WASHINGTON, DC – Nov. 5, 2015 – Leaking urine during exercise — called stress urinary incontinence, or SUI — is common, but not “normal.” In the U.S., the national average of women who experience incontinence is 1 in 3. A 2002 study done by Thyssen et al. surveyed 291 elite female athletes competing in a variety of sports from basketball to ballet regarding their history of urine loss during participation in their sport or day-to-day activities.

A full 151 reported leakage of some kind. Of the 151, five discussed it with a medical provider, and only six got pelvic floor training. Incontinence is very prevalent in the athletic community, yet most women do not seek treatment because they are either embarrassed or they assume it’s normal because everyone else they know has the same issue.

As physical therapists, we treat women every day who say that they leak urine when coughing, sneezing and exercising. The most common activities that lead to SUI are box jumps and double-unders (some women also experience SUI with deadlifts). In a physical therapy evaluation, women nearly always follow up admitting to SUI with a statement like, “Of course I leak, I’ve had two kids!”

While it is true that childbirth can be one of the factors that contribute to pelvic floor dysfunction, not all women experience incontinence after childbirth; and, it can be treated if it occurs.

Any women’s health physical therapist will tell you that it is not okay to leak urine when working out (or coughing or sneezing). It is a sign that the whole system is breaking down, and the pelvic floor is just the place it shows the most at the time.

Incontinence is just one way of identifying a pelvic floor insufficiency. It is a signal that an imbalance in the deep core exists. The deep core is a closed-pressure system, and insufficiency in any component will impact the capacity of the whole. A female athlete may not be incontinent, but may come to physical therapy with complaints of low back, hip or knee pain. As part of our initial evaluation, we ask every woman if they ever experience any incontinence. Over half of the women will say no, until we press, and then they admit that they do.

What they don’t understand is that pain in the knee may be related to weak and/or uncoordinated pelvic floor, diaphragm and hip muscles. Chronic groin strains, IT band syndrome, trochanteric bursitis, low-back pain and patellofemoral syndrome are a few of the common diagnoses that female patients seek treatment for — and an integrated approach is necessary to identify the root cause of the issue and to successfully treat the problem.

There are many factors that can lead to SUI and/or pelvic pain. The muscles of the pelvic floor may be weak from being stretched during vaginal delivery. The muscles may be hypertonic (overactive) and unable to relax, which decreases the strength of the contraction when they do fire. So they are overactive, but weak. The pelvic floor muscles may be overactive but strong; yet, the client has stronger abdominal, back, diaphragm and glottis (voice box) muscles.

Women who leak while lifting a heavy load may be in this category — holding their breath leads to a rigid thorax, yet they can’t contain about all of the pressure, so they either grunt/yell, leak urine, or sustain an abdominal hernia or herniated spinal disc. The pressure escapes the system through the weakest link. The pelvic floor may have been damaged (think episiotomy, forceps, vacuum extraction of baby, cancer/radiation) and the scar tissue affects the ability for the muscles to contract properly.

It is important to work with a therapist who can evaluate your specific condition and treat you with appropriate exercises and manual techniques. 

Sources used in this release include: http://www.ncbi.nlm.nih.gov/pubmed/11999199

Written by Ann Wendel

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The MedStar National Rehabilitation Network (MedStar NRH) is a regional system of rehabilitation care that offers inpatient, day treatment and outpatient services in Washington, D.C., Maryland and Northern Virginia.

The Network’s interdisciplinary team of rehabilitation experts provides comprehensive services to help people recover as fully as possible following illness and injury.  Rehabilitation medicine specialists, psychologists, physical and occupational therapists, and speech-language pathologists work hand-in-hand with other rehab professionals to design treatment plans tailored to each patient’s unique needs.  Rehabilitation plans feature a team approach and include the use of state-of-the-art technology and advanced medical treatment based on the latest rehabilitation research.  

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