Run Well
Page 10
The first thing to do is to realise that while stress incontinence is common, it’s not normal. You don’t need to put up with wet running shorts and treatment is available. Ideally you should have an assessment by a women’s health physiotherapist. They are trained to examine and advise you. You can ask your GP to refer you or, if you have the means, you can make a private appointment. Your individual situation will be assessed and you will be given a programme of exercises to help restore your continence. This will involve pelvic floor exercises, but it will also include other specific exercises to correct any muscular imbalances that may be adding to the problem, for example weak glute muscles. The physiotherapist may also use a range of devices to help you identify and strengthen your pelvic floor muscles, such as electrical stimulation probes and vaginal exercisers. With perseverance and hard work, over 60 per cent of women find the treatment successful, but it can take months so don’t give up. As the issue of urinary incontinence becomes less taboo and awareness of the problems increases, there is more work being done to offer solutions to women, including pessaries to insert during exercise and sports shorts designed by a female engineer which mimic the structure and support of the pelvic floor muscles.
Real-life runners
I started running aged 56. It was when I started entering events and trying to run hard down hills that I found I was leaking a bit of urine. My GP recommended an app for pelvic floor exercises. This was great and along with more advanced exercises from a specialist physiotherapist, the problem was solved.
Margaret, runner, explorer and triathlete
Did you know?
Pelvic floor muscle exercises are also called Kegels, after the American gynaecologist Arnold Kegel. In the 1950s he invented a device called the Kegel perineometer to measure the strength of pelvic floor muscle contractions. He used this alongside Kegel exercises to help treat urinary incontinence.
Q Should runners do pelvic floor exercises and do men need to do them too?
A Yes and yes! The pelvic floor is a sling of muscles that runs from your pubic bone at the front to your coccyx (sitting bone) at the back. It supports your pelvic organs, including your bladder, bowel and the uterus in women. It has an important role in helping you stay continent, and weak pelvic floor muscles can result in both urinary and faecal incontinence. Weakness can result from excess pressure on the muscles such as strain from coughing, constipation, heavy lifting or being overweight. In women, childbirth and falling oestrogen levels of the menopause can weaken it too. You can strengthen the pelvic floor muscles with specific exercises and this will improve symptoms of incontinence in the majority of sufferers. The pelvic floor muscles are also involved with erectile function and having a strong pelvic floor might help you maintain an erection, prevent premature ejaculation and result in stronger orgasms. They’re important for everyone, male or female, and particularly important for those doing high impact sports such as running.
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Pelvic floor exercises
Be warned: identifying and controlling your pelvic floor muscles can take time and practice. With perseverance and regular practice you can expect to see an improvement in any continence problems within three months.
Identify the muscles The pelvic floor muscles loop around both your urethra (water works tube) and your anus. Imagine you are in a very important meeting where breaking wind is completely inappropriate. Try to squeeze the muscles that would keep the wind in. These are the muscles around your anus that you need to work. When you are next passing urine, try to stop mid-flow and feel how the muscles contract. These are the muscles around your urethra that you need to work. Men should see their scrotum lift upwards and their penis nod downwards a little. Don’t stop mid-flow regularly, only to help you find the correct muscles to squeeze. Squeezing these front and back muscles and drawing them up together and towards each other is what you need to do during the following pelvic floor exercises.
Work the muscles You can do these exercises sitting down (easiest way to start), standing or lying, anywhere at any time. No one will know you are doing them. Remember, you shouldn’t be squeezing your bottom, raising your eyebrows or holding your breath while you do them. The pelvic floor has both fast- and slow-twitch muscle fibres and you need to work them both.
1 Take a deep breath in, ensuring you fill your belly (see here). Your pelvic floor will relax when you do this.
2 As you slowly exhale, work the fast-twitch fibres by performing five short, sharp squeezes of the pelvic floor muscles.
3 Repeat this five times making sure you fully relax your pelvic floor while you inhale.
4 Now move on to the slow-twitch fibres. Take a deep breath in. Exhale slowly and gradually draw the front and back pelvic floor muscles upwards and together. Imagine an elevator travelling up the floors. As you get stronger you will be able to hold onto the slow squeeze for your entire exhalation. Aim for five to 10 seconds.
5 Repeat this five times, slowly relaxing your pelvic floor muscles back to complete rest while you breathe in.
Do these exercises three times a day for the rest of your life. You may only feel a flicker of movement when you first start these exercises, but don’t worry. They will get stronger with regular practice. Concentrating fully on the muscles will help you properly connect with them. If you can’t identify them, they are too weak to squeeze or aren’t getting stronger with practice, then see your GP.
Q Is it safe to run with a vaginal prolapse?
A In women, the bladder, bowel or uterus can sometimes drop down from their normal position and give a sensation of dragging or aching in the vagina, and sometimes a bulge or lump can appear. The usual cause is weak pelvic floor muscles that aren’t giving these organs the structural support they need. The symptoms experienced depend on which organs are prolapsing. If it’s the bladder that’s dropping down, then it’s called a cystocele and you may experience urinary incontinence, or need to pass urine frequently and urgently. You may also find that you don’t empty your bladder properly or that the flow of urine is blocked in some way. If it’s the bowel that’s dropping down, then it’s called a recotocele, which can make passing faeces difficult. Symptoms are usually worse when you have been on your feet for a while and gravity has been at work.
Having a vaginal prolapse indicates that there is dysfunction of your pelvic floor and you shouldn’t add extra pressure to it by running. The high impact nature of running may make your prolapse worse. You need to be assessed and treated before you run again. Mild prolapses can usually be resolved with pelvic floor exercises. More severe prolapses may require insertion of a pessary (plastic ring or shelf) to supplement the pelvic floor muscles or possible surgery. Keeping to a healthy weight, avoiding constipation and delegating heavy lifting can help stop prolapses worsening too.
Q Running seems to help most health conditions. Can it help prostate problems?
A The prostate is a small gland that sits just below the bladder in men. It makes fluid which forms part of semen, and during ejaculation the muscles of the prostate contract and push the fluid out into the urethra to carry and nourish the sperm. The three most common types of prostate problem are prostatitis (inflammation, often due to infection), benign prostatic hypertrophy (BPH), where the prostate is enlarged, and prostate cancer. All three can cause prostate symptoms which include needing to pass urine frequently, difficulty initiating the stream of urine, a weak stream of urine and dribbling urine after finishing.
Physical activity is unlikely to have any bearing on prostatitis, although men with a chronic (greater than six months’ duration) prostatitis may find that exercise helps to reduce symptoms and increase wellbeing in what can be a challenging condition to control. Several studies, however, have examined the relationship between exercise and BPH. There have been conflicting results, with some showing that low intensity exercise might reduce the risk of BPH more than vigorous exercise and others showing that vigorous exercise might act
ually increase the risk of BPH. One study done in 2008 used data from the National Runners’ Health Study which included over 28,000 men. It relied on self-reporting of diagnosis and running distances but it concluded that exercise, regardless of the BMI, diet or 10km pace of the runner, may lower the risk of BPH and that potentially longer distances mean larger reductions. A Cochrane review (a systematic review of primary health research) in 2019 examined all relevant studies done to determine whether exercise could be used as a first-line treatment for the symptoms of BPH. Unfortunately, they found such low-quality evidence they were unable to draw any conclusions, so further research is most definitely needed.
The jury is also still out on exactly whether and by how much exercise might reduce the risk of prostate cancer. So far, it is pointing to yes – vigorous exercise may be most effective and the biggest risk reduction is in aggressive prostate cancer (see here).
Did you know?
The average number of times people pass urine in 24 hours is six or seven.
Q My bladder is so sensitive I have to visit the portaloo many times before a race and stop during runs. What can I do about it?
A Sometimes it isn’t a leaky bladder that causes problems, it’s an overactive one that doesn’t seem to hold much, always needs to empty and can make you live in fear that if you don’t go to the toilet you might wet yourself. Both men and women can suffer from an overactive bladder (OAB). Around 15 per cent of men have the condition and it is under-recognised and often under-treated in men because of their hesitancy to seek help. It’s particularly common in post-menopausal women where low oestrogen levels can lead to bladder muscle irritability and atrophy (thinning) and irritation of the tissues around the urethra and vagina resulting in increased urinary frequency.
Here are some things that might help:
• Stay calm In a race situation, nerves will almost certainly add to the problem, so try to relax and distract yourself.
• Avoid irritants OAB can be made worse by caffeine and alcohol, so steer clear of these.
• Drink plenty This may sound counter-intuitive, but simply reducing what you drink to avoid needing to go the toilet will just make urine more concentrated and irritating, and may harm your running performance.
• Train your bladder You may need to do this with professional help, but it is possible to retrain your bladder by gradually leaving longer and longer gaps between going to the toilet, aiming for every four hours. When you feel you need to go then change what you’re doing, distract yourself or do some pelvic floor exercises.
• See your GP If this is a new symptom for you then you may need to have some tests to look for an underlying cause such as urinary tract infection, diabetes, bladder or prostate problems. Once a diagnosis of OAB has been made then there are medications that can be used to relax the bladder. They aren’t without their side-effects, but can be very helpful for some people. Women with vaginal atrophy can use an oestrogen cream to plump up the thinned tissues and relieve symptoms. Bladder botox injections aren’t available everywhere, but can provide short-term, effective relief. In extreme circumstances, nerve stimulation and bladder surgery may be offered.
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Collecting a urine sample
Ever had a urine pot thrust into your hand at the doctors with advice to provide a sample? Here’s the best way to collect urine and minimise the risk of it being contaminated, which can mean a useless result.
1 Wash your hands. If you’re at home then wash your genital area too.
2 Wrap some toilet paper around the outside of the specimen pot, particularly if you’re a woman as aiming your stream of urine is tricky.
3 Unscrew the lid of the pot. Be careful not to touch the inside to keep it sterile.
4 Women should sit on the toilet with their legs apart and use one hand to hold back the labia so urine can flow out with minimal contact with the skin. Men can retract the foreskin for the same reason.
5 Start to pass urine, but don’t collect the first bit. A mid-stream sample is best if the sample is looking for possible infection.
6 Pop the pot under the stream of urine and collect your sample.
7 Screw the lid back on and throw away the tissue you wrapped around the outside.
8 Wash your hands.
9 Label the container if it hasn’t already been done for you.
Q I run a lot and I get a lot of cystitis. Is there a link?
A Cystitis means inflammation of the bladder and it can sometimes be caused by infection, but often by irritation too. Symptoms include needing to wee frequently, stinging and burning when you pass urine, and bladder pain. It’s much more common in women than men and there’s often a trigger, such as having sex or going swimming. There may be a link with running for you. The urethra brings urine from the bladder to the outside and the urethral opening can be quite delicate. Rubbing underwear, shorts or tights can irritate this area and cause superficial pain, and stinging or burning when you wee. To reduce this, apply some lubricant or baby’s nappy cream to the area before you run. It will act as a barrier and protect the delicate tissues. Runners often wash frequently and using soaps, bubble baths and shower gels can trigger cystitis. Taking a shower rather than a bath and avoiding using perfumed products will help to reduce the risk – plain water is fine for cleaning your genitals.
Another way running could be linked to your cystitis is by irritation of the bladder lining. The action of running and the jolting it causes may lead to the bladder walls hitting each other, which can inflame them. Similarly, if you don’t hydrate enough then concentrated urine might irritate the bladder lining too. This shows how important it is to hydrate well, especially in the hours after you run. Of course, cystitis is common and yours may be unrelated to running. If you are having frequent bouts, then do see your GP to discuss and take a urine sample with you to the appointment. This is particularly important if you are male as urine infections are much less common and the threshold for investigation is lower.
Q Can I exercise with a urine infection?
A The severity of a urinary tract infection (UTI) can vary hugely. It can make you feel very unwell, especially if your kidneys are involved. In this situation you’re likely to have a high temperature, nausea or vomiting and back pain. Running is clearly not a good idea and you should rest and recover. Similarly, if you have blood in your urine, stinging when you pee or abdominal pain, then give running a miss. If on the other hand you’ve just had a couple of extra trips to the toilet and it was a bit uncomfortable, but you otherwise feel fine, then going for a run probably isn’t going to do you any harm. Do make sure you drink plenty of water, though, because concentrated urine is only going to make things worse. Urine infections are usually treated with antibiotics, so see your GP if mild symptoms aren’t settling after a couple of days, you feel unwell or your symptoms are more severe.
Did you know?
For those with a medical condition or disability that means quick access to a toilet is essential, numerous charities provide ‘toilet cards’ which explain your need without you having to go into detail. While there’s no obligation for anyone to let you move to the front of the queue, they can help to justify your request. There’s a National Key Scheme for accessible toilets and the Radar keys are available from Disability UK. The Eurokey is the European equivalent.
Top tips for a healthy runner’s urinary system
• Hydrate yourself before, during (if necessary) and after your runs.
• Replace electrolytes lost through sweat, especially on long runs (see here).
• Respect the weather conditions and adapt your expectations, pace and hydration in hot weather.
• Don’t use anti-inflammatory medications for pain relief during long runs and races.
• Get your blood pressure checked at least every five years or more often if there’s a medical need. High blood pressure can damage the kidneys.
• Eat a healthy diet an
d drink plenty of fluid to avoid constipation, which can affect bladder function.
• Do regular pelvic floor exercises.
• Don’t suffer in silence and seek help if you experience urinary or faecal incontinence.
• If you have given birth then make a gradual, planned return to running after strengthening your pelvic floor muscles (see here).
FURTHER HELP AND ADVICE
Kidney Care UK: www.kidneycareuk.org
The National Kidney Foundation: www.kidney.org
Prostate Cancer UK: www.prostatecanceruk.org
Bladder and Bowel Community: www.bladderandbowel.org
Bladder and Bowel UK: www.bbuk.org.uk
Disability UK: www.disabilityrightsuk.org
Incontinence UK: www.incontinence.co.uk
SqueezyApp pelvic floor exercises: www.squeezyapp.com
Engineered sportswear for women: EVB Sport www.evbsport.com
Chapter 6
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The Reproductive System
Let’s move on down to the reproductive system. You might not immediately think that this system is terribly relevant to running, but once you start considering it you’ll soon see it is! It can cause huge problems, especially for women, but running also offers many benefits for the reproductive system in terms of physical, mental and sexual health. This information is intentionally not split into separate men’s and women’s sections, because it’s important we have an insight and understanding into the barriers all our running friends face. Let’s quickly recap the basic anatomy of both the male and female reproductive systems so we’re clear on exactly what lies where.