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Athletic Incontinence: a common problem for female athletes.

Readers beware: We’re about to get real, up close, and personal. People pee when they exercise...and a lot more do than you may think!

Are your running tights black or navy to hide the pee that leaks when you run and jump?  

Do you carry around a long sleeve to tie around your waist and cover your bum after runs?  

Do you wear a pad, or insert a tampon to minimize leaking during exercise?

Are you part of the peezing club? Peezing: verb, peeing and sneezing at the same time.

Were you advised to stop the sport you love to avoid the leak? 

 

Don't be embarrassed. You’re not alone.

 

Did you know, according to the North American Association for Continence, 1 in 3 women experience incontinence? 1 in 3!!!

Did you know that young, fit, female athletes that have never had children fight with urinary incontinence too? That's right, stress urinary incontinence (SUI) does not discriminate!

A recent study by Thyssen in 2002 on 150+ elite female athletes, mean age 22, revealed that 51% report leakage daily, during sport. This finding is higher than national averages for postpartum woman. 20% of women left sports due to leaking, and only 4%, or 6 women, sought help. THIS IS NOT OKAY!

We have solutions.  Women don't have to leak, or leave their sport due to leakage. A physical therapist, trained in women’s health can help.

 

Are you kegeling all day, everyday, and still leaking during sport? If you’re tired of leaking, keep reading.

 

This is why your kegel is not working; muscle training is SPECIFIC to how you train it. If you’re prepping for a 1-rep max, like a cough or sneeze, then keep kegeling, but if you’re participating in HIIT, training for a marathon, or crossfitting, then the kegel will likely fall short and you’re likely still experiencing leakage.

The load demands of sport are much greater than the strength and endurance developed during an isometric kegel. It is also important to note that the pelvic floor does not work alone in controlling continence. Running requires more muscle recruitment than just the pelvic floor. So why are we only kegeling to control continence during sport?  In fact, too many kegels can result in an overuse injury resulting in pelvic pain during sex, or when inserting a tampon, and nobody’s got time for that! We’ll keep that for another blog post.

 

In order to stop leaking, we need to strengthen and train the deep, anticipatory core central stability system to work in a coordinated fashion.

 

So what does that mean in layman’s terms?

The deep core system consists of 4 components: Diaphragm, Transverse Abdominis, Pelvic Floor, and Multifidus.

A quick lesson in anatomy:

  • Diaphragm: large muscle that spans the bottom of the ribs which controls breathing.
  • Transverse Abdominis: the bottom most layer of the 3 layers of abdominals. THE ONLY layer that encapsulates the entire waist from back to front, top to bottom. I like to think of it like a corset. The major support of your spine.
  • Pelvic floor: 3 layers of muscle acting as a sling to support and stabilize the pelvic organs.
  • Multifidus: A very thin muscle deep in the spine, it spans three vertebral segments, and works to stabilize the joints at each segmental level to minimize degeneration of the joint structures, and promote central stability for distal mobility and power.

The system works as a “piston” that follows the respiratory cycle. When you inhale the diaphragm lowers, pressing into the stomach, and into the pelvic floor increasing pressure and creating an elastic load that is released with exhaling allowing elastic recoil to release and promote stability. It is the dynamic balance of breath, pressure, and movement that produce stability and control continence. There is no static hold.  I hope you can see how an isometric kegel falls short.

We must consider different demands on the system based on activity performed, and build goal specific programs to stabilize the deep, core and prevent urinary incontinence.  The system is referred to as the “deep” or “anticipatory” core because of its ability to turn on in a predictable, consistent way to prepare for movement, optimize function, and reach peak performance.

 

So is your core prepared to take on the demand of your fitness goal?

 

Let’s go through a quick self-check of the 3 basics:

  1. Alignment
  2. Breath control
  3. Improving responsiveness of stability strategies based on demand of the task

 

Step 1: Postural alignment.

Proper alignment optimizes availability of muscles to work. All muscles have a length tension relationship, and operate best from a neutral, midrange position. If alignment is poor, the athlete does not have access to strength, and cannot produce stability.  

Problem: Poor posture in kids, Pregnancy posture.
Solution: Think of ribs as a cowbell, and the pelvis as a bowl. Ensure the bell is not tilted or rung up or down. Ensure the bowl is not tilted forward or back.  Try to align the opening of the bell with the opening of your pelvis. This is optimal alignment for your deep core to properly function.

 

Step 2: Controlled, Balanced Breath

Step 2 is dependent on successfully mastering step 1. The diaphragm muscle controls breath.  Poor posture will shift the diaphragm muscle from a neutral, midrange position making it difficult to coordinate full, balanced breath resulting in breath holding, chest, or belly dominant breathing. Breath holding is most common, and increases intraabdominal and pelvic pressures. Chest breathing is second most common resulting in decreased pressures and the inability to utilize elastic recoil of the pelvic floor to produce stability and prepare for impact. Both lead to leakage.

Problem: Breath holding, chest breathing, and abdominal gripping.
Solution: full, balanced breathe. While inhaling, think of expanding 360 degrees, simulating an umbrella. During the exhale think of collapsing the umbrella down to the handle.

 

Step 3: Matching the task to the demand.

Research performed on continent women reveals more efficient, balanced, task and demand appropriate muscle activation compared to women who leak. Women who leak tend to over recruit the pelvic floor, breath hold, grip the abdominal, activating from the outside in vs. the inside out. This strategy increases abdominal pressures, thus increasing pressure on the pelvic floor leading to leakage.  Women who leak have difficulty producing a precise, responsive contraction that is required during simple daily tasks. Instead their contractions are exaggerated.

Excursions of the pelvic floor during simple daily tasks:

Quiet breathing: 2.1mm excursion

Forceful breath: 7.0mm

Cough: 3.8mm

Problem: Expecting too much too soon.  Attempting to align, breathe, and not leak on your first attempt, which happens to be sprinting, jump roping, or box jumping.
Solution: You must be able to assume ideal, neutral, alignment, and have the ability to coordinate breath at rest, before coupling with movement, and exercise. Start with slow, controlled movements and build as if you would increase weight during a lift, or speed during a run. Keep in mind it is more difficulty to perform during high speed, high impact, and endurance activities. Have patience. Practice makes perfect.  Seek out professional help if needed.  

 

Final Word

This is a lot to take in and a problem many of us secretly deal with.  You are not along and there are actions you can take to fix this problem.  If you have questions, want to speak with a professional, or just want to learn more, please reach out directly to Dr. Erika Patterson.

 

Author Bio:

Dr. Erika Patterson – DPT, OCS

Dr. Patterson is a Physical Therapist, Sports & Orthopedic Specialist, Manual Therapist, Dry Needling Certified, RPR, and specializes in Endurance & Multi-Sport Athletes. 

info@shortnorthpeakperformance.com

www.shortnorthpeakperformance.com

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