belly)
- Add some rotation side to side with your upper body
- Don’t stick your heels way out in front while running, land with your feet underneath your body. Landing underneath reduces the amount of impact from 6-8 times your body weight (feet out on front) to 2-4 times your body weight (feet underneath)
- Don’t look out into the horizon, keep your gaze about 20 feet ahead
- Don’t grip your abdominal muscles as this could be adding pressure through the pelvic floor, resulting in more feelings of heaviness or leakage
You don’t have to do any “kegels” or pelvic floor muscle contractions while running. The pelvic floor muscles need to contract and relax on their own to do their job. By keeping the muscles contracted, they are not able to respond as they should, which could result in leakage.
Heaviness or a dragging feeling in the vagina while running may result from a pelvic organ prolapse. It may be advised to wear a pessary while running, to give your bladder more support. A pessary may be helpful to prevent the prolapse from worsening over time.
A Pelvic Floor Physical Therapist can give you specific advice on managing a prolapse, eliminating leakage and managing pain to get you back to running safely after having a baby.
If you would like to set up an appointment please email me at Camille@indywomenpt.com or call 317-689-0073
Happy Trails!
Dr. Camille Fenwick, DPT, Owner of Indy Women Physical Therapy
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