What do you do if you worry about bladder leaks when running? Or at the gym, your exercise class, or playing with your children ?? Mums I meet in clinic tell me that they are avoiding events that require them to look “sporty”. They worry about a VPL if they wear normal figure hugging gym kit. They don’t want to stand out in a baggy tracksuit trying to hide a pair of substantive knickers with a pad. Heaven forbid a party or wedding?
I’m an experienced women’s physio so I know pads aren’t (and don’t need to be) the solution but they could be a vital part of your journey out of the Miserable Place.
Tips to manage bladder leaks when running or active:
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#1. Use a pad designed for bladder leakage not menstruation
Sanitary pads and incontinence pads are not made of the same thing.
The products designed to be used for menstruation are great for that purpose but do not to cope well with liquid. As they are predominantly cottonwool based, if they get wet, they just go soggy and mis-shapen. If you are moving about they can get scrunched up, rub and leave your skin in contact with urine causing chafing and soreness.
The right pads for the task are worth the little bit of extra cost. With the advent of new technology you will be amazed how slim a proper bladder leakage pad can be to hold a large amount of liquid. They also use fabrics that can wick fluid away from the surface. This keeps damp away from your skin and reduces your worries about odour.
what to look for in the shops
The products are usually in the same ‘feminine hygiene’ aisle (or website section of an online store) but separated into one column of shelves for products for periods and one for bladder leakage.
In general, pads for ‘lighter’ bladder leakage look and feel like pantyliners and come in boxes to keep them flat and compact. This makes a good starting point if you are looking for something to keep you confident and safe against a small leak.
but if you need more than a light pad
If you suffer with more severe leakage and could potentially empty half your bladder, or would risk getting wet clothes, then look at the pads in bags which will be more absorbent. However, if you are getting that wet when you play sport your priority should be to solve the bladder problem further. Talk to your physio about what they recommend.
#2 MODERN waterproof knickers
Forget dated images of plastic pants, which rustle and sweat. The modern waterproof knicker is a far more sophisticated item!
Annabel Croft, the tennis player and TV presenter Carole Smillie (Strictly 2013!) invented these knickers. She originally thought of the concept for her teenage daughters coping with their periods. Now they are marketed for periods, postnatal and pelvic floor.
They look exactly like the classic cotton “girls pants” we’ve all worn in our day. Complete with little middle bow! But with a discreet waterproof panel back and front, which just feels like thicker cotton and importantly doesn’t rustle. They are designed to be worn with a pad but should give you the confidence to keep a pad thinner and lighter or to reduce your anxiety that your pad might overfill.
Available in a selection of colours including nude, spots, grey marl and black lace.
#3 Knickers with inbuilt protection
We are so lucky to be in the era of textile research and design and I am delighted to see this being applied to underwear.
Good for the environment. Great if you are usually fine but like to know you have back up. Possibly more discreet if you need a thicker pad than a liner.
Disadvantage – once they are wet you need to change the whole knicker. However, ideal for things like the gym – if you get bladder leaks when running on the treadmill or other higher impact classes. Strip off in the changing room and no worry to dispose of a pad.
Note: a couple of clients who have tried this option swear they will never wear pads again, certain that the pad itself was irritating their vulva and making their incontinence worse.
The gusset in these ProTech knickers is hardly thicker than your normal good robust cotton “pants” but is made of 3 layers, an absorbent fibre (holding up to 40ml = 2+ tablespoons), an odour retention layer and wick away surface. Like some of the best quality pads but fixed in place with sealed seams.
These are made by the same manufacturers as the Thinx range of period pants. A forward thinking company with their open-ness about the need for products to empower women to be active. And addressing sustainability and waste. They have a rather quirky style of presentation and some bold adverts.
Five different styles: from Hip Hugger, through classic bikini to thong. Varying prices depending on style £16 – £24 . They sent through some samples lately for me to show in clinic. The colours are fun: deep orange, blue, nude, grey and black. They are made from a silky rather than cotton fabric, much more like an ordinary fashion knicker.
NB: they are hand wash only which you might miss in the instructions (and then be very cross about!).
#4 A subtle cover-up with skorts and skirts
It started with school uniform but now we can all wear skorts! Perfect for just hiding a good pair of pants with a pad and getting on with whatever you wanted to do.
£20-£80. Offered by brands Decathalon, Salomon, Reebok and many others.
prettyfit.co.uk are stockists of the US brand runningskirts with a limited range but fun unusual prints £62.
#5 Add extra support to your core from the outside
Have a look at these if you feel just generally ‘unsupported’ at the moment.
Maybe not so much worried about leaks? More that your entire lower half moves about too much? Or that exercise is straining and fatiguing your pelvic floor and core muscles.
EVB Company founder, Yvonne Brady tells her story of returning to running after her third baby and struggling with muscle strength. Women’s health physiotherapists like myself are recommending these as an ‘extra’ layer. To create more lift and support for the pelvis, abdominals and pelvic floor.
Most of my clients have gone for the shorts style, giving the option of wearing them underneath any of their other leggings.
# 6 Add extra support to your bladder from the inside
The options have recently expanded for devices that aim to give support to your bladder from inside the vagina. Often called pessaries. The devices/brands you may see advertised include Contam, Contiform (available on prescription) and Uresta. The devices increase in price, partly reflecting the number of times that they can be used – from single week use only to monthly to reuseable for a year.
These work particularly well where you or your physiotherapist feel that the bladder has dropped only a little bit (prolapse of the anterior wall/cystocele). Yet everything else inside (particularly the uterus) is still well supported. You both feel you have created a good layer of muscles through exercise but could do with a bit more support when you are trying to be more active?
……that you will not use these ideas to make you complacent about a leakage problem. Nor as an excuse to avoid the issue of your bladder for another 3 months!
Incontinence might be “common” (45% of women report bladder leakage at 3 months after birth, even 10% of those after Caesarean) …. but it is never “normal”.
Incontinence is a sign of pelvic floor (or bladder) dysfunction. Something that needs addressing. And that can be greatly improved or completely resolved with the right exercise and help.
Incontinence is also a sign of lack of pelvic floor support. You may need to consider how pelvic floor friendly your sport is (ummm….trampolining….)?? Or you may need to modify activities to protect yourself from risk of pelvic organ prolapse.
To summarise! Do use these stop-gap options to get comfy, happier and more active NOW. But please, please commit to doing something about your pelvic floor muscles. Book an appointment with you GP to get a referral to a Specialist Physiotherapist for full assessment, support and advice. You can be much better than you are right now.
What are your tried and tested tips? Please share your experiences with other mums in our comments section below. Your story will inspire others.
Can I run yet?is a popular request from postnatal mums inphysio clinic. Before you dash out that door, use this postnatal checklist to make sure that your body is primed and ready for a successful, rewarding and injury free run. Download a printable of the 10 checks here.
We all love running
Running is a fabulous free, effective, fun way to exercise which appeals to many new mums .It’s heart, lungs, legs, bum.It burns calories quickly.You don’t need anyone else to do it with (but can if you want to).It is magic time ALONE.You can listen to music, your music. You can go at any time of day for 15 mins or 50, depending how lucky you get with your childcare. It lends itself to an erratic life, no class commitment required .You can even run in the rain.
Where will you start? Plan to avoid injury and disappointment
As a specialist physiotherapist I tend to pick up the problems that have developed or show up from mums running too soon, or without realising that their body wasn’t ready.These are things like sciatica, back or groin pain, recurrence of their antenatal pelvic girdle pain, incontinence and vaginal prolapse.
Run before? Often I worry that those who ran pre-baby are most at risk of injury as it can be difficult to work out where to re-start .You always remember what you were doing at your peak (!) but it can be tricky to find that “sweet spot” distance/time/pace to start back from.
Before you had your baby(ies) were you an erratic jogger, more into 5k fun runs or a half marathon junkie?What was your peak?Can you remember how you started out and built up from couch to that first 5k? You are going to need to take yourself back closer to the beginning to allow your body time to build the skill-sets of running in the right order – but don’t worry – it will all come together much quicker than the first time you took up running.
Or never at all? Or are you a complete newbie?Perhaps running is the only exercise option you are going to have with your post-baby lifestyle and its all new to you? You can take up running from any level of fitness but it is important to learn more about the process and tried and tested techniques of getting from couch to 5K+ so that you have fun, enjoy the process and don’t get disheartened. Follow all these steps and you will be out their running with the pros before you know it.
Can I run yet? a Mum’s Pre-run CHECKLIST
#1 Good Shoes
Will your shoes absorb 80% of the impact?
Your shoes are your first line of defence against the high impact of running.
Each step sends a jolt of high pressure, 4 times your body weight, through your ankles, knees, pelvis and spine. When running that can be 800+ steps per mile! If your foot moves to much on landing this can affect the biomechanics throughout the body and leads to common conditions such as plantarfascitis, ankle/knee strains, sciatica and hip pain.
The softening effect of the pregnancy hormones takes a while to return to normal, taking longer if you are breastfeeding.
TASK 1:Check your trainers
Look at the soles.If the tread pattern has worn away it is a sign of degrading and loss of cushioning.The sole should feel squishy not wrinkled and tough!
Try them on:with sports socks and make sure there is a gap of around half a centimetre between your longest toe and the end of the shoe as your feet will expand as you exercise.Many women’s feet flatten and change shape during pregnancy and rather like your bust you can need to be re-fitted for shoes.
Re-lace: Don’t try to secure a gaping shoe by tying the laces too tightly. Laces need to be tied firmly but not so tight that circulation is restricted during exercise. There are lots of different ways to lace shoes for your indivdual foot type.
review your orthotics:if you needed orthotics before, now with the changes of pregnancy you may need them reviewed or refitted – book an appointment with your podiatrist or physio and let them know you want to run.
go shopping with professional advice:Take your old shoes down to the nearest reputable sports shop for more advice.Many now have either a treadmill (often with video) or a force plate to create a picture of the pressure points in your foot which may provide useful information.A trained assistant will watch you run, give advice and help you try different styles.In Cambridge we have Up and Running & the sports shop at David Lloyd.
#2 Flexible back & pelvic symmetry
Can your pelvis transfer your weight from leg to leg?
Running is a sequence of standing on one leg then the other, just speeded up so you don’t see it.
TASK 2: wobble test
Try standing on one leg for a few seconds, then the other.Did they feel the same or different?Were you markedly more ‘wobbly’ one way, or have to jut your hip out to balance.Any pain triggered?Was it easier to move from right to left than left to right (or vice versa).Did one way just require more ‘thinking’?
If this simple test from one leg to the other makes you suspicious that you have a problem shifting your weight evenly, once you hit 3000 running steps this could lead to a back or pelvis problem becoming unmasked.
Check your technique: With an expert. If you already have a suspicion that your back or pelvis is not ‘right’ DON’T run yet because it is likely only to get worse.
if you had PGP during pregnancy and it is still niggling, go back to your physiotherapy team and ask for a postnatal review and assessment of your spine
if you think that your delivery might have triggered a new back or hip problem ask your GP to refer you for a physiotherapy assessment.
Are you a list kind of girl?– To Download a free printable check list CLICK here:
#3 Glavanised gluts
Have you got one bottom better than the other?
The other big load bearing muscles are the gluteals.As you stride forward each buttock needs to help take your weight and create forward propulsion.Weak bottom muscles and you will overuse your hamstrings and calves causing cramp or muscle strains.
TASK 3: the pilates bridge with knee fold test
This task mimics the job the gluts have to do when you run. Check your gluts are working equally well right and left with this task – you should feel your buttocks not your hamstrings take your weight and your foot should feel that it can just ‘float’ off the floor.
Lie on your back with your knees bent, feet flat.Draw yourself up into a bridge position.Are you hips level?Can you feel both gluteals (bottom muscles) working evenly or is one side doing all the work?Now focus on supporting your body weight with your right leg and let your left knee fold in over your hip.Feel the work in your right bottom.Then put your foot down and repeat folding your right knee in. You should feel your buttocks not your hamstrings take your weight and your foot should feel that it can just ‘float’ off the floor. You should be able to move smoothly from one side to the other without dipping hips, cramp in feet or hamstrings or rapid fatigue.
Focus your training: before you go out running and risk an injury, build up your muscle strength and co-ordination by doing a few sessions of my postnatal pilates sequence specifically designed to Galvanise your Gluts.
A traditional head lift/crunch style abdominal exercise doesn’t reflect the role the abdominals have to play when you move. In a sit-up/crunch you are keeping your legs still and moving your upper body – but when you run you need to keep your body still and move your legs!At full sprint both your feet will be off the floor at the same time.
TASK 4: The Pilates double table top position reflects this action well.
Can you do 10 leg extensions from table top postion, maintaining neutral spine, a lightly engaged core and while breathing naturally??? Your abdominals should not bulge or dome. NB: Start with your arms by your side (arms back, seen in the picture, is the more advanced version).
Focus your training: Follow my postnatal Pilates sequences Mind the Gap I progressing to Mind the Gap II for a few days – you will see a great improvement of your ability to control the abdominal wall which will mean you have back and pelvic support when you are running.
Postnatal pelvic floors can be slow to react and need waking up before you run.No good getting half way down the road before you start to think – ooh all a bit floppy and leaky….. where’s my undercarriage support….???
TASK 5: 35 second pelvic floor pre-run priming routine:
Turn your toes out, like a ballet dancer.Tighten your pelvic floor and notice how this position favours the back passage (the anal sphincter) just like you are stopping wind.Pretend you are having tea with the queen and made the mistake of baked beans for lunch.You need to effectively close the anus opening without clenching your buttocks more than a smidgen and without it showing on your face.Do 5 on and off squeezes, not trying to hold, just good squeeze, let go completely.
Then turn your toes in, like a pigeon. Now when you tighten up underneath it should feel different.Less going on at the back and more focus at the front, around the bladder tube and vagina area.Let the area be soft, almost a bit saggy,then lift and tuck the vagina up inside.Let go – completely.Then repeat 5 on – off contractions.Best lift you can do and relax.
Finally turn your toes into your normal standing posture.Now try to do both the previous actions at the same time.Most people start with the back tightening and then like a big zip come forward to lift and tuck the front.When you let go each time now it should feel like there was a bigger ‘up’ and a bigger ‘drop’.Repeat.If you are feeling clever add in some side to side tension too!
When you have done 5 squeezes with your toes turned out, 5 with your toes turned in and 5 with everything together you will have done 15 really good pelvic floor muscle contractions.NOW your muscles will awake and far more ready to cope with the impact as you run.
Check your technique: If you need to refresh your knowledge of pelvic floor anatomy do watch the videos in our Pelvic Floor School.
Focus your training: Pelvic floor need more attention?Check out my Pilates for your Pelvic Floor routine.20 mins everyday for a week and you should already feel an improvement. If you don’t then organise a proper vaginal assessment of your pelvic floor muscles with a specialist physiotherapist.
Have you warmed up your brain connection to your core?
Runners can be a little guilty about using running to warm up (yes you know you do). The purpose of the ‘warm up’ is literally to bring your muscles and tissues to a warmer temperature to make them less likely to injure (like bringing eggs to room temp before you bake!).A brisk walking pace before you break out into a jog is recommended.Or…because I am a multi-tasking kind of person – you could do some household chores while at home – hoover, mop a floor, hang out the washing – anything that makes you feel that you want to remove a layer.
TASK 6: pre-run prep
But I also recommend that you warm up your brain. 5 simple tasks (you will recognise them from the checks above) to focus your neural connections on the muscle actions that you need to run well. Have your kit on (including shoes), do this right in the hallway before you dash out the door.
TIP: or if you only get your run in the evening when your partner comes in from work – do your warm up while the kids are in the bath – even half an hour before you actually go will still be effective – you will be warm and all the right connections switched on – then as soon as you have the requisite childcare …you can be gone!
Focus your training: If you are better disciplined with a voice to keep you attentive and help with breath and timing the 10 minute Pre-run Prep in my postnatal pilates sequence has it all covered. Follow the links for free access to these professionally made videos.
Everyone pays attention to a good bra fitting postnatally.You may need your sports bra re-fitted too.
Especially if you now have a bigger bust.Protecting and caring for your delicate breast tissue isimportant after the stretching through pregnancy and breast feeding. An ill fitting bra will press on your trapezius muscles (running along the neck and back) which can cause pain and discomfort.
TASK 7:put your old sports bra on
Wear it for about five minutes to assess comfort and fit. Lift your arms up, bend down and jump to see if the bra and breasts stay in place. If you find spillage over, under or at the sides, reassess!
There are two types of sports bras. For small to medium busts compression bras press the breast against the chest wall to minimise bounce and enhance support as you move but if you are bigger than a 36B you will find you need an encapsulation bra (who thought that name up?), so that there is support for each breast in a proper cup.
Are you a list kind of girl?- To Download a free printable check list CLICK here:
#8 Support Pants
Extra layers in all the right places.
Again, its all about support.The best pair to reduce joggle.Of the belly, of the pelvic floor, of your back.Maybe even wear two pairs?
JoJo Maman have a good pair of postnatal ones that are made of thick lycra. You can wear the tummy panel high up to under the ribs to help hold your tummy, or roll back (like yoga pants) to reinforce the pelvis. They also have a vest that comes down to give tummy support if you prefer support top down rather than bottom up.
Or tight cycling shorts under your running ones to come up higher over your tummy.
If you plan to do a lot of sport invest in the clever design of the EVBsport.com * range of leggings, shorts and capris. They have special extra support stitching for the abdominals and pelvic floor areas. Designed from the ground up by a running mum.
* this is an affiliate link, if you make a purchase by clicking through from here I receive a small commission at no further cost to you. Thank you, this helps to support this blog.
#9 Bladder and bowel check
Be prepared for unexpected events
Your Bladder:Running is going to make the bladder jig up and down.You could get bladder leaks on running, even if you have been fine for normal activities till now. Running is a higher impact activity than most other things and could unmask a pelvic floor problem. If it happens, you are not going to panic as on this website we have all the information you need to sort it out.At the same time it could happen and we don’t want it to spoil your first run because you didn’t expect it. For that first run have a good quality panty liner in place so that anything unexpected doesn’t embarrass you. Any signs of bladder trouble default to brisk walking, which can be just as effective for fitness and calorie burning, for now.
If you are already experiencing bladder leaks please don’t run yet –sort it out with advice from us here at Supported Mums or by getting in touch with your local specialist physiotherapist. And meanwile there are lots of other ways to get fit which are more pelvic floor friendly.
Your Bowel:The pelvis is a compact space. If the bowel is full it will feel uncomfortable when you run and could put pressure on the bladder causing unexpected leakage.
TASK 9 wees and poos before you go!
Leave time in your routine to have the option to empty your bladder & bowel before you go out.You need privacy and TIME for a good poo.Take a book to read – it helps switch off your thinking brain and let you relax.
Humans have a tendency to try to over achieve and then feel disappointed and demotivated when we fail to reach our goals.You can’t start back running where you left off months ago.You will just feel unfit and disappointed.The best advice I ever read for getting back into running was aim to underachieve.You want to get home thinking – “that was great, I feel fabulous, I could easily have done more, I can’t wait to go again “.
TASK 10: download a pacing app
There are lots of great couch to 5km programmes that will help you pace your run and lead you safely and effectively from nothing back to your 5 km and beyond.
I highly recommend the much loved “Laura” the voice of the Podcast “Couch to 5km” downloadable from the NHS choices website, and now also as a free app. It got me from barely able to run for 1 minute (I know, for a physiotherapist frankly quite shocking!) to a comfortable 20 min just like it said it would. There are also extension podcasts for C25K graduates. If you want to be able to listen to your own playlists there are many paid for options you could try.
Run to enjoy the headspace
Half the week I ‘run’ rather than walk my dog. My runs are my treat to listen to my favorite podcasts. Now I’ve done the NHS couch to 5km app enough times I can set my phone timer for suitable walk/run intervals in the background to keep to a plan that challenges me but doesn’t over do it.
There are lots of books about Running and Mindfulness, or running as mindfulness (quick Amazon search will give you more than 5 recent ones). Authors explain the benefits on mood, anxiety and sleep patterns.
Or run with friends for motivation and company:
if you ran before with a group ask your partner or family to help you with childcare specifically for that time-slot so that you can rejoin the group you used to belong to.
Buggyfit classes and/or baby boot camps have lots of cardiovascular elements and you can take your baby in their pram. This would be a good place to learn warm up and cool down sequences and find like minded local mums to get out running with.
If you are in Bath, Bristol or London you are lucky to have This Mum Runs networks near you. This Mum Runs is a community encouraging and supporting real mums into or back into running. For beginners they run (paid for) courses to take you from new to running for 30 minutes. You join a once a week group (at a mum friendly time), led by a TMR trained coach called a “Runmaker” who helps with learning to pace and running technique. Then you aim to do 2 independent runs on your own or with friends in between. Graduates or those who can already run comfortably for 30 mins can join in a local, free running group, led my a Run Angel, thoughtfully on an evening or Sunday morning 8am. Read more on their inspiring website.
Can I run yet? If you can tick all 10 then Go run girl!
Missing a few? We can support you
Specialist Physiotherapists help postnatal women build up their bodies to run again. We work to pre-empt the most common problems that can arise if you run on an under prepared postnatal body. I hope this guide is a useful focus on the essential ground work to make your running the fun, useful, effective and safe activity that it should be. Please don’t hesitate to ask questions in the comments below.
Please let me and other readers know how you have got on and which tips resonated with you? We can all inspire each other.
Are you a list kind of girl?– To Download a free printable check list CLICK here: