Running & Pelvic Health: Why Leaking or Heaviness Isn’t Just a “Pelvic Floor Problem”

Dr. Ally Loupe, PT, DPT

If you’ve ever felt leaking, heaviness, or pressure in your pelvic floor while running, you’re not alone and you’re not broken. These symptoms are your body’s way of asking for a change, or for some help, not a sign that you have to give up the activities you love.

Contrary to popular advice, the solution isn’t always “just do your Kegels.” In fact, runners with pelvic floor symptoms don’t need more squeezing, they need better coordination and responsiveness throughout the whole body.

Let’s break down the real reasons you might be having pelvic symptoms with running and how you can start improving things today.

1. It’s Not Just About Strength, It’s About Coordination

The pelvic floor doesn’t work in isolation. It’s part of your core canister, working closely with your diaphragm, deep abdominal muscles (like your transversus abdominis), and even your rib cage. If any part of this system isn’t working optimally, especially under impact and load, symptoms can pop up.

Things that can disrupt this coordination:

Poor pressure management (think breath-holding, straining, or gripping your abs or glutes instead of using your deep core for stability)
Hormonal changes (especially postpartum or during perimenopause/menopause)
Constipation or dehydration
Compensatory patterns coming from elsewhere in the body from old injuries or imbalances (like old ankle or foot injuries)

2. Your Pelvic Floor Responds to the Whole Body Chain

Running is a full-body event. When you run, your body absorbs and transfers force through every joint from your foot to your ribcage. Dysfunction or compensation at any part of that chain can increase demand on your pelvic floor.

Here’s a breakdown of the pattern your body naturally moves through during part of the running gait cycle:

Loading (Mid-Stance):

Foot pronates
Ankle dorsiflexes
Tibia internally rotates
Hip internally rotates and adducts
Pelvic inlet widens & pelvic floor lengthens

This sets you up to absorb force and support your pelvic organs.

Propulsion (Push-off):

Foot supinates
Ankle plantarflexes
Tibia externally rotates
Hip externally rotates and abducts
Pelvic outlet narrows & pelvic floor lifts

This allows a strong, supported push-off without compensating through your low back or pelvic floor.

If that all sounds like a bunch of jargon, don’t worry, these are simply different movement patterns we assess at Genesis PT & Wellness to better understand why you might be experiencing pelvic floor symptoms with running. It’s important to work with a provider who can get to the root cause of your symptoms and identify why certain motions may not be happening smoothly. When your body can’t access these movements, it often compensates by overusing or tensing other areas, which, over time, can lead to pain or dysfunction.

3. What “Tight Hips” or IT Band Pain Could Be Telling You

That nagging tightness in your hips or outer thigh? It’s often your body’s “Plan B”.

Many runners chalk up symptoms to tight hip flexors or IT bands. But often, this is your body compensating for a lack of hip internal rotation in mid-stance (when the foot is fully in contact with the ground and the other is swinging through).

If you can’t access that movement, different muscles (like your IT Band, TFL or lateral quad) will overcompensate and become irritated and cranky, leaving the muscles feeling “tight” in the process. Tight muscles are often weak muscles because they lack the full range of motion to optimally respond. Rather than spending your time stretching over and over, your time may be better spent strengthening this area through its full range of motion. These are some of the things we do to help you access that movement when running.

Improve hip internal rotation mobility
Work on responsive foot pronation
Strengthen through the full range of motion
Stack your rib cage over your pelvis without clenching your muscles
Mobilize the thoracic spine and rib cage
Focus on strengthening rather than over stretching.

Speaking of the rib cage…

4. Your Rib Cage is a Big Deal (Yes, Really!)

Your pelvic floor mirrors your rib cage. If your ribs are flared forward and compressed in the back, your pelvis will follow suit. This makes pressure management difficult especially during high-impact activities like running.

Try these strategies to help:

Practice long, controlled exhales (4 steps in, 6 steps out while running).
Mobilize the thoracic spine (add in some good yoga twists as part of your warm up routine).
Strengthen obliques & serratus anterior (an underrated muscle attached to your rib cage).
Focus on rib cage stacking and expansion in all directions without gripping muscles like your glutes or your rectus abdominis (the 6 pack muscles).

5. Running Tips for a Healthier Pelvic Floor

Support your pelvic floor by supporting your entire system. Here are some real life tweaks and quick wins:

Cadence: Aim for 160–180 steps per minute
Shorter stride: Reduces overstriding and impact
Soft landings: Train your foot-ankle-hip chain to absorb force
Wear wide toe box shoes
Slight forward lean: Especially on treadmills
Interval running: Build endurance without symptom flare-ups

It’s important to note that the idea is NOT to try to make big changes to your form while running, as this can lead to a whole host of other weird issues. Instead, work with your pelvic floor therapist on mobility, strength, loading, and force absorption drills off the treadmill or running path first, and those changes will naturally carry over to running.

6. Specifics for Return to Running Postpartum

One of the most common questions we get is, “When is it ‘safe’ to start running again after birth?” The answer… It depends on your healing, symptoms, and goals, but we typically begin run-prep work around 12 weeks postpartum. During this time, we work on double leg loading and progress to single leg loading, followed by higher intensity work to help you return to running gradually between 3 and 6 months postpartum.

At Genesis PT & Wellness, our approach is whole-body, hands-on, and high value.

In addition to developing a strength and mobility plan, we might assess and cover:

Pelvic floor mobility & coordination
Breathing strategy and core engagement
Mobility from rib cage down to the foot and ankle
Force absorption and single leg control
Drills for responsiveness

Whether you’re newly postpartum or have been dealing with symptoms for years, it’s never too late to get the support you need!

Ready to Run Stronger (and Symptom-Free)?

Running should feel powerful, not painful or fearful and pelvic floor symptoms shouldn’t keep you on the sidelines. If you’re ready to get back to confident, comfortable running, click here to book your evaluation or send us a message.

We are here to help you move better, feel better, and stay active for every season of life.