If you have ever planned a run on the Brown’s Creek State Trail around where the bathrooms are, worn black shorts on purpose, or cut a long run short because you leaked at mile three, this post is for you. Leaking with running, jumping, or heavy lifting is one of the most common things I treat at Enhance PT in Stillwater, and it is also one of the most fixable. Here is what is actually going on and what it takes to resolve it.
Is leaking during a run normal?
No. It is common, especially among female athletes and postpartum runners, but common and normal are not the same thing. Leaking with impact is called stress urinary incontinence, and it is a signal that your body is not managing pressure well under load, not a life sentence and not something a pad solves.
I hear some version of “I figured it was just part of being a mom who runs” almost every week. The runners logging miles on the Gateway Trail or doing the Stillwater Loop across the St. Croix Crossing bridge and back over the old Lift Bridge are not weak or broken. Most of them have simply never had anyone look at how their whole system handles impact. You can read more about urinary incontinence in general at MedlinePlus, but the short version is that leaking with exercise is a treatable mechanical problem.
Why does running make you leak?
Running leaks happen when the pressure inside your abdomen spikes faster than your pelvic floor can respond, and that is a coordination and mechanics problem more often than a strength problem. Every footstrike sends force up through your body, and your diaphragm, abdominal wall, and pelvic floor have to manage that pressure together, thousands of times per run.
When that system works, the pelvic floor responds reflexively before each impact. When it does not, pressure finds the path of least resistance. The breakdown can come from a lot of places: a breath-holding habit, ribs that flare and dump pressure downward, a stride that overloads one side, a pelvic floor that is actually too tight to react quickly, or yes, sometimes genuine weakness. The St. Croix Valley does not help you here either. The hills coming up from the river change your mechanics and your breathing, and plenty of my clients leak on hills but not on flat ground, or only late in a run when fatigue changes their form.
This is why I look at the whole system, not just the pelvic floor. It is the same logic behind every evaluation at my practice, whether the complaint is leaking or knee pain.
Why pads and “just do kegels” usually fail
Pads manage the symptom and kegels only treat one possible cause, which is why so many runners try both for a year and end up exactly where they started. A pad does nothing about the pressure problem, it just absorbs the result. And kegels are a strength exercise, so they only help if weakness is the actual driver.
Here is the part nobody tells you: a large share of leaking runners have pelvic floors that are overactive, meaning tight, guarded, and held at partial contraction all the time. A muscle that never relaxes cannot generate a quick, strong contraction when your foot hits the pavement. Telling that runner to do more kegels is like telling someone with a clenched fist to grip harder. It often makes things worse. The only way to know which camp you are in is an actual pelvic floor assessment, not guesswork.
What does an assessment look like for a runner?
A runner’s evaluation at Enhance PT is a full 60 minutes, one-on-one, and it looks at you as an athlete, not just a pelvic floor. We start with your history: training volume, when the leaking happens, what mile, what surface, hills or flat, full bladder or empty. The pattern itself is diagnostic.
Then I watch you move. Squatting, hopping, single-leg loading, and your breathing strategy under effort, because how you breathe when you push is usually how you breathe when you run. I look at your running mechanics and cadence, since overstriding and slow turnover increase the impact your system has to absorb on every step. If it is appropriate and you consent, an internal pelvic floor assessment tells me whether your muscles are weak, overactive, uncoordinated, or some mix, and those are very different treatment plans. Internal work is always optional, and plenty of runners start entirely externally. This whole-athlete approach is the same reason I offer a dedicated running assessment as part of my orthopedic practice.
What actually fixes leaking with running?
What resolves it is retraining the whole pressure system under progressively harder loads until running stops being the exception your body cannot handle. Here is how the common quick fixes stack up against what actually works:
| Common quick fix | Why it falls short | What actually resolves it |
|---|---|---|
| Pads or dark shorts | Manages the symptom, changes nothing | Treating the pressure management problem itself |
| Generic kegels | Only helps if weakness is the driver | An assessment first, then the right exercise for your pelvic floor |
| Emptying your bladder constantly | Trains your bladder to be more irritable | Normal bladder habits plus impact retraining |
| Just running less | Symptoms usually return when you return | Graded return to impact with better mechanics and breathing |
| Core work like crunches and planks | Can increase downward pressure | Coordinating breath, ribs, and pelvic floor under load |
Treatment usually includes breathing retraining, pelvic floor work matched to what we found, cadence and form adjustments, and a progressive impact program that starts where you are and builds back to your normal routes. Most of my runners see meaningful change in 4 to 8 visits, and almost none of them have to stop running entirely to get there.
How do you get started in Stillwater?
You can book directly, no physician referral needed, thanks to Minnesota direct access, which allows evaluation and treatment for up to 90 days without seeing a doctor first. Enhance PT is a private, one-room practice inside River Valley Athletic Club at 1826 Northwestern Ave in Stillwater, a few minutes from the trailheads you already run. Evaluations are $200 for a full 60 minutes, follow-ups are $175, and HSA and FSA cards are accepted with superbills available on request. Every visit is one-on-one with me, and pelvic physical therapy here always looks at the whole athlete.
The bottom line
Leaking when you run is common, but it is not normal, and it is very rarely fixed by pads or a generic kegel program because the real problem is usually pressure management, not just weakness. A proper evaluation looks at your breathing, mechanics, cadence, and pelvic floor coordination together, and most runners see meaningful change in 4 to 8 visits. If you want to get back to the Brown’s Creek Trail without mapping the bathrooms first, schedule online or call (651) 369-1196.