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Pelvic Health Physiotherapy, Physiotherapy
7 myths busted: Urinary incontinence in athletes
November 12, 2020 | by Adrienne Sim

Contrary to what you see in the media, leaking urine does not have to be accepted and covered up with continence products. There is help! To prove our point, here are 7 myths about urinary incontinence that apply to all people with a pelvis:

Myth #1

“Light Bladder Leakage” and/or “Exercise Induced Leakage” is just part of being a woman.

Urinary Incontinence Leaks Fortius

MYTH BUSTED

Any amount of leakage with any activity, in any person, does not have to be accepted as the norm.

There are different types and causes of urinary incontinence. In fact, it is very common, affecting 3.3 million Canadians of all ages9.

Urinary incontinence is normalized by the media and continence product industry and misunderstood as being a consequence of having a baby or a side effect of ageing. It is often associated with feelings of shame, as well as withdrawal from activity and social interaction, which can negatively affect health and lead to a decreased quality of life.

There is help! High-level research shows that supervised, pelvic floor muscle training is highly effective in the treatment of all types of urinary incontinence and should be offered as a first line therapy5,6. Furthermore, supervised pelvic floor muscle training can be preventative in continent pregnant people and has been shown to reduce urinary incontinence in late pregnancy and postpartum5.

Myth #2

Pelvic floor/core needs to be strengthened

MYTH BUSTED

It’s not always about strengthening, but rather about optimizing the function and fitness of the entire system. Simply focusing on contracting the pelvic floor and core could lead to over-active/tight muscles, which could make things worse in some people. Overactive/tight muscles can also present issues such as bladder or bowel urgency, frequency, constipation, painful sex or even injury where the core cannot be responsive to the demands of a task.

Some people need to learn to relax their pelvic floors before they can start training them up again. Others need to learn to balance out their abdominals and breathing, and learn new strategies to manage pressure or impact and address the demands of their particular sport or activity.

In addition, urinary incontinence could also be linked to other issues or previous injuries like the hip, knee, foot or even the shoulder. This brings us to the importance of individual, whole-person assessments, including the pelvic floor and core, and what is needed in order to train and optimize function and fitness in the individual – there is no recipe or one exercise that will resolve this issue!

Myth #3

Athletes don’t experience urinary incontinence

Urinary Incontinence Sport Fortius

MYTH BUSTED

Research has shown that urinary incontinence does happen in athletes and even happens in young athletes who have not had babies. In fact, female athletes are 3 times more likely to experience urinary incontinence than their inactive counterparts3.

The rates of urinary incontinence vary and are most commonly associated with sports involving running and jumping. In fact, it has been shown that up to 80% of trampolinists experience urinary incontinence7.

Fitness professionals including yoga and Pilates instructors also have comparable rates of urinary incontinence to the general population at 30%2.

People with urinary incontinence change their movement patterns and withdraw from or change their physical activity1. Therefore urinary incontinence should not be disregarded in athletes and fitness professionals, but rather should be viewed as a performance optimizing issue.

Also of note, exercise may not necessarily be protective from developing urinary incontinence if there is an underlying dysfunction in the system.

Myth #4

Kegels don’t work

MYTH BUSTED

Yes they do, but only when done correctly and appropriately. Research has shown that up to 60% of people do a pelvic floor contraction (also known as a kegel) ineffectively or incorrectly with verbal instructions9.

In fact, recent 2020 guidelines from the Society of Obstetrics and Gynaecologists of Canada recommend that ‘Pelvic floor muscle training should not be implemented without an appropriate evaluation and adequate patient training. Providing verbal instructions and written handouts alone does not constitute evidence-based pelvic floor muscle training’.

Pelvic floor awareness with the ability to contract and relax effectively is a basic foundation. A fit and functional pelvic floor not only needs strength, but also needs endurance, appropriate tension or tone, reflexive activation, ability to coordinate with movement and be a team player. Treatment goes beyond the kegel and needs to be activity or sport specific.

At Fortius, we incorporate ultrasound for real-time feedback of pelvic floor and core function and training.

Myth #5

It’s normal to experience urinary incontinence when pushing your body to the max
Urinary Incontinence Max Effort Fortius

MYTH BUSTED

Often, urinary incontinence with maximal exertion is misunderstood as a consequence of pushing the body to its physiological limits. HOWEVER, this indicates that something in the system is not working in an optimal or balanced manner (i.e., not managing pressures or impact well or a muscle imbalance issue).

In this case, the body is not meeting the demands of your sport, which can potentially lead to bigger problems down the line (altered movement patterns, withdrawal from activity or even potential injury). Not all people leak on maximal effort, it is important to know that this can be treated and people can give maximal effort in sport and stay dry.

Myth #6

I will have to stop my activity/exercise/sport while getting pelvic floor treatment

MYTH BUSTED

The goal of pelvic floor treatment is to maintain activity/sport participation at a subthreshold/symptom-free level. Training needs to be adapted in order to address the underlying issues which will ultimately allow for the body to adapt and help to prepare the individual for the next level of performance.

The typical training principles apply with respect to specificity of training to address inefficiencies such as fatigue (endurance), capacity (strength), form/strategies used and compensatory patterns.

 

Myth #7

It’s too late to get help

Pelvic Health Physiotherapy Fortius Sport & Health

MYTH BUSTED

It’s NEVER too late!

At Fortius, we offer pelvic floor physiotherapy to help people of all ages with bladder and bowel control, pregnancy and postpartum care, pelvic pain and more.

We use a whole person approach, with real-time ultrasound and training in internal examinations for treatment that is tailored to your needs and performance goals.

Visit our website to learn more, or to book your first appointment!


References

  1. Bo, K. 2020. Physiotherapy management of urinary incontinence in females. Journal of Physiotherapy. 66, 147-154.
  2. Bo, K., Bratland-Sanda, S., Sundgot-Borgen, J. 2011. Urinary incontinence among fitness instructors including yoga and Pilates instructors. Neurourology Urodyn. 30, 370-373.
  3. Carvalhais, A. Natal, J., Bo, K. 2018. Performing high-level sport is strongly associated with urinary incontinence in elite athletes: a comparative study of 372 elite female athletes and 372 controls. Br J Sports Med. 52, 1586-1590.
  4. Dufour, S. Wu, M. 2020. Conservative Care of Urinary Incontinence in Women. Journal of Obstetrics and Gynaecology of Canada. 42(4), 510-522.
  5. Dumoulin, C., Cacciari, L., Hay-Smith, J. 2018. Pelvic floor muscle training versus no treatment, or inactive control treatment, for urinary incontinence in women. Cochrane Database Systematic Review
  6. Dumoulin et al. Incontinence 6th Edition (2017). ICI-ICS. International Continence Society, Bristol UK, ISBN: 978-0956960733.
  7. Eliasson, K., Larsson, T. Mattson, E. 2002. Prevalence of stress urinary incontinence in nulliparous elite trampolinists. Scand J Med Sci Sports 12, 106-110
  8. Thompson, J., O’Sullivan, P. 2003. Levator plate movement during voluntary pelvic floor muscle contraction in subjects with incontinence and prolapse: a cross-sectional study and review. Int Urogynecol J Pelvic Floor Dysfunction. 14(2): 84-8.
  9. https://www.canadiancontinence.ca/EN/what-is-urinary-incontinence.php