“Sometimes I pee when I’m running!”

In a recent research study of 112 elite female athletes, 54% of the participants reported leakage with sneezing or coughing. 86% were slightly bothered by the symptoms. Both women who have never been pregnant and those who had children, suffer with incontinence. A high impact sport such as running, seems to increase the risk of urinary incontinence. Pelvic floor muscle function can deteriorate over the years if the muscles aren’t used and/or trauma occurs.  This happens to patients who are sedentary and sit for hours on end, as well as women who have delivered. Pelvic floor muscles can also weaken with age as estrogen levels decline. Quality of life can be quite compromised if you are on a “bladder leash” and must know where all bathrooms are located. Runners who leak from muscle fatigue and poor coordination of their trunk muscles, often wear black to reduce the embarrassment of wet clothing from leaking urine. Little research is available on the incidence of incontinence. Incontinence is defined by the International Continence Society as an involuntary leakage on effort or exertion such as sneezing or coughing. One in three women have either urge incontinence (increased frequency of going to the bathroom), stress incontinence (leaking with coughing, sneezing, or laughing), or a combination of the two, called mixed incontinence. 38% of female runners, who have given birth, will experience leakage. 28% of female runners who have not given birth will experience leakage.  Research has revealed that those who do run, or do high impact sports, like jumping, more frequently leak. 26.3% of all fitness instructors have leakage.

There are treatment options other than medication, which dehydrate a person, or surgery. The Department of Health Research & Development’s research supports the conclusion that 85% of patients will significantly improve with behavioral therapy. Behavioral therapy usually given by a specially trained pelvic health physical therapist or incontinence nurse consists of neuromuscular reeducation and therapeutic exercise, which progress from isolated  muscle function to deep intrinsic trunk muscle group exercises, coupled with proper breathing. Over forty years of clinical research clearly demonstrates that giving a woman a sheet of written exercises was not effective. In an effort to gain strength, endurance and coordination of pelvic floor muscles, individual supervised instructions has been proven to be effective. At first, tools such as surface electromyography, or ultrasonography can clearly demonstrate if the muscles are working effectively and efficiently. Education also includes proper breathing by not holding your breath.  Expaning  the diaphragm, which increases the intra-abdominal pressure, places more stress on the pelvic floor muscles. Stiffness of the pelvic floor muscles supports the pelvic organs and creates integrity of the pelvic girdlle. The superficial pelvic muscle diaphragm exerts sufficient pressure on the urethra to prevent voiding until it is socially acceptable. Typically muscle function improves in 6-8 weeks. 

Many women, who run long distances, like wearing an orthotic like a pessary, an intra-vaginal support for the organs. This device decreases the strain on the muscles. Another orthotic that can be worn is the FEMME. This is an outer garment to give more support of the perineum and deep muscles of the pelvis.                            Concern about urinary incontinence is being investigated by different groups in their journals, such as the Journal of Human Kinetics and International Journal of Gynecology and Obstetrics. The prevalence of athletes who suffer from incontinence is being researched. 95.5% of athletes have never discussed this condition with a medical professional. Athletes state their performances are affected by leaking and are frustrated by this. Informing athletes of the effectiveness of specialized physical therapy intervention is needed to improve athletic performance to the best of their ability!