What’s new with Running and Prolapse (POP)? Not only is it Pelvic Organ Prolapse Awareness month, but we also celebrated Global Running Day in early June. So for our next research round-up, let’s talk about what we can glean from recent studies that discuss the prevalence of POP in activities that involve running. 

What do we know? 

Research at the cross-section of sports medicine and pelvic health IS growing. However, we still have a long way to go to understand how best to advise and guide folks who want to engage in fitness and sport. This is particularly true with activities that involve higher impact forces. Previously we discussed having significantly more research on incontinence and athleticism. Lourenco et al. (2017) noted that as sport specific impact forces increase, rates of incontinence increase (higher impact, higher rates of incontinence). In addition it is noteworthy, that female recreational runners with the highest peak braking forces were 8x more likely to have a running related injury (Napier et al. 2018). 

But what about running and prolapse?  

What’s new…Highs and Lows?

In a 2016, 311 triathletes, ranging from Sprint to IronDistance, were recruited for a survey study. The authors found that 5% of the participants reported symptoms of POP (Yi et al. 2016). An additional survey of 1,379 runners and CrossFitters found that the Runners reported higher rates of POP symptoms than CrossFitters (12.7% vs 7.8%). (Forner et al. 2021). 

Considering the historical concerns about the relationship between high impact forces and the development or aggravation of POP, these prevalence rates are lower than expected. Interestingly, while the training of a triathlete and a runner seem to have more overlap, there was more similarity in the prevalence rate of POP in the Triathletes and CrossFitters (5% and 7.8% respectively). One takeaway may be that the triathletes and CrossFitters participate and train more movement variety than those that ONLY run. Running is a very repetitive impact activity. Exploring new movement patterns and activities might be a path for some to improve symptoms and build/rebuild resilience. 

But wait…..there’s more! 

In a 2024 study, runners were recruited for an instrumented treadmill study. Following data collection, they were offered the opportunity to opt into pelvic health surveys. Of the 66 that chose to participate and met inclusion criteria, 4.6% reported symptoms of prolapse while running. (Wiebe et al. 2024- ABSTRACT). This value was similar to the prevalence reported for triathletes and CrossFitters. So what gives?

A few things to note, Wiebe et al. (that’s me and my amazing team!) recruited athletes for a running study vs. recruiting for a study that explored pelvic health variables in those that run. This helped to reduce what is called the sampling bias, which is a strength of our study. A sampling bias is a fancy science term meaning folks with pelvic health issues are more likely to sign up for a study that is studying pelvic health, thus having the potential of artificially elevating the numbers in the results. Of course, the 66 that opted into the pelvic health survey were clearly-clued-into the purpose of the secondary study. However, the hope is that by sampling for runners first, our results MAY depict a more accurate reflection of the prolapse prevalence in the running population at large.

It is important to remember, as we discussed in the High Intensity and Pelvic Health blog earlier this month, up to 75% of folks self-select out of fitness due to POP symptoms. This may explain the lower prevalence found in our data. Conversely, there is a proposed thought process that physical activities can have a positive training effect on the pelvic floor (Bo and Nygaard, 2020; Leightner et al. 2018). Our findings MAY support this hypothesis, but we still have a LONG way to go to draw those conclusions.

So where do we go from here? 

Running and impact related activities have also been historical no-no’s to prevent or manage POP, so the lower than expected prevalence noted in these studies DOES support avoiding blanket edicts. However, please note POP is multifactorial, so this means we cannot suggest that the opposite blanket statement-that running is appropriate for everyone- is true.

Instead, our job is to distinguish and develop:

1. For whom is running appropriate? 
2. Individualized ways to coach or dose it in a way that improves folks tissue/symptom tolerance
3. Use strategies to rebuild and prepare folks for impact

Try these ideas to help with Running and Prolapse 

Here are some adaptations and strategies to help you make those decisions and develop programs to try to reduce aggravating forces and pressures on the prolapse and pelvic tissues in the trenches.

1. Ease your abs. Gripped abs while you run adds pressure/force from above downward towards your prolapse. A stiff trunk is not what you need when you are trying to absorb impact. Instead, we need to be springs with each step. This includes having a springy center.

2. Reduce pelvic floor rigidity. Folks often hold a Kegel while running thinking they are protecting their prolapse. But the pelvic floor MOVEs up and down while we are running in the same pattern as the glutes (lengthens to prep for foot contact, contracts up at foot contact). Learning to integrate that up and down movement in the pelvic floor with your glutes and abs helps reduce central stiffness (think SPRINGY), and helps absorb impact. 

3. Rotate. Emphasize rotation through your whole torso (not just your upper chest) while running to break up a tendency to grip at the tummy. This also helps to keep you propelling forward not bouncing up and down while you run (which increase impact forces). (More on that here)

4. Lean. Shift forward into the run like you are running up a gentle hill. Shifting your body mass over the lead leg reduces over-striding to the front, reducing impact forces. This also creates more stride behind you-kicking up your glutes (see#2), huge for absorbing impact! (More on that here)

5. Symptoms are Signals. Listen up, your body is giving you hints as to what you are ready for. A one size fits all approach to return to run, simply doesn’t work. YOUR signals are YOUR guide. Modify as needed. (More on that here)

Opportunities Abound!

While the lack of research is still glaring, recent efforts and attention on these needs are opening new doors, and, of course creating, lots of new questions! These are opportunities to keep digging deeper to keep moving the ball forward for the folks we care about!

Don’t wanna miss a post and enjoy subscriber only content and discounts- join my newsletter here. 

To Learn more, see courses below that can help you dig deeper: 

For Individuals 

For Pros interested in helping women return to run with prolapse (and other athletic activities) keeping pelvic health in mind

References

Lourenco TRDM, Matsuoka PK, Baracat EC, Haddad JM. Urinary incontinence in female athletes: A systematic review. IntUrogynecol J. 2018;29(12):1757-1763. doi:10.1007/s00192-018-3629-z.

Napier, C., C. L. Maclean, J. Maurer, J. E. Taunton, and M. A. Hunt. “Kinetic Risk Factors of Running-related Injuries in Female Recreational Runners.” Scandinavian Journal of Medicine & Science in Sports 28.10 (2018): 2164-172/

Yi J, Tenfelde S, Tell D, Brincat C, Fitzgerald C. Triathlete risk of pelvic floor disorders, pelvic girdle pain, and female athlete triad. Female Pelvic Med Reconstr Surg. 2016;22(5):373–6. https://doi. org/10.1097/SPV.0000000000000296.

Forner LB, Beckman EM, Smith MD. Do women runners report more pelvic floor symptoms than women in CrossFit®? A cross- sectional survey. Int Urogynecol J. 2021;32(2):295–302. https:// doi.org/10.1007/s00192-020-04531-x.

Wiebe JW, LaCross J, Huang M, Nguyen A, Fridman L, Tran N, Napier C. Prevalence of Pelvic Health Symptoms Associated with Pelvic Floor Overactivity in Recreational Female Runners. Poster Presentation. American Academy of Sports Physical Therapy-American Physical Therapy Association. Combined Sections Meeting. Boston, MA. February 2024

Bø K, Nygaard IE. Is physical activity good or bad for the female pelvic floor? A narrative review. Sports Med. 2020;50(3):471–84. https://doi.org/10.1007/s40279-019-01243-1.

Leightner, Monika. “Evaluation of Pelvic Floor Kinematics in Continent and Incontinent Women during Running: An Exploratory Study.” Neurology and Urodynamics (2018); 37: 609-818. DOI: 10.1002/nau.23340