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Exercise and Urinary Incontinence

Stress urinary incontinence refers to the leakage of urine that occurs during physical activities, such as coughing, sneezing, walking and lifting. It is not surprising that many women lose urine during exercise given the impact exercise may have on the bladder, the urethra or the tube that allows urine to exit the body, and the pelvis. If women have urinary incontinence during exercise, it is not uncommon for many women to give up exercising entirely because of the social embarrassment associated with this condition. One-fifth of women who exercised recreationally stopped exercising because of the incontinence.

Nearly one-third of recreational athletes have some urinary incontinence during exercise. Exercises that involved repetitive bouncing, such as aerobics or running, are most likely to provoke urinary incontinence.

Loss of urine during exercise is not only limited to middle-aged women who have had children. Over 25% of young college varsity athletes or physical education majors who had not had any children reported some leakage while participating in their sport. Nearly 2/3 of gymnasts reported some leakage, but only 10% of the swimmers had loss of urine. This is not surprising since swimming is a much lower impact activity. Another study compared incontinence in physical education majors which was nearly three times more common than in students studying nutrition. Both of these groups of women were just as likely to have occasional incontinence in other activities of daily life, regardless of whether they were athletes or not. This suggests that exercise alone does not cause incontinence but that the high intensity of exercise raises the pressure in the bladder and exceeds the woman's continence threshold. The continence threshold is the amount of pressure that the urethra is able to withstand before loss of urine occurs. This threshold may be decreased from such factors as childbirth which stretches the tissues in the vagina and weakens the muscles and connective tissue in the pelvis. Other conditions decreasing the continence threshold include certain medications such as alpha blockers, estrogen deficiency as seen in post-menopausal women, obesity, chronic coughing, and nerve disorders as occasionally seen in women with diabetes.

High impact exercising also predispose women to leak. With jumping or running, the bladder has to accept over 25 pounds of force from the abdominal organs slamming down against the bladder and the urethra which can exceed the continence threshold and result in incontinence.

There is also evidence that loss of collagen in the connective tissues may be responsible for the loss of urine in women who lose urine during exercise. As women get older there is a loss of collagen and this may be responsible for some of the incontinence that occurs in women during exercise.

Are women who exercise at risk for clinically significant incontinence later in life? Probably not. A study that questioned female Olympians who competed 20-30 years ago, found that those who participated in high impact sports (gymnastics and track and field) were not more likely to have more severe incontinence today than women who competed in lower impact exercises such as swimming.

Solutions to exercise incontinence

Most importantly, women should not stop exercising. This is especially important as a women reaches middle age and can easily become overweight. Being overweight is definitely associated with urinary incontinence so women can get into a vicious cycle if they stop exercising as they can become more overweight and have even more incontinence. Some women may cope with the use of pads used during exercise, others can change from high-impact to lower impact exercises such as swimming. There are also pelvic muscle strengthening drills that can stop or cut down leakage during exercises. Now there are inserts containing a small, single use liquid covered with silicone that can be inserted into the urethra and conforms to the urethra creating a seal and preventing the loss of urine during exercise. The insert is removed during regular bathroom visits where it is discarded and replaced with a fresh insert. Finally, for women whose quality of life is impaired by the incontinence, surgery can alleviate incontinence in most women. Bottom line, help is available for those who suffer from incontinence during exercise. If you want to explore the various treatment options you should discuss them with your doctor.

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Reprinted with permission from Neil Baum MD, neilbaum.com.

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