While pregnancy is often what calls attention to pelvic floor muscles, it’s important for all runners to understand this muscle group. Basically, the pelvic floor is a group of muscles and connective tissue that attach to the pelvis. Together, they act as a sling, or hammock, to support the internal organs of the lower part of the abdomen, including the bladder, uterus, and rectum.
But for runners who have had children or plan to some day, it’s also important to understand how pregnancy affects this part of our anatomy, and the implications of those effects on our running. In addition to supporting our organs the muscles of the pelvic floor are involved with continence, the ability to voluntarily hold in your bodily fluids (read: make it to the bathroom without peeing your shorts).
So let’s explore this muscle system in further detail and learn how it affects your running.
Throw Me a Bone
We’ll start with the bones of the pelvis. You’ve got the left and right ischium, ilium, and pubis. Each ilium attaches to the sacrum and coccyx and each pubis are joined via the pubic symphysis, a cartilaginous joint. Where the ilium meet the sacrum is known as the sacroiliac, or SI joint.
There are many bony prominences (also called ‘bony knobs’ – ew) where the muscles of the pelvis attach, many can be felt through the skin such as the iliac crest, the ischial tuberosity (commonly called the “sit bone”), the anterior superior iliac spine (ASIS), and the posterior superior iliac spine (PSIS).
|Ilium (left and right)||Upper part of the hipbone.|
|Ischium (left and right)||Base of the pelvis.|
|Pubis (left and right||Inner middle bone of the pelvis.|
|Sacrum||Large triangular bone at the center of the pelvis, at the base of the spine.|
|Pubic Symphasis||The joint where the left and right pubic bones meet.|
|Iliac Crest (left and right)||Wide ridge of bone you feel across your lower back just above your butt.|
|Ischial Tuberosity (left and right)||The sit bones.|
|ASIS (left and right)||The bony knobs you can feel in the front of your waist.|
|PSIS (left and right)||the bony knobs you can feel on your lower back near your belt line.|
Put Some Muscle into It
The coccygeus is a triangle shape that connects the lower part of the sacrum to the coccyx. Its primary function is holding up your uterus (so it doesn’t fall out when we run, obvs).
The levator ani is the main pelvic floor muscle and it’s the one that contracts during orgasm (yay!). It is formed by three parts: the puborectalis, pubococcygeus, and the iliococcygeus – try saying that three times fast. You can think of them as the inner, middle and outer parts.
The pubococcygeus, or middle part, is the most important of the three parts of the levator ani. It connects the pubic bone to the coccyx bones, acting like a hammock (it’s at the center of the illustration to the right). This is the part of the levator ani that controls continence; it holds your pee in. This is what benefits from all those Kegels you’re definitely doing all the time.
While the levator ani and the coccygeus are the muscles most commonly thought of in the pelvic floor, it should be noted that the deep lateral hip rotator muscles like the piriformis, work with these two pelvic floor muscles to stabilize the hips.
As we know, each of our muscles is part of an anatomy train and rarely works alone.
Pelvic Floor Muscles
|Coccygeus||Triangular muscle connecting the sacrum to the coccyx. Primary function is holding in organs.|
|Levator Ani||The sling like muscle that connects the coccyx to the rest of the pelvis. Primary function is orgasm, continence, and holding in organs.|
That’s Some Nerve
The major nerve involved with the pelvic floor is the pudendal nerve, which is really fun to say. Poo-den-dahl. The pudendal nerve serves the perineum, the area between the rectum and the genitals, and controls sensation in the genital area (so thank it every day), and provides motor control of the pelvic floor muscles (so your partner should also thank it).
Vaginal delivery of a baby can damage this nerve, leading to problems like incontinence. Additionally, this nerve passes between the piriformis and the coccygeus so if there are any injuries to either one of these muscles, inflammation or prolonged contraction of one of these muscles will compress the nerve. Ouch!
You Can’t Run Away from These Problems
Issues arise from damage to any part of the pelvic floor that can subsequently impact running. Most commonly troublesome are prolapse and urinary incontinence (the peeing of the shorts). Both of these result when muscles lose their ability to contract at full strength, typically because they are over-stretched from childbirth.
Prolapse is when your organs slip or fall out of place, and this is the origin of the myth that running will make your uterus fall out. Prolapse of the uterus is more common in postpartum women than you might think. It should be noted that vaginal birth is not the only cause of weakened pelvic floor muscles and prolapse. Age may also be a culprit, as the natural decrease in estrogen after menopause may cause the uterus to drop. So masters runners take note!
A couple other types of prolapse caused by weakened pelvic floor muscles are rectocele (rectal prolapse) and enterocele (small intestine prolapse). Some female runners who have experienced prolapse describe it as feeling like your organs are going to fall out of your body when you run, sneeze, cough, or do anything. If you experience anything like this, you should definitely see your doctor or physiotherapist ASAP. Prolapse is serious business.
Urinary incontinence is when you lack voluntary control over urinating. A weakened pelvic floor causes stress incontinence. A small amount of fluid leaks from the bladder, usually because of outside pressure like sneezing, coughing, or even laughing. Stress incontinence can really put a damper on running. It’s no fun to worry about wetting your tights every time you lace up.
Why does it happen? The urine leaks out because the pelvic floor muscles are too weak to fully support the bladder and urethra. Again, it’s worthwhile to see a doctor or physiotherapist who can work with you to strengthen the muscles and minimize the … uh … undesirable effects.
Is prolapse or incontinence normal after having a baby?
Yes! Although they definitely warrant medical attention, these problems are way more common than you may think, so don’t be embarrassed. Although statistics are a little lacking, 40-70% of women in the US experience incontinence after childbirth and it is estimated that nearly half will have some type of prolapse.
You Need Therapy
The dysfunction that stems from the pelvic floor weakness or imbalance is usually a matter of the muscles no longer functioning at full force. This is where seeing a doctor or a physical therapist can be of great benefit, either to give you exercises that help re-strengthen the muscles or offer advice for procedures that might be needed in extreme cases. Look for someone who specializes or is familiar with pelvic floor issues.
A specialist like this can help get you back running faster and healthier. You can find someone in your area here. Additionally, there are many great support sites online to connect with other women who are dealing with pelvic floor problems.
Did you experience pelvic floor issues postpartum?
To get a really comprehensive look at the structure of the pelvic floor, check out this excellent 3-D video from Fisio-Notizie