Urinary Incontinence in Female Athletes: Understanding and Management

Urinary incontinence (UI) is a significant, yet often under-discussed, issue among female athletes. While it is reported to generally affect 25% to 29% of sportswomen, this figure can escalate dramatically in certain sports. High-impact activities, for instance, see much higher rates; notably, up to 80% of female trampolinists experience stress urinary incontinence (SUI).

UI is more common in women than men, with SUI – the most common type among athletes – being 2-4 times more likely to affect women.

Several factors contribute to UI in athletes:

1. Increased Intra-abdominal Pressure: High-impact activities generate significant pressure within the abdomen, directly challenging pelvic floor integrity.
2. Repetitive Ground Reaction Forces: The constant impact from activities puts continuous strain on the pelvic floor.
3. Pelvic Floor Muscle Overload or Weakening: Intense and repetitive physical demands can either weaken the pelvic floor muscles over time or acutely overload them.
4. Altered Pelvic Floor Biomechanics: The unique demands of high-level athletic performance can subtly change how the pelvic floor muscles function, affecting their ability to maintain continence.

Sports most likely to contribute to UI are those involving high-impact movements where both feet simultaneously leave the ground. These include:

• Trampolining (showing the highest prevalence)
• Gymnastics
• Running
• Jumping sports

The good news is that sport-related incontinence is treatable. First-line approaches typically involve Pelvic Floor Physiotherapy. This is considered the cornerstone of treatment, focusing on strengthening and coordinating the pelvic floor muscles.

At ESIC we use Real Time Ultrasound Scanner to ensure that the deep core muscles and pelvic floor engage correctly. Sports people often have strong abdominal muscles and can assume that they therefore have a strong deep core. This is not necessarily the case. Assessment with the RTUS allows our patients to see first-hand just how their muscles are working. If the pelvic floor and core are weak, targeted exercises can then be given to improve their strength and endurance.

This has a very positive side affect, as not only will it improve continence, it will improve the kinetic chain, and therefore performance.

It’s important to note that experiencing episodes of incontinence at a young age due to athletics is not associated with an increased risk of UI later in life compared to non-athletes. This highlights that with proper management, athletes can continue to pursue their passions without long-term detriment to their bladder health.