“Allie just completed a 15-week clinical internship with John Fiore at Sapphire Physical Therapy. Allie will joint the Sapphire PT staff the end of May. Rachael Herynk, DPT currently specializes in women’s health and is a great treatment resource for urinary incontinence”.
-John Fiore, PT, Sapphire Physical Therapy
Urinary incontinence (UI) has been historically associated with the elderly and with childbearing women. Recent studies however have shown that physically fit, nulliparous (non-childbearing) women also suffer from UI, and that involvement in high-impact sports activity can increase the risk of incontinence.1
Urinary Incontinence is defined as an involuntary loss of urine. There are three main types of incontinence, which vary by symptoms: Stress incontinence is a loss of urine associated with activities that increase physical stress and pressure in the abdomen and bladder such as laughing, sneezing, coughing, exercising, and heavy lifting. Urge incontinence is losing a considerable amount of urine for no apparent reason after feeling a sudden, urgent need to void. Mixed incontinence most often involves a combination of stress and urge incontinence. It can include leakage of varying degrees with strenuous physical activity (stress), and a strong, sudden urge to urinate immediately, which does not allow the individual to make it to the toilet in time.
Though social or cultural factors may discourage women from reporting or seeking help for their symptoms, urinary incontinence is quite prevalent. Depending on populations surveyed, investigation methods, and definitions used, the prevalence ranges anywhere from 4%-39% in the general population, versus 28%-51.9% of athletes surveyed. Incontinence is shown to be higher in female elite athletes practicing high-impact sports. Women who attended gyms and performed high-impact exercises had a higher prevalence of UI than those who did not participate in any high-impact exercise.5
Some risk factors for the development of urinary incontinence include hard physical work, perimenopausal estrogen deficiency, constitutional weakening of connective tissue, obesity, and professional sports.5 Researchers Silva et al. (2013) suggest that high-impact sports involving abrupt and repeated increases in intra-abdominal pressures exceed perineal force resistance, which correlates with increased symptoms of stress and urge incontinence.5 According to a study by Thyssen et al., exercises that involved repetitive bouncing/jumping were associated with the highest incidence of incontinence. Higher rates were found in participants of gymnastics, ballet, aerobics, badminton, volleyball, athletics, handball, and basketball. During my clinical exposure to women’s health physical therapy, patients often reported “a flood” during downhill running.
Despite the high prevalence of Incontinence in general and athletic populations, studies show that fewer than 50% of women with incontinence seek help for their symptoms.2However, physical therapists who specialize in treatment of the pelvic floor can effectively reduce a woman’s symptoms of incontinence and enable her return to running and recreational activities. Physical therapy will address strengthening and coordination of pelvic floor muscles, postural education, pressure management, and will optimize running, jumping, and lifting mechanics.
Physical therapy is often an underutilized option for treatment of incontinence. If you are having symptoms of urinary incontinence, a physical therapist experienced in women’s health can help you get back to the physical activities you enjoy!
Allie Molnar, SPT
1) Jean-Baptiste J., Hermieu JF. Sport and urinary incontinence in women. Prog. Urol., 2010; 20(7):483-490. 2) Koch, L. (2006). Help-Seeking Behaviors of Women with Urinary Incontinence: An Integrative Literature Review. Journal of Midwifery & Women’s Health, 51(6). doi:10.1016/j.jmwh.2006.06.004. 3) Kruger, J. A., Dietz, H. P., & Murphy, B. A. (2007). Pelvic floor function in elite nulliparous athletes. Ultrasound in Obstetrics and Gynecology Ultrasound Obstet Gynecol, 30(1), 81-85. doi:10.1002/uog.4027. 4) Hodges P, Sapsford A, Pengel LHM. Postural and respiratory functions of the pelvic floor muscles. Urol. Neurodynam. 2007;26:362-71. 5) Poświata, A., Socha, T., & Opara, J. (2014). Prevalence of Stress Urinary Incontinence in Elite Female Endurance Athletes. Journal of Human Kinetics,44(1). doi:10.2478/hukin-2014-0114. 6) Salvatore S, Serati M, Laterza R, Uccella S, Torella M, Bolis P-F. The impact of urinary stress incontinence in young and middle-age women practicing recreational sports activity: an epidemiological study. Br J Sports Med, 2009; 43(14): 1115-8.7) Da Silva Borin LC, Nunes FR, De Oliveira Guirro EC. Assessment of pelvic floor muscle pressure in female athletes. PMR, 2013; 5(3): 189-193
8) Thein-Nissenbaum, J. M., Thompson, E. F., Chumanov, E. S., & Heiderscheit, B. (2012). Low Back and Hip Pain in a Postpartum Runner: Applying Ultrasound Imaging and Running Analysis.J Orthop Sports Phys Ther Journal of Orthopaedic & Sports Physical Therapy, 42(7), 615-624. doi:10.2519/jospt.2012.3941. 9) 7 Types of Incontinence. (n.d.). Retrieved April 11, 2016, from http://www.healthcommunities.com/overactive-bladder/primary-secondary-incontinence.shtml)