Can’t Run Without Needing to Pee? Pelvic Floor Therapy Might Be the Answer

I go through seasons of running. It’s a fitness habit I enjoy — but one I’ve struggled to maintain because of unexpected pelvic floor symptoms, especially urinary urgency. 

Here’s what happens: I hop on the treadmill at the gym, start with a gentle five-minute walk to warm up, and then pick up the pace. Almost immediately, I feel the urge to urinate, even if I just went before getting on the treadmill.

It’s frustrating. I’m already warmed up. I’m in a groove. The last thing I want is to interrupt my run, use the bathroom again, and start over — especially if I know I might feel the urge all over again in just a few minutes.

As I started opening up about this in pelvic floor physical therapy (PT), I realized I wasn’t alone. Many runners, especially those assigned female at birth, experience urinary urgency, leaking, or even bowel urgency that can make running feel unpredictable, stressful, or totally off-limits. For me, the turning point came when I learned that pelvic floor therapy could actually help.

If you’ve ever dealt with urgency while running — bladder or bowel — pelvic PT is here to help. There are some common (and treatable) reasons behind it. Here’s what I’ve learned, and what can actually help.

What is urinary urgency?

Urinary urgency is a sudden, intense urge to urinate that can feel nearly impossible to ignore or delay. When you feel it, you typically have to go right now. And if you ignore it, it can feel like you may pee your pants. (Urge incontinence, or leaking as a result of intense bladder urgency, is also very common.)

This urge can seem to come out of nowhere, even when your bladder isn’t full. This sensation can be especially disruptive during activities like running, where frequent bathroom breaks can throw off your rhythm and make exercise feel frustrating or inaccessible.

While urinary urgency can be common, especially for those who already experience conditions like urinary incontinence, overactive bladder, and/or a tight pelvic floor, it's not something you have to live with forever. 

Why do I need to pee when I start running?

Running is a high-impact activity, and with every stride, you naturally increase pressure inside your abdomen. That pressure is transmitted downward, right onto your bladder and pelvic floor muscles. 

If those muscles are tight, weak, or just not coordinating in sync as you move, that added pressure can irritate your bladder and urethra, often triggering that all-too-familiar sense of urgency that’s hard to ignore.

But it’s not just about the mechanics of running. Other factors — like emotional stress, how much water you’re drinking (or not), and even your caffeine habits — can all play a role in how sensitive your bladder feels. 

And even if you don’t actually leak, the fear of leaking can add a mental load that makes everything feel worse. Stress and anxiety can cause your body to tense up, including your pelvic floor — which only makes urgency more intense. It’s a frustrating cycle, but it’s one you can break with the right tools and support.

Preventing mid-run bathroom emergencies

Fortunately, exercise-induced urinary urgency is treatable — and no, you don’t have to just live with it to keep doing the things you love, like running. 

Pelvic floor therapy offers a personalized, supportive approach to help you get to the bottom of what’s causing your urgency and feel more in control of your body.

A pelvic floor therapist will evaluate your pelvic floor muscle function and get a better idea of how they could be contributing to your symptoms. For example: 

• Are they constantly gripping and unable to fully let go? 
• Are they overcompensating for weakness in other areas, like your deep core? 
• Are they out of sync with your breath or movement patterns? 

It’s a common misconception that surgery means your pelvic floor is weak — for many people, it’s actually the opposite. The muscles might be overactive, tight, or just not coordinating the way they should.

Treatment for exercise-induced urinary urgency might include:

• Learning how to consciously relax and release your pelvic floor (like the reclined butterfly stretch)
• Breathwork to better manage intra-abdominal pressure
• Bladder retraining and timing strategies
• Techniques to calm your nervous system and ease urgency triggers
• Rehabilitation of foot and hip strength, balance, and running mechanics
• Warm-up exercises to activate your deep abdominals and pelvic floor muscles to support your body as you run (like pelvic tilts or a bridge exercise)

Pelvic floor therapy is gentle, collaborative, and built around your unique body. It’s not invasive or painful — it’s supportive, empowering, and designed to help you move with more freedom and confidence.

With the right tools and guidance, getting back to running (or whatever movement you love) doesn’t have to mean pushing through discomfort.

How to stop urinary urgency while running 

If you’re dealing with urinary urgency, a few small shifts in your routine can make a big difference. Here are some practical tips from pelvic physical therapist Dr. Ashley Rawlins, PT, DPT:

1. Be mindful of fluid intake timing: Stay hydrated throughout the day, but try not to load up on fluids right before your run — especially drinks that can irritate your bladder, like coffee, seltzer, or citrus juices. It might feel like drinking more will help prevent thirst or cramping, but too much fluid right before exercise can increase urgency. Instead, focus on consistent hydration throughout the day to keep your body in balance. 
2. Try light compression: Some runners find that gentle compression around their lower abdomen or vulva can reduce that urgent sensation. Compression shorts designed for pelvic support can offer just enough pressure to make a difference.
3. Use urge suppression techniques: When urgency shows up mid-run, there are ways to calm your system. Try slowing your pace, taking a pause, focusing on slow, steady breaths, and doing a few gentle pelvic floor contractions. These can help signal to your bladder that everything’s OK — no emergency here.
4. Ease into intensity: If you’ve recently increased your speed or distance and noticed more urgency, your body might be asking for a slower progression. Gradually building up intensity gives your pelvic floor time to adapt and helps prevent injury, too.

These small changes can offer real relief — but if urgency is keeping you from enjoying your run (or stopping you from running altogether), working with a pelvic floor physical therapist can help you get to the root of the issue with support that’s personalized to your body.

What about bowel urgency?

Bowel urgency — sometimes called “runner’s diarrhea” — is another common challenge, especially for runners managing digestive conditions like irritable bowel syndrome (IBS). What many don’t realize is that pelvic floor dysfunction can play a role here, too.

Just like with bladder control, your pelvic floor plays a key role in bowel control and coordination. If the muscles aren’t relaxing at the right time — or are constantly overworking to compensate for strain or stress — you might feel the urge to go too soon, too often, or have trouble fully emptying your bowels.

So if your runs are getting interrupted by bowel symptoms, you’re not out of options.

Tips for managing bowel urgency while running

If urgency is throwing off your runs, the good news is that there are simple, pelvic PT-recommended tips for this, too. Rawlins also shared a few practical tips to help you feel more in control of your bowels on your run:

1. Set up a pre-run bathroom routine: If you can, try to empty your bowels before heading out — but don’t force it. Straining puts pressure on your pelvic floor and can make symptoms worse. A regular “pre-run bathroom routine” (like having a warm drink, doing some light movement, or sitting quietly for a few minutes) can help your body get into a rhythm.
2. Consider morning runs: Your bowels are naturally more active in the morning, so it might be easier to go before a run earlier in the day. Plus, running before meals means you’re less likely to be affected by potential food triggers.
3. Ease into your workout: A gradual warm-up, like a light walk or easy jog, can help wake up your digestive system and your pelvic floor. Try doing this at home as part of your routine before heading out, giving yourself a chance to go to the bathroom first.
4. Avoid known triggers: Some foods and drinks can be irritating to your gut, especially right before your run.  Things like caffeine, artificial sweeteners, high-fiber meals, greasy or spicy foods, and lots of added sugar are common culprits. If bowel leakage and/or urgency is an issue, try saving those for after your run.
5. Talk to your doctor about medications that could help: For races or long runs, some people take over-the-counter medicines like Imodium. This can be helpful for certain cases, but it’s best to check in with your doctor before trying this one.

You deserve support

Experiencing urinary urgency doesn’t mean something is wrong with you. It just means your pelvic floor might need a little extra support.

“Pelvic floor therapy can help you understand if your pelvic floor muscles (the ones that wrap around and support your vagina, urethra, and anus) are playing a role,” explained Rawlins. “It’s a way to fine-tune how those muscles are working, and to look at other factors like diet or stress that could be contributing to your symptoms.”

With the right guidance and care, it’s entirely possible to feel more confident, comfortable, and at ease in your stride. Running should feel freeing, not something you have to brace yourself for!

Curious about what pelvic floor therapy could look like for you? An appointment with an Origin pelvic floor therapist is a great place to start. You’ll get personalized support, answers to your questions, and a clear plan to move forward — literally and figuratively.