“I stopped running shortly after having my baby. I just leaked every time I tried.”
“My mom said leaking is one of those things that just happens when you get older.”
“All the ladies at my gym joke about running to the bathroom before we do box jumps!”
Do these comments about athletic incontinence resonate with you at all? If leaking has you modifying your workout routine or stopping something you love, believe me, you’re not alone. This summary article estimates that around 50% of women experience some type of urinary leakage when participating in recreational exercises. Let that sink in—that’s 1 in 2 women! If that seems high to you, let’s see what some other studies show:
- Poswiata, Socha and Opara (2014) examined the prevalence of stress urinary incontinence in elite female endurance athletes (runners and cross country skiers). They found that 45% of all of the women had leakage with sneezing or coughing! (Side note: only 24% of these women had ever had children!)
- Carvalhais, Jorje and Bo (2018) compared 372 elite athletes to 372 age-matched controls. They found the prevalence of UI in the athletes at 29.6% compared to 13.4% in the control group. They also found that high level sports, a family history of UI, a history of a UTI and constipation were associated with increased rates of incontinence.
- McKenzie, Watson, Thompson and Briffia (2016) examined the prevalence of stress incontinence in women attending gym or exercise classes. They found that out of 361 women, almost 50% reported slight to moderate leakage!
So, as you can see, leaking urine during exercise is a major problem for many women. So, what do we do with that information? Does that mean that women are just doomed to leak when they work-out? Absolutely not! My colleagues and I here at Atlanta PT help women overcome leakage every day and return to the workouts they love!
So, what can be done about leaking during exercise?
First, let’s talk about stress urinary incontinence, the most common type of leakage during exercise. Stress incontinence refers to urinary leakage that is associated with an increase in intra-abdominal pressure. For those who exercise regularly, this can occur with running, jumping (jumping rope, jumping jacks, box jumps, trampoline), dancing (zumba, too!), weight lifting, squatting, pilates/yoga, bootcamp classes, kicking, and many other forms of exercise.
Why does it happen? There are many causes of bladder leakage, so it is always important to be medically evaluated. We know that hormones can play a role, as well as anatomical factors (pelvic organ prolapse or urethral hypermobility). Other factors can include childbirth history, body mechanics, breathing patterns/dysfunction, obesity–and I’ll add here, previous orthopedic injury or low back/pelvic girdle pain.
From a musculoskeletal viewpoint, SUI has to do with a failure of the body to control intra-abdominal pressure. Basically, there are forces through the abdomen and pelvis during movements, and our body needs to control and disperse those forces. The deepest layer of muscles that work together for pressure modulation are the pelvic floor muscles, the transverse abdominis, the multifidus, and the diaphragm. In terms of the pelvic floor muscles specifically, remember that we want strong, flexible, well-timed muscles. Tight irritated muscles can contribute to UI just as much as weak overly stretched out muscles. I’ve talked about this many times on my personal blog, www.jessicarealept.com, and you can read this article (with some excellent videos from my colleague Julie Wiebe, PT) for a summary (why kegels are not always appropriate for UI) It is also important that a person has properly firing muscles around the pelvis–especially the glutes! but also the other muscles around the pelvis.
The way in which a person moves can also be a significant contributing factor to SUI. For example, if a person holds his or her breath while jumping rope, the diaphragm is not able to move well, and the entire pressure system will be impacted (leading to possible leaks!). I have also seen women develop SUI or pelvic organ prolapse after performing regular exercise using incorrect form/alignment or after performing exercises that were too difficult for them to do correctly. Often, this leads to compensatory strategies that can make pressure modulation very difficult for the body.
What can you do about Athletic Incontinence? First things first–stop “just dealing with it!”
I recommend a medical evaluation to start, but always encourage people to seek conservative treatments first prior to medications and/or surgery. The best person to evaluate you from a musculoskeletal perspective is a PT who is specialized in treating pelvic floor dysfunction (and if you live in metro Atlanta and have SUI, come and see us! We would love to help you!). We always start by performing a comprehensive evaluation.
- A detailed history, including your obstetric history (if applicable), daily habits, diet/fluid intake, and your regular exercise routine
- Evaluation of your movement patterns (specific exercises, weightlifting, etc.) which are causing you problems
- Head to toe evaluation of your spine, ribcage, abdominal wall, hips, breathing patterns, alignment/posture, knees…all the way down to your feet to see how your movement at each spot could be influencing your pressure system. We also look at how your various muscles fire to help to identify which muscles may not be firing at the right times or which muscles may be tight and impacting your movements.
- Evaluation of the pelvic floor muscles. As the pelvic floor muscles are located internally, the best way to assess them is with an internal vaginal or rectal assessment. That being said, if you are uncomfortable with that, there are options for external assessment that will still help us gather some information (just know that this will likely be a little less thorough).
Treatment for SUI often includes:
- Re-establishing the proper timing and coordination of the pelvic floor, diaphragm, multifidus and transverse abdominis to stabilize the lumbopelvic region and modulate pressure during movements. Remember, our goal is to optimize this team working together–it’s not just about the pelvic floor, and kegels are not always the answer.
- Retraining the proper firing of the muscles around the pelvis during movements, and helping you move better to control the pressures in your pelvis with movement.
- Correction of postural/alignment problems which could be contributing factors
- Manual therapy and specific exercises to improve previous findings in spine, hips, knees, etc.
- Education on proper alignment, breathing patterns, and movement sequences during preferred exercises.
- Education on bladder health, dietary patterns, fluid intake, patterns for emptying bladder, toilet positioning, etc. to encourage healthy bladder function.
- Treatment of co-existing bowel dysfunction, sexual dysfunction or orthopedic pain (as this is often all connected!).
- **Some women also benefit from using assistive equipment like a tampon or a pessary to help stabilize the urethra or support the vaginal wall during exercise depending on her specific situation.
In summary, if you are leaking urine and it’s making it hard for you to exercise the way you want, remember that you are not alone. You don’t have to “just deal with it.” While urinary leakage is common, it is not normal, and you can take steps today to help get back to an active lifestyle!