Something I never told my closest friends, I now share openly on social media—I used to pee my pants when I ran.

A life-long runner, I ran through almost my entire pregnancy until it no longer felt “good” anymore. So I was more than eager for my first run post-baby without a giant belly, only to be greeted by a leaky bladder that made running at any pace unpleasant.

While postpartum leaking is common, affecting 1 in 3 women, it’s not normal and signals intra-abdominal pressure overloading the muscular system, leading to leaks. This prevalence increases in high impact female athletes, like runners.

At 30-years-old, I found myself ‘incontinent.’ As my bladder function waned so did my joy of running, as the emotional toll of dealing with an ‘embarrassing’ issue made me avoid a sport I had always loved.

At the time, I was practicing as a “generalist” physical therapist and tried interventions on my own without success. I then sought help from pelvic floor physical therapy. I saw minimal improvement initially with therapy and after my third pregnancy a surgeon told me without urethral sling surgery, I would never be able to run without leaking. I was devastated.

Determined I had not exhausted all conservative options, I tried pelvic floor PT again. Professionally, I switched gears and dove headfirst into Pelvic Floor PT education and training. Applying all I had learned personally and professionally, I was thrilled to finally see improvement.

I was so blown away at the ability to overcome my struggle through small changes and share this knowledge helping other women do the same. While pelvic floor PT treatment should always be personally tailored, here are eight tips that can be generally helpful to those dealing with stress urinary incontinence:

1. Don’t empty just in case: Less urine, less leaking, right? WRONG! Like Pavlov’s dog, this teaches the bladder to hold progressively less urine AND the urine becomes more concentrated, irritating the lining of the bladder, causing MORE urge and leaking.
2. Identify food triggers: MANY foods and drinks can irritate the bladder. For me it was a B12-containing pre-workout supplement.
3. Better breathing: Pelvic floor health and function is directly correlated to proper (diaphragm) breathing.
4. Running form change: forward lean, short stride, faster cadence, forefoot strike—all help align the pelvic floor with the diaphragm for improved bladder control with less force on the pelvic floor.
5. Total body mobility: In particular, loss of mobility in the back and hips affects pelvic floor function.
6. Strength training: I teach women to incorporate pelvic floor function into total body strength training. It’s way more than Kegels!
7. Add support: Much like a bra, a Uresta pessary acts as an internal support for the bladder and urethra to stop leaks. This was truly a game changer for me, allowing me to work on running form changes without leaking.
8. Realistic goals: Changing habits and building strength takes time. There are no end dates, we’re looking for life-long improvement and long-term function.

What was once my source of embarrassment and emotional pain has now become my mission in life. When I first experienced leakage, I would not even tell my closest friends. Now, I share my story with the world to encourage women struggling with pelvic floor issues. I am in the process of formulating workout programs that incorporate expertise from pelvic floor specialists specifically for women who leak or have another pelvic floor dysfunction.

We can absolutely keep moving and doing the activities we love, leak free!

Caroline Packard is a pelvic floor physical therapist. To catch up with her work, and learn more about solutions, find her on Instagram @carolinepackarddpt.

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