Incontinence in the Female Athlete

When you picture a female athlete what comes to mind? Strength, power, cardiovascular endurance… Someone at their peak physical conditioning!

What I’m sure you didn’t think of was incontinence, but research has indicated that up to 47% of women who regularly engage in exercise experience some degree of urinary incontinence (1). Even nulliparous (have not had children) high level athletes, depending on the sport being played reported urinary incontinence ranging from 0% (golf) up to 80% (trampolinist) (2). One may hypothesize that due to an elite athlete’s level of physical activity and training that their pelvic floor would be strong. We know that this cannot be the case as athletes are known to leak particularly in sports with high impact (3). The highest reports of incontinence occur in activities such as gymnastics, track and field and some ball sports (2). Furthermore research has shown that women have poor pre-contraction of the pelvic floor muscles prior to an increase in intra-abdominal pressure (3). Intra-abdominal pressure increases during loading or stress and without this contraction women are at risk of leakage during exertion (3).

Urinary leakage in our athletes isn’t often discussed. We are quick to send our athletes for rehabilitation from a sprained ligament or strained muscle but this sign of pelvic floor weakness is often ignored or disregarded. Little has been studied with regards to the pelvic floor in female athletes.

Urinary incontinence can be a barrier to exercise for high level athletes as well as the general population and as a result can significantly impact their quality of life (4). Pelvic floor rehabilitation has been proven to be effective in the postpartum population and is recommended as first line conservative treatment for urinary incontinence. There is little evidence to date studying pelvic floor rehabilitation in athletes however the same principles may be applied. Strengthening, muscle patterning and timing of pelvic floor contractions during specific sport related movements can play an important role in preventing incontinence. The pelvic floor muscles also play an important role in core strength and stability. As an athlete at any level it is important to maintain a solid base of support through a strong core to maintain lumbar and pelvic stability.

If you are an athlete or just enjoy exercises and have been experiencing urinary incontinence give us a call to book an appointment with one of our pelvic floor physiotherapists.

References:

1. Nygaard I, DeLancey JO, Arnsdorf L, Murphy E. Exercise and incontinence.
2. Obstet Gynecol. 1990;75(5):848-851.
3. Bo K. Urinary incontinence, pelvic floor dysfunction, exercise and sport. 2004;34(7):451-64
4. Bo K, Berghmans B., Marked S., Van Kampen M. (2014) Evidence Based Physical Therapy for the Pelvic Floor: Bridging the Science and Clinical Practice. Elsevier Health Sciences
5. Carls C. The prevalence of stress urinary incontinence in high school and college-age female athletes in the midwest: implications for education and prevention. 2007, 27(1):21-4