I wanted to follow up on the blog from last week and discuss another common issue with female athletes and pelvic floor dysfunction: Leaking urine. Women who exercise frequently often experience stress urinary incontinence, or leaking urine with their sport or activity. Again, this blog is not just for collegiate level athletes, but is speaking to any of you who exercise often and at higher intensities and leak urine with these activities. Stress incontinence is not normal, it is a symptom of a faulty stability system, namely the “core” muscle group. Despite this fact, the prevalence in women who practice high impact sports has been found to be as high as 41% (Jacome et al). Overall, up to 50% of women will experience stress urinary incontinence in their lifetime. (Nitti et al).
Many women stop exercise or back off the sport they love due to incontinence. This can have a very big impact on emotional health. I see this weekly in my clinic, women who come for treatment who are very disappointed, but feel they have no other choice but to stop running, or cross fit, or pilates because of their leaking. The good news is Pelvic Physical Therapy can help!
Why Do We Leak?
The reason women struggle with leaking urine during exercise is somewhat complex, due to the nature of the system. The core musculature which are the deep abdominal muscles (Transverse abdominus and the Oblique’s), the deep spinal muscles (multifidus) the pelvic floor and the diaphragm, must coordinate to control for intrabdominal pressure, spinal and pelvic stability, and sphincteric control of the urethral muscles. This prevents the bladder from leaking with higher impact or difficult exercises. I want to break each of these down and discuss why just doing “Kegels” isn’t often effective.
First, we can discuss the pressure control system of the core. The diaphragm and pelvic floor coordinate for breathing, creating a piston like movement with breath. The abdominals and spinal muscles form the canister that houses the abdominal contents. If any one part of this system is weak, or overly active, there is a problem with ability to control abdominal pressure. For example, if you are lifting a weight that is too heavy for you, what is your first instinct? To hold your breath, and muscle through it. This action creates increased pressure down into the pelvic girdle, and guess what? You start leaking urine because the system can only take so much.
This system works as a feed forward mechanism to control for spinal stability and pelvic stability for activity. They should coordinate, and fire just before you take off running, or perform your box jump. If any one of this system is slow to fire, weak or over active, then it will not fire in time. This will again, create a compensatory action from other muscles, and loss of control of the pressure mechanics and the result if often, urine leakage.
The Pelvic Floor and Leakage
The pelvic floor is the primary sphincter for the urethra, controlling for urination. So of course, weakness here can allow for leaking urine with high level activities. But, it isn’t always just he pelvic floor that is the problem. It may be only slightly weak, but if it does not coordinate correctly with the diaphragm, abdominals or spinal muscles, then again, the pelvic floor is not able to solely provide that sphincteric control that it can when the others are doing their job correctly.
Doing Kegels would be like only exercising one muscle in the knee to improve jumping distance. You don’t have to be educated in kinesiology to know that to jump far, many many muscles are involved. To maintain good spinal and pelvic stability and keep from leaking urine, many muscles are involved. To only do Kegels as the answer to this problem is futile. Therefore, so many women fail. This is why it is important to see a pelvic physical therapist. A Pelvic PT can examine you individually and determine where your deficit is, and give you the tools you need to fix that imbalance.
Why is a Pelvic Floor PT Important?
Videos, books, programs, are all great information and education, but they don’t look at YOU. Every person is different in their movement patterns, habits and personality. Each person responds differently to different cues as to how to find and engage the core system correctly. Once you see a Pelvic PT, and know where your deficits are, and know that you can correctly engage this system, you will have the tools you need for a lifetime to remain active in the sport you love and stay healthy.
We would love to help you stop leaking urine with your sport or activity! Schedule an appointment with one of our Physical Therapists who specialize in pelvic floor dysfunction. Don’t let stress incontinence stop you from exercise another day!
Sarah Dominguez PT, MSPT, CLT, WCS
Nitti VW. The prevalence of urinary incontinence. Rev Urol 2001;3(Suppl 1):S2–6.