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The impact of running on the perineum

Published by PhysioExtra, June 11, 2021

For new moms and all athletic women

Running is a very popular activity, for good reason. It’s easy to do, and all you need is a good pair of shoes suited to your running style and a place to run—a treadmill, your neighbourhood streets, or the park next to your house. That said, you might not realize the impact that running can have on your perineum…

About organ prolapse

Although running is very popular among young mothers, this article applies to all women who exercise and play sports.

Studies show that
50% of women who have had at least one child will experience organ prolapse and that 20% of childless women will also be diagnosed with this condition. In other words, having a C-section doesn’t protect your perineum! On the up side, only 5-10% of these women will experience symptoms. Essentially, many women don’t even realize there’s a problem! One of the things that can weaken the perineum, increasing the risk of organ prolapse, is high-impact physical activity. The impact on your perineum created by running is equivalent to 3x your body weight.

What is the perineum?

The perineum, or pelvic floor, is a group of muscles found in the base of your pelvis, which originates from the pubic symphysis, surrounds the vagina and anus, and attaches to the coccyx. Its primary function is to control the passage of urine, stool, and gas. It is the only muscle group in the base of the pelvis, making it solely responsible for supporting the pelvic organs (bladder, uterus, and intestines). In women, the perineum is traversed by the clitoris, the urethra, the vagina, and the anus, whereas in men, it includes only the urethra and the anus. This muscle group also plays a role in sexual function. The perineum also helps to stabilize the pelvis, which is especially important when it comes to running.

How does it affect running?

Anatomically speaking, the pelvis supports the sacrum, which in turn supports the lumbar spine. If the pelvis becomes unstable during running, this could throw the entire spine out of balance. A stable pelvis helps to keep the legs properly aligned during running. Of course, the pelvic floor isn’t the only muscle group involved in running; never underestimate the importance of the transverse abdominal muscles and the gluteal muscles!

How soon can I start running again after giving birth?

Imagine suffering a severe sprain of your pelvic floor muscles. That’s what giving birth is like! Think of it this way: Would you ever consider running on a sprained ankle? Just like after a sprain, the perineum is also swollen after childbirth. The natural healing process for a muscle sprain is roughly 3 months, which is why many experts recommend waiting 3 months after delivery before you start running again. Just like recovering from an ankle sprain, once you start running again, you’ll need to do muscle strengthening exercises to avoid re-injury. Time heals all wounds, of course, but your muscles will still need a little help to get back in shape.

If I gave birth more than 3 months ago or even a few years ago, am I less at risk?

Not necessarily. There are many risk factors for a weakened pelvic floor, including childbirth, pregnancy, menopause, high-impact activities, obesity, chronic cough, etc.

Here are a few signs that your perineum isn’t ready for running:

  • If you experience leakage while running, it’s a sign of a weakened pelvic floor.
  • If you experience heaviness while running, it’s a sign that your pelvic floor may not be ready to support 3x your body weight.
  • If you have pain in your knees, ankles, etc., it may be a sign that you lack stability in your pelvis and strength in your perineum.

How can I know?

During a pelvic floor rehabilitation assessment, the therapist will do a manual vaginal examination to evaluate the strength (from 0 to 5) and endurance of your perineum, and whether you are contracting the muscles correctly without any compensation. Studies have shown that 25-30% of women contract their pelvic floor muscles incorrectly, even after a thorough examination by a physiotherapist. After your assessment, the physiotherapist will then give you a customized exercise program.

Have a great run!

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