Stress Urinary Incontinence in the female athlete

One of the most common, but rarely discussed issues that female athletes face is urinary incontinence during exercise. This phenomenon is also known as stress urinary incontinence and is defined as the involuntary leaking of urine during activities like running, jumping, laughing or coughing. One study estimates that leaking of urine occurs in 47% of exercising women (average age was 38 years in this study). Many attribute this problem due to pregnancy and childbirth; however, studies have shown that 25-28% of high school and collegiate athletes who have never been pregnant report stress urinary incontinence. These numbers are even higher in sports that significantly increase the intra-pelvic pressure like gymnastics and trampoline where 60-80% of athletes report incontinence!

What's the Cause of Stress Urinary Incontinence (SUI)?

In most cases, SUI is caused by a dysfunctional pelvic floor. The pelvic floor is made up of muscles, connective tissue and sphincters. These three types of structures have three main functions: 1) stabilize the spine and the pelvis, 2) support the pelvic organs, and 3) control the retention and release of urine and stool.

One reason the pelvic floor can become dysfunctional is that the muscles and connective tissues become stretched or weak during or after pregnancy. However, they can also become too tight or "stay on" too much of the time, so that they can't contract quickly or strong enough during high-impact activities, like in running or jumping sports.

What's the big deal?

Stress urinary incontinence is not only embarrassing for women, but many either stop exercising altogether or stop doing sports/activities that they love to avoid this problem. In addition, pelvic floor dysfunction can also lead to pain – during intercourse or at rest, so this problem can negatively impact many areas of women's lives.

How to treat it?

Fortunately, there are several ways to improve pelvic floor function and stop episodes of incontinence. The first step is to be evaluated by a physician who specializes in the pelvic floor (certain sports medicine physicians, gynecologists or urologynecologists). Often patients are referred to women's health physical therapists to learn exercises to improve their pelvic floor function. It's important to note that the exercise regimen is more unique and comprehensive than Kegel's for every woman. Some women improve with Kegel's, but others need to learn to relax their pelvic floor rather than strengthen it. In addition to therapy, there are medications, injections and surgical procedures that can be used if necessary.

What's the bottom-line?

For the female athlete, pelvic floor dysfunction and incontinence is under-reported, under-diagnosed and under-treated. It can lead to women avoiding sports or exercise as well as decreased performance. With the right diagnosis and treatment, it can be completely resolved – often with rehabilitation alone!

1. Bo K. Urinary incontinence, pelvic floor dysfunction, exercise and sport. Sports Med. Review article. 2004; 34 (7): 451-464

2. Bo K, Backe-Hansen KL. Do elite athletes experience low back , pelvic girdle and pelvic floor complaints during and after pregnancy? Scand J Med Sci Sports. 2007; 17: 480-87

3. Carls C. The prevalence of stress urinary incontinence in high school and college-age female athletes in the midwest: implications for education and prevention.  Urol Nurs. 2007. Feb 27; 1: 21-24, 39.

4. Caylet N, Fabbro-Peray P, et. al. Prevalence and occurrence of stress urinary incontinence in elite women athletes. Can J Urol. 2006 Aug; 13(4): 3174-9

5. Joy EA, Van Hala S, et. al. Health-related concerns of the female athlete: A lifespan approach. American Family Physician. www.aafp.org/afp

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