Returning To Running Postpartum - 6 Evidence-Based Tips That Can Help (And When to See a Pelvic Floor Physio)

If you notice urine leakage when running, you’re not alone. Leaking during high-impact exercise is incredibly common, particularly after pregnancy and birth, but it does not mean you have to give up running.

The good news? There are several evidence-based strategies that can reduce symptoms and help you run with more confidence. Below are six practical things you can try, plus guidance on when it’s time to see a women’s health physio in the Sutherland Shire for tailored support.

Why does leakage happen when you run?

Running is high impact. Every foot strike creates a burst of pressure through the abdomen and pelvic region. If your pelvic floor muscles, hips, or connective tissue support system can’t manage that load yet, you may experience leakage, often called stress urinary incontinence.

This is especially common (but not normal) for:

• Postnatal runners returning to exercise

• Women with pelvic floor weakness, reduced endurance or poor coordination

• Women with connective tissue laxity or pelvic organ support changes

1) Strengthen your pelvic floor and hips

Pelvic floor muscle training is one of the most effective first-line strategies for leaking with running. Aim for at least 3 months of progressive training that targets:

• Endurance (long holds)

• Coordination (quick pulses and timing)

• Strength and tone

A well-conditioned pelvic floor helps “clamp” the urethra closed during moments of increased downward pressure, like impact at foot strike.

Just as important is hip and glute strength. Your glutes and pelvic stabilisers help control pelvic alignment and reduce strain on the pelvic floor during running. Single-leg strength work, progressively loaded, is especially helpful.

Postnatal physio tip: If you’re not sure you’re contracting the pelvic floor correctly, a pelvic floor assessment with a women’s health physio can make training far more effective.

2) Adjust your running technique (small changes can help)

Tiny posture and form tweaks can offload pressure from your pelvic floor.

Try:

• A slight forward lean from the ankles (not bending at the waist)

• Stacking ribs over hips to improve alignment at impact

• Looking straight ahead or slightly down (especially if you tend to look up)

These adjustments can reduce unnecessary pelvic and spinal strain and help your body absorb impact more efficiently.

3) Don’t brace your abs or “hold” your pelvic floor while running

This surprises a lot of runners.

Actively squeezing your pelvic floor or heavily bracing your abs while running can actually make leakage worse. During running, the pelvic floor needs to move and respond naturally to impact. Think springy, not stiff.

When you hold tension:

• Downward pressure on the pelvic floor can increase

• The “core canister” can’t function optimally

• Shock absorption reduces (your body gets rigid)

Instead, aim for relaxed, responsive muscles that can react and rebound with each stride.

4) Progress gradually (your pelvic floor needs load management too)

Your pelvic floor is a muscle system like any other. If you overload it too fast, it won’t cope.

A graded plan, like a walk-run “Couch to 5K” style progression, gives your pelvic floor time to build:

• Functional strength

• Endurance

• Coordination under impact

Slow, steady progress is the goal, especially if you’re returning to running after birth.

5) Increase your cadence slightly

Cadence is the number of steps you take per minute.

A small cadence increase, without increasing speed, often means:

• Shorter stride length

• Lower impact force per step

• Reduced load through the pelvic floor

Many runners describe this as running feeling lighter. It can be a simple and effective change if leakage happens mainly on harder strides, downhill sections, or faster paces.

6) Consider a pessary (a game-changer for some women)

Sometimes leakage while running is not only about muscle strength. It can be related to connective tissue or ligament support, especially after pregnancy, birth, or hormonal changes.

If you’ve tried strength work and technique changes and you’re still leaking, a pessary may be a great option.

A pessary is a soft silicone support device inserted into the vagina. It can act like a “backstop” for the urethra and bladder support system, essentially assisting structures that are currently under-supported. For many women, it’s an absolute game-changer that allows them to run comfortably and confidently again.

A pelvic floor physiotherapist (women’s health physio) can help determine if this is appropriate and guide you through options.

When should you see a pelvic floor physio in the Sutherland Shire?

If you’re leaking regularly when running, or it’s affecting your confidence, it’s worth seeing a pelvic floor physio for an individual assessment. A tailored plan is especially important if you have:

• Leakage that is not improving

• Vaginal heaviness, dragging, or bulging symptoms

• Pain (pelvic, hip, lower back) with running

• Postnatal concerns (core recovery, prolapse symptoms, return-to-run guidance)

• Frequent urgency, or leaking on the way to the toilet

A women’s health physiotherapist can assess:

• Pelvic floor strength, coordination, endurance and timing

• Hip and trunk control

• Running load and technique contributors

• Whether support options (like a pessary) could help

Final thoughts

Leaking urine when you run is common, treatable, and not something you have to “just put up with.” With the right combination of pelvic floor rehab, hip strengthening, technique changes, graded progression, and support tools, many women can return to running symptom-free.

If you’d like personalised guidance, seeing a women’s health pelvic floor physiotherapist in the Sutherland Shire can help you get a plan that’s realistic, evidence-based, and built around your body and your goals.

Your body isn’t broken, it just needs the right support. 🏃‍♀️💪

Sources:

Donnelly, G. M., et al. (2020). Returning to running postnatal: Guidelines for medical, health and fitness professionals managing this population. Journal of Women’s Health Physical Therapy, 44(2), 71–79.

Dumoulin, C., et al. (2018). Pelvic floor muscle training versus no treatment for urinary incontinence in women. Cochrane Database of Systematic Reviews, 2018(10), Article CD005654.

Heiderscheit, B. C., et al. (2011). Effects of step rate manipulation on joint mechanics during running. Medicine & Science in Sports & Exercise, 43(2), 296–302.

Woodley, S. J., et al. (2020). Pelvic floor muscle training for prevention and treatment of urinary and fecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews, 2020(5), Article CD007471.

Bladder Pain Syndrome (Interstitial Cystitis)

Bladder Pain Syndrome (Interstitial Cystitis)

Charlotte Conlon & Heidi Barlow are a Women’s Health Physiotherapists from Flow Physio Co Sutherland. Today they talks to us about Bladder Pain Syndrome (Interstitial Cystitis)

What is bladder pain syndrome?

The bladder is a pelvic organ that stores urine which is produced by the kidneys, until we decide to empty, the urine then travels down the urethra and is expelled from the body.

Interstitial cystitis is a condition causing bladder pressure, bladder pain and sometimes pelvic pain. Symptoms can vary from person to person and can range from mild to agonising. 


Common symptoms of interstitial cystitis 


• Pain in the bladder/abdomen when the bladder is filling up with urine. The kidney’s make urine constantly so they rarely get a break from pain, some may experience some temporary relief when they empty their bladder 


• Bladder urgency and frequency.  A person with a healthy bladder may urinate 7 times per day, in comparison to someone with bladder pain who may urinate in excess of 20 times day and night.

• Lower back and pelvic pain 


• Worsening of symptoms with menstruation 


• Pain with sexual intercourse 


• Ulcers/sore/bleeding in the bladder which sometimes can be seen in the urine 


• Lack of sleep to due increased urination over night 



Treatment options

• Lifestyle factors such as avoiding smoking and alcohol 


• Dietary factors such as avoiding caffeine, coffee, acidic and spicy foods 

• Managing constipation 


• Physiotherapy - Bladder pain syndrome is associated with an overactive tight pelvic floor, as the bladder fills the pelvic floor tightens and this can increase the severity of symptoms. Physio’s will perform internal and external releases of the pelvic floor and deep internal hip rotators and they can teach you how do do this. They will teach you bladder training and give you techniques to use to try and space out the time between urinating.


• Medication: Pain relief medication can help and your doctor may prescribe medication to help the bladder urgency and frequency


**There is currently no single treatment that has been found to be effective for majority of patients with bladder pain syndrome and to achieve symptom relief, many treatment options may need to be combined**

WHAT IS DIASTASIS RECTI / ABDOMINAL SEPARATION? Women's Health Physio

Charlotte Conlon is a Women’s Health Physiotherapist from Flow Physio Co Sutherland. Today she talks to us about abdominal separation (diastasis recti) during and after pregnancy.

What is a Diastasis Recti?

An abdominal separation that occurs when either side of the rectus abdominis muscles (the 6-pack muscles) separate from the linea alba.

What is the linea alba?

The linea alba is a connective tissue which runs vertically down the centre of the abdominals.

What happens during pregnanacy?

In pregnancy, this stretch of the linea alba can be caused by a number of factors including; hormonal changes, weight gain, weakness of the abdominal muscles, stretching of the abdominal wall or heavy lifting.

Is it normal?

It is considered a normal part of pregnancy and should decrease in the weeks after birth as the uterus shrinks.

When is considered abnormal?

It is considered abnormal to have greater than 2cm separation at 6-weeks post partum.

WHAT CAN YOU DO?

We recommend having a 6 week check up with a Women's Health Physiotherapist who will assess your abdominal separation and the integrity of your pelvic floor. It will also involve assessing the position of your pelvic organs to make sure there is no prolapse.

Following this, your Women’s Health Physio will be able to safely prescribe a postnatal exercise program for you to begin (see here: Returning to Exercise Safely after Pregnancy).

What is a pessary and how does it help treat pelvic organ prolapse?

Charlotte Conlon is a Women’s Health Physiotherapist from Flow Physio Co Sutherland. Today she talks to us about using pessaries in the management of pelvic organ prolapse

Pelvic Organ Prolapse

Pelvic organ prolapse is when one or more of the pelvic organs (bladder, uterus and bowel) slip down into the vagina causing a bulge or a heavy dragging feeling. Prolapse happens due to damage of the support structures of the pelvic floor including muscles, fascia or ligaments.

What is a pessary?

A pessary is the leading conservative treatment for pelvic organ prolapse.

A pessary is a silicone device that it inserted into the vagina to help support a pelvic organ prolapse .  A pessary can manage symptoms of a prolapse, these symptoms include a feeling of heaviness or dragging around the vagina a bulging around the vagina and incomplete emptying of your bladder or bowel.

A pessary can be very useful to help you continue  to be physically active and participate in chosen activities which may typically worsen a prolapse. A pessary can be worn all the time or it can be worn just when demands are hight i.e.: when running or jumping. 

What kind of pessary will I use?

Every womens body and prolapse is different therefore the type and size of pessary will vary immensely from women to women. The type and size will depend on the type of prolapse, the symptoms it causes and your anatomy. The pessary has to be fitted correctly and it may take several tries to get the right one. After the first fitting, you will need to be reviewed in 2 weeks to have the pessary checked. Follow up is needed every 3 months as sometimes a different size or shape of pessary will have to be fitted, as things may improve or change over time. 

What’s it like having a pessary? 

If you have a pessary that is the right size and in the right position, you won’t be able to feel it and you’ll be able to do all your normal activities. A pessary that is to small can fall out but it cannot end up anywhere else in your body. A pessary with is to big may cause rubbing and irritation. 

Does the pessary cause any side effects?

Pessary side effects are very low-risk they and you should tell your physiotherapist immediately if you have any discomfort, increased vaginal discharge or if you have trouble urinating or opening your bowels. An oestrogen cream and taking the pessary out daily or weekly may be needed to help prevent some of these side effects. 

How long will it take to fit a pessary?

A pessary fitting appointment will take 60 minutes and will include a full prolapse assessment. Measurements will be recorded for a baseline and follow-up appointments will compare these measurements to monitor changes over time. We will use a sterile pessary fitting kit to ensure we find the correct size as this may take a few attempts, once the size is decided you will then purchase that size. 

 

2019 Guidelines for Physical Activity in Pregnancy - Flow Physio Co Sutherland - Women's Health Physio

The 2019 Canadian Guideline for Physical Activity in Pregnancy  provide guidance for pregnant women, obstetric care and exercise professionals on prenatal exercise.

The guidelines provide evidence based recommendations regarding physical activity throughout pregnancy in the promotion of maternal, foetal and neonatal health. 

The Benefits of Being Active through Pregnancy

In the absence of contraindication, following these guidelines is associated with fewer newborn complications and maternal health benefits such as:

• Decreased risk of gestational diabetes and preecplamsia

• Less risk of Instrumented-assisted delivery; and

• Decreased risk urinary incontinence post birth

What is Recommended?

The guidelines make 4 strong recommendations and 2 weak recommendations:

1. All women without contraindications should be physically active throughout pregnancy (Strong recommendation, moderate-quality evidence)

2. Pregnant women should accumulate at least 150 of moderately intense physical activity each week to achieve clinically meaningful health benefits and reduction in pregnancy complications (Strong recommendation, moderate-quality evidence)

3. Physical activity should be accumulated over a minimum of 3 days per week, however being active everyday is encouraged (Strong recommendation, moderate-quality evidence)

4. Pregnant women should incorporate a variety of aerobic and resistance training activities to achieve greater benefits (Strong recommendation, high-quality evidence)

5. Pelvic floor muscle training may be performed on a daily basis to reduce the risk of urinary incontinence - instruction on proper technique is recommended (Weak recommendation, low-quality evidence)

6. Pregnant women who experience light-headedness, nausea or feel unwell when they exercise flat on their back should modify their exercise position to avoid the supine position (Weak recommendation, very-low quality evidence)

Enhancing maternal health and reducing pregnancy complications

In conclusion prenatal exercise should be therefore considered the front line therapy for reducing the risk of pregnancy complications and enhancing maternal physical and mental health. 

What should you do?

You should check with your obstetric care provider or Women’s Health Physio to make sure you don’t have any contraindications to exercise and enjoy the wonderful benefits of being active through pregnancy.

Source:

• 2019 Canadian Guidelines for Physical Activity in Pregnancy