Leaking While Running? Here's What's Happening and How to Fix It

Leaking is Common, But Not Something You Have to Live With

If you leak a little when you run, you're far from alone. Bladder leakage during running and other high-impact exercise is one of the most common reasons women stop running, cut workouts short, or plan every route around a bathroom.

It's common, but it isn't normal, and it isn't something you simply have to accept after having a baby. Leaking with running has clear, well-studied causes, and that means there are clear ways to address it. Here's the science behind what's happening and what actually helps.

What Changes After a Vaginal Delivery

To understand leaking with running, it helps to know where your bladder normally sits and what supports it.

Bladder neck position

The bladder neck is where the bladder meets the urethra. In a well-supported pelvis, it sits up behind the pubic bone. In that position, when pressure pushes down from above, the urethra is squeezed closed against firm support, a bit like stepping on a garden hose.

Imaging studies of women after vaginal delivery have shown that the bladder neck often sits lower and moves more under pressure than it did before birth. When the bladder neck drops further down the vaginal canal, it loses some of that backstop. Downward pressure can then push the urethra open instead of pinching it closed.

The genital hiatus

The genital hiatus is the opening in the pelvic floor muscles that the urethra, vagina, and rectum pass through. Vaginal delivery stretches this opening considerably, and in some women it stays wider afterward. The levator ani muscles that surround the hiatus can also be stretched, weakened, or occasionally injured during birth.

A wider hiatus and a lower bladder neck together mean less support underneath the bladder at exactly the moments it needs it most.

Why Running Is a Stress Test for Your Pelvic Floor

Running is one of the most demanding activities your pelvic floor faces. Every time your foot hits the ground, your body absorbs an impact force several times your body weight. Over a single mile, that happens hundreds of times.

With each foot strike, pressure inside your abdomen spikes. That intra-abdominal pressure pushes down on the bladder and the pelvic floor, and the pelvic floor has to respond instantly to keep the urethra closed. Research using ultrasound imaging has also shown that the pelvic organs, including the bladder neck, move downward with the impact of running.

Put these together and you can see why running reveals problems that walking doesn't:

• Repeated, rapid pressure spikes with every stride

• Downward movement of the bladder neck with each landing

• Fatigue over time, which is why many women are fine for the first mile but start leaking later in a run

• Timing demands, because the pelvic floor has to contract at the right moment, not just be strong

If the bladder neck already sits lower and the hiatus is wider after childbirth, the pelvic floor has less margin for error, and leaking is often the result.

Strengthening the Levator Ani to Lift and Support

The good news is that the levator ani muscles respond to training. When they're strong and well-coordinated, they do two important things for runners.

First, they lift. A good levator ani contraction draws the bladder neck upward and forward, back into its supported position behind the pubic bone. Studies using ultrasound have shown pelvic floor training can improve bladder neck support and narrow the genital hiatus.

Second, they brace. Well-trained muscles stiffen the pelvic floor so it resists being pushed down with each foot strike, rather than giving way under pressure.

Effective training for runners goes beyond basic Kegels. It includes:

• Correct technique first, making sure you're lifting and squeezing rather than bearing down

• Strength, with sustained holds that build muscle capacity

• Speed, with quick contractions that match the rapid pressure changes of running

• Endurance, so the muscles hold up late in a run

• Relaxation, because a pelvic floor that's always clenched can't respond well either

• Functional practice, gradually adding jumping, hopping, and running-specific drills

Whole-Body Care: It Starts at Your Feet

Your pelvic floor doesn't work in isolation. Running is a whole-body movement, and the force of every landing travels up what's called the kinetic chain: from your foot, through your ankle and knee, into your hip and pelvis, and on to your low back.

How that force is absorbed along the way matters. When the foot, ankle, knee, and hip absorb impact well, less of that force reaches the pelvis and pelvic floor as a sudden jolt. When something in the chain isn't doing its share, the pelvis and pelvic floor can end up taking more of the load.

That's why we look at more than the pelvic floor itself. Factors that can influence leaking include:

• Foot strike and cadence, since a heavy, overstriding landing sends more force up the chain

• Hip strength and control, especially the glutes, which help stabilize the pelvis with every step

• Trunk and rib cage position, which affects how pressure is directed inside the abdomen

• Breathing patterns, since breath-holding or bracing hard can drive pressure downward

• Overall training load, including mileage, pace, and fatigue

Small changes, like a slightly quicker cadence or better hip control, can reduce the demand on the pelvic floor and make a real difference in symptoms.

Tools That Can Help You Keep Running

There's rarely a single fix. Most runners do best with a combination of approaches tailored to their body and goals.

Pelvic floor physical therapy

Pelvic floor muscle training is considered a first-line treatment for stress urinary incontinence, which is the type of leaking most runners experience. A pelvic floor physical therapist can confirm you're contracting correctly, build a progressive program, and connect your pelvic floor to the rest of your running mechanics.

Compression garments

Supportive compression shorts or leggings designed for pelvic support may help some runners feel more supported and leak less. The research on these garments is still limited, so think of them as a helpful add-on rather than a stand-alone solution.

Pessaries

A pessary is a small, removable device placed in the vagina that supports the bladder neck from below, helping restore it to a better position during activity. Some women use one only while running or exercising.

Fit and positioning matter. A pessary that's the wrong size or sits in the wrong spot won't give the support you need. It should be fitted by a qualified provider, and a pelvic floor therapist can help you understand how it works alongside your muscle training.

Getting back to running after baby

If you're postpartum, a gradual, guided return to running helps protect your pelvic floor. Published return-to-running guidance generally recommends building up in stages and checking readiness first, rather than jumping straight back into your old routine.

How Our Pelvic Floor Therapists at Empower Help Runners

Our team works exclusively in pelvic health, with extensive ongoing continuing education and FAAOM fellowship-trained clinicians, a credential held by roughly the top 1% of physical therapists nationally. That combination of pelvic floor and orthopedic expertise lets us treat your pelvic floor and your running mechanics together.

Every visit is a full hour, one-on-one, in a private closed-door treatment room. You'll never be rushed or split between patients.

Your care may include a detailed pelvic floor assessment, a look at how you move and run, a progressive strengthening program, and guidance on tools like compression garments or pessary use. The goal is simple: to get you running with confidence, without planning your route around the bathroom.

Ready to run leak-free? Call our team at 346-677-0150 or visit www.empowerpelvichealth.com/whatwetreat to learn more.

A friend recommended Empower to me after I couldn't walk/run/sneeze/cough/laugh/jump anything without peeing myself. They've taught me all sorts of new ways to strengthen my pelvic floor; they figured out what I was doing wrong when trying to prevent leakage (I was making it worse!) and helped me with many other issues I didn't know how to fix. HIGHLY recommend! ~ Kimi H.

I came in for chronic left groin pain that was getting in the way of my workouts. Ashley took the time to really understand what was going on and built a plan just for me. Every session, she worked with me one-on-one in the gym, coaching my form and movement. ~ Analiese B.