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A Pelvic Floor Physical Therapist’s Guide To Urinary Incontinence

Urinary incontinence is much more common than many women realize.

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A woman performs an assisted bridge pelvic floor strengthening exercise. Photo by

Common Causes Of Urinary Incontinence

Urinary incontinence is surprisingly common among female runners of all ages and skill levels and often causes women to abandon sports due to embarrassment while harming their self-esteem and overall health. In order to help ourselves, we need a deeper understanding of our bodies and a better understanding of what “normal” really means. This understanding, along with the knowledge regarding the cause and potential treatments of these symptoms, will allow women a better opportunity to advocate for their health and quality of life.

What causes UI?

Conventional wisdom holds that there are a number of risk factors for urinary leakage, including old age, pregnancy and delivery. However, research is beginning to unveil the magnitude of women experiencing these symptoms who meet none of the above criteria. While some additional risk factors have been identified (like childhood bedwetting, eating disorders, anxiety and even oral contraception), researchers S. Almousa and A. Bandin van Loon confirmed in a recent study that we’re not sure what drives these numbers.

Much of the research points out that high-impact exercise may not necessarily cause urinary incontinence; rather, it may uncover it. Many recreational and elite athletes may have adequate bladder control in their daily lives, only recognizing their difficulty with urinary control during repetitive, high-impact activities.

There are a number of theories regarding why this may happen, but much like the risk factors, they are only theories. One possibility mentioned frequently in research is that running and jumping activities cause an increase in intra abdominal pressure, fatiguing the pelvic floor muscles repetitively and thus leading to muscle weakness. A contradictory theory exists, arguing that strenuous exercise should actually be strengthening the pelvic floor rather than weakening it.

What we are sure of is that this condition is common, and that it is treatable. A study published in 2017 found that urinary incontinence is present in up to 20 percent of women under the age of 45 who have never had children. When looking at female athletes who participate in high-impact sports, like running, estimates run as high as 42 percent. Even at that magnitude, it is openly believed that these symptoms are underreported.

Urinary incontinence doesn’t just cause sport abandonment in women. Research published by Maturitas in 2010 suggests it can also cause young girls and women to feel alone in their experiences, even though we have proof that it is an experience shared by many. Additional research published by the British Journal of Sports Medicine suggests that it can decrease sexual function and pleasure, diminish self-esteem and harm social and intimate relationships, leading to depression and social withdrawal.

Stress Incontinence And Urge Incontinence

So what causes UI? It’s important to understand that there is more than one kind of incontinence, and all types are common in high-impact female athletes. The first is the one most frequently discussed: stress incontinence. Stress incontinence occurs when a woman loses urinary control while coughing, sneezing, or during activities like running. True stress incontinence—the inability to control your bladder while performing certain activities during an increase in pressure throughout the abdomen—is typically a result of muscle weakness. In women who experience this, pelvic floor, hip and abdominal strengthening is important.

The second kind of UI, urge incontinence, occurs when a women gets a strong, sudden urge to urinate that she cannot control. Unlike stress incontinence, urge incontinence is often caused by tightness in pelvic floor, hip and abdominal musculature. Women experiencing urge incontinence may actually suffer increased symptoms as a result of strengthening because their muscles may already be in a state of spasm. They may instead require pelvic floor relaxation exercises, or specialized stretching.

In my clinical experience, there are few cases of strictly stress or urge incontinence. More often, doctors and physical therapists encounter women experiencing something called mixed incontinence, which, as the name suggests, is caused by both muscular weakness and tension throughout the regions previously mentioned. This requires both strengthening and relaxation to improve the function of your muscles, as in many other running injuries.

Common Irritants And Solutions

For all types of incontinence, factors such as diet, water intake and bladder habits can assist women in improving bladder control. Decreasing common bladder irritants can make control significantly better. Some common irritants include caffeine, alcohol, carbonated drinks, artificial sweeteners, spicy foods and acidic foods. Not all irritants affect everyone equally, but paying close attention to your leakage after consuming food and drink can provide insight into what triggers the reaction.

Water intake is another important factor. Often times when women leak, they consciously or subconsciously decide to decrease their water intake. This can lead to further bladder irritation, which also increases symptoms. Although it’s counterintuitive, drinking more water throughout the day is an important step to improving bladder control.

Regardless of why a woman experiences urinary leakage, exercise should be the first line of defense. Pelvic floor physical therapists may be able to help determine what is contributing to your leakage, what changes in your habits could help improve your control and assist you in returning to exercise symptom-free. Therapy can both help women avoid surgery and educate them in ways to remain symptom-free throughout their lifetime.

Remember: Just because something is common does not mean that you have to live with it!

Rebecca Maidansky is a writer, pelvic floor physical therapist and women’s health advocate. After receiving her doctorate in physical therapy from Temple University in Philadelphia, she moved to Austin, Texas. She is currently working at a specialty clinic, focusing exclusively on pelvic floor health, with a special interest in rehabbing athletes with pelvic floor dysfunction. As a runner and outdoor enthusiast herself, she wants to make sure no one has to leave the sports they love simply because they do not know help is available.


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