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Picture this: You’re in the last 200 meters of a 5K. You’re pushing hard—a PR and possible age group award in sight. You’ve run a smart race—a fast race—and nothing will come between you and the finish line. As you burst into another gear and start to kick, you feel it. A warm, wet sensation. You cross the finish line triumphant and realize: “Oh crap, I just peed my pants.”
Talking about incontinence seems more taboo than other running problems. We talk about it less than our chafing issues and gastrointestinal nightmares, but it’s just as common. Amanda Olsen, DPT, PRPC, a pelvic health physical therapist, says that in a room full of runners, anywhere from two to eight out of 10 people—both women and men—have experienced some sort of urinary incontinence.
The elites are not immune. A 2014 study in the Journal of Human Kinetics found that more than 40 percent of elite female runners report leaking during running. In the May edition of Colleen Quigley’s newsletter, she said it happened to her at the USATF 1-Mile Championships from running so hard.
But why does this happen? And are there ways to prevent it? We chatted with two pelvic floor specialists and a urologist to find out.
Why You Pee When You Run Hard
Leaking urine during intense exercise—especially running—is typically a form of stress urinary incontinence, board-certified urologist Justin Houman, MD, FACS, explains. When you run or exert yourself, pressure in your abdomen increases dramatically, he says.
This increased pressure places strain on the bladder and the pelvic floor muscles that support it. The faster you run, the more those pelvic floor muscles work, according to a 2017 study in Neurourology and Urodynamics. “If those muscles or the urinary sphincter aren’t strong or responsive enough to counter that pressure, small amounts of urine can leak out,” Dr. Houman says.
Of course, any mention of pelvic floor strength or dysfunction, and people immediately think of women, and particularly women who’ve given birth. But stress urinary incontinence can happen to people who’ve never been pregnant, of any age, from high schoolers to masters runners, according to Olsen. And it’s not just women. “Men can also experience leakage, especially if they’ve undergone prostate surgery or have pelvic floor dysfunction,” Houman adds.
So peeing your pants or even just leaking urine can happen to anyone, but there are triggers. First, a no-brainer: Houman mentions that running with a full bladder is going to spell trouble, especially if you plan to jump, sprint, or run downhill.
Running with a stiff thoracic spine and sucking in your core while you run can contribute to urinary leakage, and running on harder surfaces can further exacerbate symptoms, according to Rebecca Maidansky, DPT, who specializes in pelvic floor health and who founded Lady Bird Physical Therapy.
How to Not Pee Your Pants
In case you need to hear it: If you pee when you run, it’s OK. “Urinary leakage is incredibly common and has nothing to do with personal failure or hygiene. It’s a muscle and nerve issue, not a willpower issue,” Houman says.
Even so, no one wants to cross the finish line with a puddle in their underwear. To prevent peeing while you run, Olsen recommends a well-rounded strength-training program that emphasizes the muscles that adduct (bring toward the midline of the body) and extend your hips. This is because these muscles help to ensure stability of the pelvis when running and are directly connected with the pelvic floor muscles, she says. A 2024 study in The Journal of Women’s & Pelvic Health Physical Therapy supports the correlation between hip strength and the incidence of stress urinary incontinence.
Olsen suggests doing exercises like bridges, planks, clamshells, split squats, and Romanian deadlifts a few days a week. Additionally, Maidansky recommends always warming up before a run—even if it’s just five minutes of movement—to activate the muscles of your core and lower body.
In addition to including strength training and pre-run warm-ups into your routine, Houman recommends trying to gradually increase intervals between urination, which can help improve bladder control. “Stay ahead of hydration, but avoid overhydrating right before a run, and empty your bladder before exercising, especially if running long distances or at high intensity,” he adds.
Olsen and Maidansky emphasize the importance of seeking the help of a medical professional if you regularly experience stress urinary incontinence from running.
“Since there can be different forms of pelvic floor muscle dysfunction, it’s important that anyone experiencing urinary incontinence while running seek consultation with a pelvic floor physical therapist—ideally one who specializes in pelvic floor issues in runners,” Olsen says.
Maidansky agrees: “The shame and secrecy people feel around pelvic floor dysfunction leads them to suffer in silence far longer than necessary. Bladder, bowel, and sexual health are integral to living a healthy and happy life. There shouldn’t be any shame around discussing these mandatory bodily functions.”
