Urine Leakage in the Female Athlete

I continue to be blown away by the number of young female athletes who are leaking urine during their sports activities.  I have heard that many women who leak think it is normal.  I also hear women say that it is normal for them to leak urine because that’s what women do. It is never normal to leak urine especially in a young woman who has not had children.  Urine leakage is a symptom that occurs when there are musculoskeletal dysfunctions within the pelvic girdle.

I would consider urinary leakage or incontinence to be a sports injury.  No, it may not be a sprained ankle or a torn ACL, but having urinary incontinence is a sign that there is something wrong with the stability system within the spine and pelvic girdle.  When a female athlete has knee pain, a coach, guardian or physician would suggest she see a physical therapist.  This is prescribed to help rehab her knee back to good health, because knee pain prevents an athlete from performing her best.  But what about a female athlete with urinary leakage?  Leaking urine can be embarrassing, frustrating and can greatly limit the athletes’ performance, therefore it is an important issue in the lives of these women.

The International Continence Society states stress urinary incontinence is the “complaint of involuntary leakage on effort or exertion or with sneezing or coughing”.  Some studies over the years have reported a prevalence of incontinence, up to 69% in the general population.  This occurs, due to the muscles and support structures in the pelvis being unable to withstand the pressure that is created in the abdomen with activities; such as coughing, sneezing or changing positions, like moving from sit to stand. You can read more about this on a previous blog, “Why do I pee my pants when I laugh”.

Recent research is showing a rise in incontinence in the young and athletic female population.  Having a teenager with urinary incontinence, just doesn’t seem right.  While it is more common for women who have had children to experience urinary incontinence, younger female athletes are also experiencing urine leakage with their sport. Young women who haven’t had children shouldn’t experience incontinence, right?  Well, no they shouldn’t but they do.

Risk factors for stress incontinence include: increased age, pregnancy and vaginal delivery, being a female, strenuous work, and exercise. A 2011 study that looked at urinary incontinence in female athletes found that a whopping 41% of elite female athletes experience urinary incontinence with their sport, and 95% of them would not dare discuss this issue. (Jacome et al)  Another study from 2006 found 29% of athletes studied had incontinence versus just 9% of their non-athlete counterparts. (Caylet et al.) Not all female athletes have incontinence, but there are sports which have a higher prevalence of incontinence in females; usually due to increased ground reaction forces through the body from landing after jumping or weight shifting movements. For example, one study found 0% female golfers had incontinence, while 67% of female gymnasts had leaking with their activity.  Leakage is reported both during competitions as well as practices for female athletes.

Research suggests female athletes have a stronger pelvic floor than the general population. So if they have higher pelvic floor strength, then why are female athletes leaking?  One theory suggests the added impact of repetitive stress on the muscles, ligaments and connective tissue can cause stretch weakness or overuse to these structures, causing them to become weak or fatigued and less able to control the increase in pressure which then makes them more likely to leak.

So, as I said before, a female athlete with knee pain would see a physical therapist for rehabilitation of the knee.  A female athlete experiencing urinary incontinence, with sport or daily activities, should do the same. It is stated in the literature that conservative treatment, namely pelvic muscle training should be the first line of treatment for stress urinary incontinence (Bo et al).  There is something wrong with her stability system, therefore, she should rehab it. It is important to bring this issue up in order to reduce the stigma associated with it, and get these athletes help.  Improving the function within the pelvic girdle can not only cure incontinence, it can greatly improve sport performance as well.  There are physical therapists who are specifically trained in pelvic floor rehabilitation, which is the kind of therapy a female athlete with urinary incontinence needs.  These physical therapists know how to diagnose impairments and improve the coordination of “the core” to ensure continence.

At Foundational Concepts, specialty physical therapy is what we pride ourselves in.  We treat pelvic floor dysfunction, prenatal/ postpartum pain and especially urinary incontinence in female athletes.  If you would like to learn more about pelvic floor physical therapy you can visit our website atwww.foundationalconcepts.net or call us at 816-569-2802.

Please share this with the female athletes you know and the people that care for and work with them. Let’s encourage them to speak up and hopefully we can contribute to decreasing the rate of urinary incontinence in female athletes.

–Amanda Fisher, PT, DPT 

This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you.  If you enjoyed this blog, check out our website at foundationalconcepts.net for more blog entries and to learn more about our specialty PT practice, Foundational Concepts.  Follow us on Twitter @SarahpelvicPT or @Jenn_pelvic_PT or @AmandaFisherPT and like us on Facebook/Foundational Concepts for updates.