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Athletic development specialists dedicated to the art and science of excellence in movement

Pelvic Floor Dysfuction, Urinary Incontinence, and Female Athletes

Sports has its fair share of “taboo” subjects like “what happens at the bottom of the pile after a fumble” or “did the Minnesota Twins really blow the air conditioner toward home plate when the opposing teams came to bat in the Metrodome” or “did Manti Te’o’s girlfriend really exist?”  Pelvic floor dysfunction and urinary incontinence are two taboo subjects that are vitally important yet often overlooked, particularly for female athletes.  There are many theories on why athletes are more susceptible than others (impact, stress, exertion, etc), but for now it’s important to simply raise awareness.

One survey indicated that 90 percent of female athletes sampled never told anyone of their problems and had no knowledge of preventive measures. (Carls 2007)  Jacome (2007) similarly found that “[95.5% of] athletes had never discussed their condition with a health professional. In the focus group, all athletes described preventive urination to avoid urine leakage. It was mentioned that [urinary incontinence] affected their performance and made them feel uncomfortable and frustrated.”

Borin (2012) studied female athletes in volleyball, handball, basketball, and compared them with nonathletes.  Number of games per year, strength training, and on-court workout had a significant negative correlation with perineal pressure (increases in those variables decreased perineal pressure).  The study’s finding suggested that “perineal pressure is decreased in female athletes compared with nonathlete women. A lower perineal pressure correlates with increased symptoms of urinary incontinence and pelvic floor dysfunction.”  

Research also suggests that ground impact may be responsible for increased pelvic floor dysfuction and urinary incontinence symptoms in female athletes.  Eliason (2002) studied 35 elite trampolinists (range 12-22 years) and found approximately eighty percent of the trampolinists reported involuntary urinary leakage, but only during trampoline training. The leakage started after 2.5 years of training.  Age, duration of training, and training frequency all increased risk. All women above 15 years of age reported urinary leakage.  Authors conducted pelvic floor strength tests and found that pelvic floor strength compared favorably with expected norms.  This result suggests the dysfuction of the pelvic floor is related to neurological factors, not muscle weakness.  

Nygaard’s (1994) findings reinforce the connection between ground impact and pelvic floor dysfunction.  Studying a group of college athletes, authors found that (28%) reported urine loss while participating in their sport, with the highest proportions coming in gymnastics 67%, basketball 66%, tennis 50%, field hockey 42%, track 29%.  Authors observed no statistically significant relations between incontinence and amenorrhea, weight, hormonal therapy, or duration of athletic activity. Activities most likely to provoke incontinence included jumping, high-impact landings, and running. Forty percent and 17% of the women first noted incontinence during their sport while in high school and junior high school, respectively.

Summary

Many athletes don’t make the connection, but despite the popularity of certain “core” routines, most core training fails to address the neuromuscular risk factors behind this condition.   Though pelvic floor rehabilitation is typically a medical issue treated with specialized physical therapy, risk factors can be addressed and symptoms can be prevented through targeted neuromuscular reeducation.  It’s important to recognize the condition is normal in female athletes, yet preventable and treatable.  As the “elephant in the room” that no one wants to speak about, raising awareness is the first step toward reaching effective exercise interventions.    

References

Borin LC, Nunes FR, Guirro EC.  Assessment of Pelvic Floor Muscle Pressure in Female Athletes.PM R. 2012 Nov 2. pii: S1934-1482(12)00431-5. doi: 10.1016/j.pmrj.2012.09.001. [Epub ahead of print]

Eliasson K, Larsson T, Mattsson E.Scand J Med Sci Sports.  Prevalence of stress incontinence in nulliparous elite trampolinists.2002 Apr;12(2):106-10.

Carls C. The prevalence of stress urinary incontinence in high school and college-age female athletes in the midwest: implications for education and prevention.Urol Nurs. 2007 Feb;27(1):21-4, 39.

Nygaard IE, Thompson FL, Svengalis SL, Albright JP.  Urinary incontinence in elite nulliparous athletes. Obstet Gynecol. 1994 Aug;84(2):183-7.

Jácome C, Oliveira D, Marques A, Sá-Couto P.  Prevalence and impact of urinary incontinence among female athletes.  Int J Gynaecol Obstet. 2011 Jul;114(1):60-3. doi: 10.1016/j.ijgo.2011.02.004. Epub 2011 May 14.

Comments

Incontinence is a very common

Incontinence is a very common problem in women athletes. If you are suffering from incontinence, but feel embarrassment in talking to doctor or any other person, it will only increase your problem. Incontinence is nothing to hide about as there are thousands of people in the world are suffering from this. There are many incontinence products and treatments available for the remedy.

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