Stress Urinary Incontinence and Athletes

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Stress Urinary Incontinence (SUI) and Athletes – Written by Eliza Bernardi 
 

Did you know, lots of athletes leak! You’re not alone!
 

Female athletes have a high prevalence of stress urinary incontinence.

It is well known that the incidence of SUI in elite athletes is higher than normal controls, with varying rates reported in the literature. Female athletes that compete in sports that expose them to repeated high impact/high intra abdominal pressures (trampolinists, gymnasts, athletics, running sports) seem to be more at risk:

  • Thyssen et all 2002 – urinary incontinence affects 51.9% of elite athletes
  • Jacome et all 2011 – urinary incontinence occurs in 41.5% of athletes performing high impact sport
  • Vitton et all 2011 – urinary incontinence occurs in 33.1% of intensive sport group and 18.3% in non intensive sport
  • Eliasson et all – 80% of trampolinists had urinary incontinence

Despite this high prevalence, most athletes do not seek help from a health professional. Carls et all 2007 and Jacome et all 2011 report that 90-95.5 % of athletes who experienced SUI during sport had never spoken to anyone about it!
 

So why is SUI so common amongst our female athletes? Do athletes have weak pelvic floors?

In 2016, Middlekauf et all looked at the pelvic floor strength of female cross fitters who had been attending at least three work outs a week for almost two years. They found that the CrossFit group had a stronger pelvic floor squeeze compared to controls. Additionally, in Eliasson et al’s 2002 study involving trampolinists (80% who had incontinence), most of the athletes had a strong pelvic floor. Kruger, Dietz and Murphy 2007 also showed that female athletes had more pelvic floor muscle bulk compared to controls. So, it doesn’t seem to be a strength issue?
 

In Kruger, Dietz and Murphy 2007 study, they found that there was a significant difference between how much the pelvic floor can stretch under load in athletes vs controls. This means that the size of the hole in the pelvic floor becomes bigger which can cause the bladder neck to drop leading to incontinence. This could also explain why most of the athletes in the studies mentioned above, experience SUI towards the end of their training sessions as their pelvic floor becomes more stretched over the session.
 

What can be done? There is some good evidence that suggest pelvic floor muscle training can improve athletes symptoms. Furthermore, it’s important to know the risk of still having incontinence post sporting career. Do the athletes who experience SUI during their sport still have leaking once they stop?
 

Bo et all 2010 found that 78% of athletes who experienced SUI during sport experienced it later in life and in Eliasson et all 2008 study involving trampolinists, 76% of the of the trampolinists who leaked still leaked five years after stopping. Athletes who did not leak during sport generally didn’t get SUI later in life.
 

Take home message: 

If you are an athlete that leaks during sport, you aren’t alone. There is plenty that can be done to treat it now and to help prevent and manage issues later in life.

 

References:

  • Thyssen H, Clevin L, Olesen S, Lose G, “Urinary Incontinence in Elite Female Athletes and Dancers” International Urogynecology Journal, Vol 13 pp15-17, 2002
  •  Kruger J. A, Dietz H.P, Murphy B.A “Pelvic floor function in elite nulliparous athletes” Ultrasound Obstetrics Gynecology, Vol 30: pp81-85, 2007
  • Eliasson K, Edner A, Mattson E, “ Urinary incontinence in very young and mostly nulliparous women with a history of regular organised high-impact trampoline training: occurrence and risk factors”, International Urogynecology Journal, Vol 19:5, pp687-696, 2008
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