Putting your pelvic health on the podium in preparation for marathon training

Running is booming, with global studies showing that more people than ever before are running. What is even more fascinating is that female participation rate is growing more than males. Hazel Eatwell, Specialist Pelvic Health Physiotherapist, shines the spotlight on the benefits of running to women and what they can do to ensure their pelvic health is not forgotten about during the gruelling training for the 26.2 miles of a marathon.

The benefit of running

So, what is it about running that's so enjoyable? Is it the love of seeing the world and nature up close, is it the physical challenges it brings, or is it simply that it's the most effective exercise that can be crammed into busy lives between work, childcare, and family duties? Whatever the reason, there's no doubt about the amazing effects it has on women’s mental and physical health.

Mood enhancing

Running increases your heart rate and gets the blood flowing around your body. In response to any perceived stress or pain, the brain releases chemicals called endorphins. As well as acting as natural painkillers, endorphins have a positive effect on mood, giving you a high that helps you feel relaxed and more positive.

Bone health

Running is also beneficial for your bone health. This is a key concern for women, as they are more at risk of developing osteoporosis, a condition that weakens your bones and makes them more likely to break. Until you're around 30 years of age you normally build more bone than you lose. However, during the menopause your bone breakdown occurs at a faster rate than your bone builds up, resulting in loss of bone mass.

As a living tissue, your bones strengthen when you use them, and as running is a weight bearing exercise this provides the perfect stimuli to both build new bone mass when you're younger and maintain bone strength when you're older.

Cardiovascular risk

Women are at increased risk of cardiovascular disease, especially during the perimenopause and after the menopause when their oestrogen is low. Oestrogen has a protective effect reducing the build-up of fatty plaques that can cause arteries to narrow. Regular exercise like running also lowers the risk of cardiovascular disease, which can include disease, stroke, and vascular dementia, as well as helping women maintain a healthy weight.

What if I want to run but can’t?

For some women they can run happily with no issues, and reap the many rewards discussed above. However, for some, the running journey may be slightly more complex. You may be managing some running but nowhere near the training frequency and mileage required for marathon distance, or simply not running at all.

Pelvic health matters in running

Running and pelvic floor problems is an issue of concern, so how can we help to support you striving for those challenges, whilst maintaining tip top pelvic health? We recommend that you start by either addressing or acknowledging the following information.

1. Don't put up with leakage

Running can cause more urinary leakage than other forms of exercise due to the high demands it places on your pelvic floor. Your pelvic floor is a group of muscles that sit across the bottom of your pelvis, and it's there to support the organs of the bladder, bowel, and uterus. It should keep you dry when you're moving, exercising, laughing or sneezing.

Sadly, leakage is common in running, but not normal, and is a sign that your body isn't managing what you're asking it to do. It's therefore sensible to discuss with a pelvic health physiotherapist any issues you're having as there are many strategies that we explore that can help both reduce the impact of running upon your pelvic floor, and of course strengthen it.

2. Do not ignore a heavy dragging sensation in your pelvis/vagina

A heavy, dragging sensation in your vagina/pelvic region may be a sign of a pelvic organ prolapse. This is a condition whereby the pelvic organs move down with gravity and cause a vaginal lump or heavy feeling.

Fortunately, there are several steps you can take to improve your pelvic floor support for running which may include performing regular daily pelvic floor muscle exercises, using a pessary device, or even trialling a continence device. A pelvic health physiotherapist or gynaecologist can advise on the options available.

3. Start tracking your menstruation cycle

Menstruation is starting to be considered the fifth vital sign of female health, being as important as temperature, pulse, respiratory rate, or blood pressure. But how much do you really know about your menstrual health?

If your period changes during your marathon training, vanishes completely, or you haven’t started your period by 16 years old, it's important to investigate the possibility that you may be suffering from Relative Energy Deficiency in Sport (RED_S). This is when you don't get enough energy from your diet to match the energy demands of your training and life. This imbalance of energy causes an ‘energy deficit’ and can mean your body starts to function poorly, both in running and in health. In the short term, RED_S can affect your performance, adaptation to training and mental health. In the long term, it can cause dysfunction of your menstrual cycle, cause bone weakness and impact cardiovascular health.

Another reason for fluctuation in the nature of frequency of your periods from your late 30s or early 40s may often be the first indication of perimenopause, which is when you experience menopausal symptoms due to hormone changes but still have your periods. Starting to track your periods will again provide valuable information to understand what your normal is so you can understand if there are any changes which may be indicating any changes due to perimenopause.

4. Make every day a potential running day

Dina Asher Smith, a British sprinter, helped raise the taboo subject of menstrual cycles on live TV when she reported that she believed the effects of her menstrual cycle caused her to pull up with cramp during the European Championships 200m final. But what does this mean for you? Should you run or not run-on specific days of your menstrual cycle? The short answer is no. Listen to your body and run if you want to. A recent 2020 meta-analysis found that currently it's not possible to make general guidelines about what types and intensities of exercise are best suited to particular stages of the menstrual cycle. The conclusion is that we're all different and need to take an individual approach. Again, this means tracking your cycle and seeing if you notice any patterns, and then working with your body rather than against it.

Need more support?

As highlighted, running is a fantastic activity with many health benefits for women, however you cannot compromise your pelvic health. If you're struggling with any of the issues discussed above during your training, or have recently had a baby and are looking to return to running, or simply looking for more guidance, please speak to one of our pelvic health specialist physiotherapists. They can assist you by providing expert help with a range of pelvic conditions, as well as teach you to perform pelvic floor muscle exercises correctly. They can also guide you through appropriate strategies to enable a safe return to running without compromising your pelvic floor, whether that be a marathon or a couch to 5K.

Last updated Thursday 2 February 2023

First published on Wednesday 28 September 2022