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Managing Stress Incontinence



How often do you find yourself skipping a workout if it involves jumping or running? Do you find yourself crossing your legs when you sneeze or cough? While urinary leakage is a common occurrence among many athletes and individuals, this is actually not a normal behavior that should happen or that we should let progress. This loss of urine is called stress (urinary) incontinence, and is defined as the involuntary loss of urine with physical effort or exertion, such as jumping or running, coughing, or sneezing (Haylen et al., 2010).


Within the fitness industry, this incident is more commonly seen in high impact sports. It was reported that 36% of females experienced stress incontinence among various sports, including CrossFit, olympic lifting, track and field, and more (Teixeira et al., 2018). In a study by Rodriguez-Lopez et al., over half of the elite athletes, including males and females, reported experiencing incontinence while running, with stress incontinence being the most frequent form of incontinence reported (2022). While stress incontinence is more commonly reported by females, this can also be a problem that male athletes face as well. However, it is often due to changes related to aging or pelvic-related surgeries or disorders, such as prostate removal (Koch & Kaufman, 2022).



So why is there an increase with high impact sports and athletes experiencing incontinence? Shouldn’t all the exercising prevent this from occurring? While one could assume that’s true, it also comes down to physical capacity and consideration of other factors that can contribute to symptoms as well. First, It is thought that stress incontinence occurs due to the increase in intra-abdominal pressure from the abdominal muscle contraction and ground reaction forces that our body absorbs during high impact movements (Teixeira et al., 2018). As a result, this can increase the force applied to the organs within the pelvis and pelvic floor muscles that support our trunk. When our pelvic floor muscles are unable to withstand the force, incontinence, or urine leakage occurs.


For comparison, if you consider squatting and loading up to a 1 rep max, eventually you might have trouble getting out of the bottom of that squat and have to bail out of that lift because your legs and core were not able to overcome the load. Similarly, if your pelvic floor muscles are not strong enough to tolerate the increased intra-abdominal pressure and force from landing or hitting the ground, this might result in leakage during those movements.


Lastly, as mentioned, we need to be considerate of various factors that can contribute to these symptoms or leakage experienced. This might include pregnancy and postpartum changes, aging, increase OR decrease in exercise activity, previous pelvic floor dysfunction, psychosocial stressors, diet and weight, and comorbidities or other diseases and disorders, such as diabetes or hypertension (Shamliyan et al., 2009). When we add any of these factors plus our physical limitations, this can contribute to leakage with high impact activities.


So, how do we go about addressing this issue?



Your favorite answer… more exercise!


In all seriousness, it is important to continue to keep moving for overall health purposes, but we may shift our focus to increasing our strength and managing intra-abdominal pressures while being active. To help with this, try some of the following tips below:


● First try to coordinate your breath and abdominal brace. This will help to reduce these symptoms by reducing the intra-abdominal pressure (pressure within the abdomen and on the pelvic floor) while performing these provoking movements.



● Got the brace down? With heavy lifts or jumping, try to coordinate your exhaled breath and abdominal contraction before jumping or coming out of that lift.



● If you notice leakage with jumping or running, one thing we can start with is thinking of having a softer landing.


● Add in some single leg exercises to improve the strength of the supporting hip and core musculature.



Still unsure of what to do? Contact us for an assessment to help you learn customized modifications and keep you training. We use a 3-step process to help athletes feel better and move better, which includes:

1. Fixing your pain.

2. Figuring out the root cause.

3. Providing you the necessary tools to get back to being active and not dealing with this

again.




Molly Pierson




References:


Haylen, B.T., De Ridder, D., Freeman, R.M., Swift, S.E., Berghmans, B., Lee, J., Monga, A., Petri, E., Rizk, D.E., Sand, P.K. and Schaer, G.N. (2010). An international urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourology and Urodynamics, 29: 4-20. https://doi.org/10.1002/nau.20798


Koch, G. E., & Kaufman, M. R. (2022). Male stress urinary incontinence. The Urologic clinics of North America, 49(3), 403–418. https://doi.org/10.1016/j.ucl.2022.04.005


Rodríguez-López, E.S., Acevedo-Gómez, M.B., Romero-Franco,N., Basas-García, Á., Ramírez-Parenteau, C., Calvo-Moreno, S.O., & Fernández-Domínguez, J.C.(2022) Urinary incontinence among elite track and field athletes according to their event specialization: A cross-Sectional Study. Sports Medicine Open, 158(1):78. doi: 10.1186/s40798-022-00468-1


Shamliyan, T.A., Wyman, J.F., Ping, R., Wilt, T.J., & Kane, R.L.(2009) Male urinary incontinence: Prevalence, risk factors, and preventive interventions. Reviews in Urology, 11(3):145-65.


Teixeira, R.V., Colla, C., Sbruzzi, G. et al. Prevalence of urinary incontinence in female athletes: a systematic review with meta-analysis. International Urogynecology Journal29, 1717–1725 (2018). https://doi.org/10.1007/s00192-018-3651-1

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