athletic incontinence

What is Athletic Incontinence?

Urinary Incontinence (UI) usually occurs when in motion and when you exercise it can get even worse because you are likely breathing heavy, lifting something, bearing down, running, jumping, and twisting. Both stress urinary incontinence and urge incontinence can occur with exercise, known as Athletic Incontinence. 

Technically, there is no official medical term called Athletic Incontinence (AI). But many refer to the leakage of urine that occurs with exercise as Athletic Incontinence.

Male vs Female Athletic Incontinence

Female Athletic Incontinence

New studies are being conducted since more and more women are participating in athletics. Women who practice high-impact, high-intensity exercises are eight times more likely to suffer from involuntary urine loss compared to less active women the same age.[5] The sports at risk for this condition include acrobatic trampoline (trampoline), long-distance running, volleyball, weight lifting, and also basketball.[2] Unlike those with stress urinary incontinence that occurs during coughing, sneezing, laughing, or lifting weight, these young women report the symptom only during exercise.[3] It usually affects young women who have never had a child[4]. Therefore, they do not have the usual risk factors such as advanced age, obesity, pregnancy, or smoking [5].

The mechanism of athletic incontinence is complex and multifactorial and includes biomechanical factors such as sudden impact and displacement of the pelvic floor during exercise, increased intra-abdominal pressure, excess fat loss leading to the lack of menses and leads to low estrogen levels, and joint hypermobility [3] [6].

The physical and urodynamic exams of these patients are not always able to be reproduced.[7] Pelvic floor muscle training may improve athletic incontinence [8]. As a result, many of these physically active women use vaginal devices such as tampons or pessaries to minimize urine loss.[9] Restrictive diets and the use of supplements could also aggravate bladder symptoms.[7]

Male Athletic Incontinence

Except for the estrogen deficiency issue, male athletic incontinence should also follow the same pattern as female athletes such as those associated with heavy lifting, running, and jumping. If a man is already experiencing urgency symptoms, then any jarring movement could cause some leakage through a bladder muscle contraction.  

Symptoms of Athletic Incontinence

Generally, most athletes empty their bladders before exercising and the exercise itself uses up extra water in the bladder. So, unless the person is actively hydrating during exercise, little urine should be in the bladder in the first place.

Types of Urinary Incontinence

1. Stress Urinary Incontinence (SUI)

SUI is urine leakage associated with increased abdominal pressure because of laughing, sneezing, coughing, climbing stairs, or other physical pressure abdominal cavity and the bladder. Because of this, exercises like aerobics, golf, and tennis worsen the SUI symptoms. The amount of urine loss can be small or large. Thus, the sufferers usually use thin to medium pads. (1-3 per day is common)

2. Urge Incontinence

Involuntary leakage accompanied by or immediately preceded by the feeling of imminent urination or urgency. It is uncontrolled urine loss that cannot be prevented and usually a large quantity of urine is lost.  Frequency symptoms and urge at night is also present. Excess intake of water, tea, coffee, and alcohol can also aggravate the symptoms.

3. Overflow Incontinence

Overflow incontinence occurs when the bladder is over-filled and the increased bladder pressure exceeds the ability of the urethra to keep the urine from coming out. People experience a sense of incomplete emptying, slow-flowing urine, and urinary dribbling because of overflow incontinence. Symptoms of overflow incontinence may be confused with mixed incontinence. Patients may lose a small amount of urine when waking, sneezing, or coughing. Symptoms of frequency and urgency are present as the muscle of the bladder attempts to push out urine.

4. Mixed Incontinence

Patients with mixed incontinence have symptoms of both stress incontinence and urge incontinence. There is mild to moderate loss of urine with activity or without warning. Urinary frequency, urgency, and nocturia can be present

5. Functional Incontinence

The inability to hold urine due to reasons other than neuro-urologic and lower urinary tract dysfunction (delirium, psychiatric disorders, urinary infection, impaired mobility).

Treatment for Athletic Incontinence

The goal is to empty your bladder right before you exercise and lean forward (if you are a female) and push your fist into area behind the pubic bone to force the residual urine out of the bladder

Products for Athletic Incontinence

  • Athletic Incontinence pads: There are a variety of products that can help collect any urinary leakage in the form of pads that are super absorbent
  • Athletic Incontinence underwear: If pads aren’t your thing, then disposable underwear might be a better idea
  • Catheters: You might consider a single use catheter or intermittent catheter to empty your bladder completely before working out.

Prevalence

It appears to be more common in women. Because of this, very little has been written about men with regard to athletic incontinence.

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Sources
  1. Almeida MB, Barra AA, Saltiel F, Silva-Filho AL, Fonseca AM, Figueiredo EM. Urinary incontinence and other pelvic floor dysfunctions in female athletes in Brazil: A cross-sectional study. Scand J Med Sci Sports 2016; 26 (09) 1109-1116
  2. Fozzatti C, Riccetto C, Herrmann V. , et al. Prevalence study of stress urinary incontinence in women who perform high-impact exercises. Int Urogynecol J Pelvic Floor Dysfunct 2012; 23 (12) 1687-1691
  3. Araújo MP, Oliveira Ed, Zucchi EV, Trevisani VF, Girão MJ, Sartori MG. [The relationship between urinary incontinence and eating disorders in female long-distance runners]. Rev Assoc Med Bras (1992) 2008; 54 (02) 146-149
  4. Eliasson K, Edner A, Mattsson E. Urinary incontinence in very young and mostly nulliparous women with a history of regular organised high-impact trampoline training: occurrence and risk factors. Int Urogynecol J Pelvic Floor Dysfunct 2008; 19 (05) 687-696
  5. Hagovska M, Švihra J, Buková A. , et al. Prevalence of urinary incontinence in females performing high-impact exercises. Int J Sports Med 2017; 38 (03) 210-216
  6. Dias N, Peng Y, Khavari R. , et al. Pelvic floor dynamics during high-impact athletic activities: A computational modeling study. Clin Biomech (Bristol, Avon) 2017; 41: 20-27
  7. Barton A, Serrao C, Thompson J, Briffa K. Transabdominal ultrasound to assess pelvic floor muscle performance during abdominal curl in exercising women. Int Urogynecol J Pelvic Floor Dysfunct 2015; 26 (12) 1789-1795
  8. Da Roza T, de Araujo MP, Viana R. , et al. Pelvic floor muscle training to improve urinary incontinence in young, nulliparous sport students: a pilot study. Int Urogynecol J Pelvic Floor Dysfunct 2012; 23 (08) 1069-1073
  9. Glavind K. Use of a vaginal sponge during aerobic exercises in patients with stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 1997; 8 (06) 351-353