It seems like more than ever, we are inundated with advertisements for products that simply provide a band-aid effect for a common issue among women, stress urinary incontinence (SUI),or the involuntary leakage of urine with exertion such as coughing, sneezing, laughing, lifting, jumping, or any form of exercise.1 As an example, Depends recently released a product called “Silhouette Active Fit Briefs” for women, with advertisements featuring young women in trendy outfits wearing their Depends briefs proudly. Reebok CrossFit recently was criticized for spreading a viral YouTube video, which purported that experiencing SUI during workouts was not a need for concern, but rather a badge of honor. In our society, stress urinary incontinence is quickly becoming viewed as a normal consequence of exercise; however, no matter your age, there are ways to reduce and even eliminate this issue.
SUI is a disorder that does not simply affect women who are post partum or elderly – it can affect any age bracket, from teenage girls to women over the age of 65. While there are many causes for SUI, this article will focus in on the effects of high impact, strenuous exercise on urinary leakage. As female athletic participation has drastically increased in the past 20 years, now more then ever females are engaging in these types of sports, with numerous incredible benefits to their health, well-being and self-confidence. However, in a study of 86 high school and college athletes, 28% reported SUI during sport and 92% of those with urinary incontinence never even reported their symptoms. Another study of 144 college varsity athletes found that 28% of them also reported SUI during sport, with the most prevalence recounted amongst gymnasts. The most common activities to produce leaking were jumping, high impact landings, and running. This is quickly becoming a widespread issue with seemingly little to no education with regards to its the detection, causation and rehabilitative potential. Urinary leakage, no matter how minute, can become a serious problem, not simply due to social embarrassment but also due to the hygienic implications of it. ¹ ²
Before we dive into what pelvic floor physical therapists can do to help these symptoms, let’s begin with the basic function of the pelvic floor muscles. You may or may not be aware that there are muscles which make up your pelvic floor, which prevent you from urinating involuntarily, amongst other functions. Below are some facts about your pelvic floor muscles:
The pelvic floor is composed of three layers of muscles. These muscles, along with the muscles of the abdominals and hip make up “the core.” The core also includes your diaphragm, a primary muscle of breathing that has a close relationship with pelvic floor muscle function.
The pelvic floor muscles provide support for your internal organs (like your bladder), aid in stability of the pelvis, sacrum, and lumbar spine, contain structures known as sphincters that open and close you anus and urethra, and are vital in sexual functioning.
Dysfunction in the pelvic floor muscles can increase your risk and cause pelvic organ prolapse, sexual pain or lack of stimulation, urinary incontinence, fecal incontinence, chronic constipation, and hip, pelvic and low back pain. Having any of the previous listed symptoms is a sign of pelvic floor muscle dysfunction.
The pelvic floor muscles have to be able to accept loads appropriately as part of a larger support system in order to prevent leakage of urine. The demands of high- level sports and exercise can cause pelvic floor muscle fatigue and a repetitive increase in intra-abdominal pressure leading to urinary leakage if the pelvic floor muscles are dysfunctional.
Now that we have the pelvic floor muscle lesson out of the way, let us use the example of “Eager Elizabeth.” Elizabeth is 3 months postpartum and is looking to get back into shape. She starts to pursue various forms of exercise, and in her basic boot camp class she notices urinary leakage with squatting and jumping. Elizabeth assumes this is normal for a new mom and should live with it because numerous friends and mom leak urine. What Elizabeth doesn’t realize, like many other women out there, is that there are conservative treatments such as pelvic floor physical therapy to eliminate the urinary leakage.
The great news for Elizabeth, is the pelvic floor muscles, like any other muscles can be retrained. Physical therapists that are specialized in women’s health can perform a detailed assessment of the pelvic floor muscles along with rest of the body as a whole to formulate an individualized training program that will eliminate leaking during activities. Along with eliminating leaking during activities, retraining the pelvic floor muscles to function optimally will prevent future problems down the road such as worsening of symptoms, pelvic organ prolapse and potential low back, pelvic, and hip pain. There is strong evidence to support pelvic floor muscle training is an effective treatment for SUI.³
The goal for every physical therapist should be to try and return patients optimally to activities that are meaningful to them. Using Cross Fit as an example, the goal should not be to simply tell someone not to do it, but make sure they are performing the high level exercise safely and appropriately. Plenty of woman and men are capable with the right training and progression, to perform any high level exercise safely and effectively. However, like all types of exercise that become popular, the spectrum of quality training and instruction becomes wide.
The team at New Dimensions Physical Therapy, located in Manhasset, NY, is specially trained in treating a wide range of pelvic floor issues ranging from urinary incontinence, fecal incontinence, chronic constipation, sacral, pelvic, and low back pain, and pain during pregnancy and postpartum. We are unique from other practices in that we offer one on one individualized care for appointments up to one hour. It’s time to break the assumption that SUI is normal, and return you to jumping and running around pain free and urine free so you can get back to what matters most!
Heath, A, Folan S, Ripa B, et al. Stress urinary incontinence in female athletes. . J WomensHealthPhys Therap. 2014; 38(3):104-109
Carls C. The prevalence of stress urinary incontinence in high school and college-age female athletes in the Midwest: implications for education and prevention. UrolNurs. 2007; 27(1): 21-24, 39
Bo K. Pelvic floor muscle training in treatment of female stress urinary incontinence, pelvic organ prolapse and sexual dysfunction. World J Urol. 2012; 30 (4): 437-443
Dumoulin C, Hay-Smith J, Habee-Sequin GM, et al. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women: a short version Cochrane systematic review with meta-analysis. Neurourol Urodyn. 2015; 34(4): 300-308