Practicing at 5 Point Physical Therapy, you would think we only see incontinence in an older population. However, younger patients come in with these issues and they can be caused by current or lingering orthopedic injuries. In active young adults, any altercation in your movement patterns can contribute to the integrity of your pelvic floor. I noticed this when I first started practicing here… histories of “flat feet,” chronic ankle sprains, past knee surgeries, etc. in young adult populations who also described urinary incontinence or other pelvic floor dysfunction symptoms they were experiencing. It can be very complex. 

Stress urinary incontinence is the most common form of bladder weakness for elite athletes. How do these women in amazing shape leak urine? Increased intra-abdominal pressure for long periods of time onto the pelvic floor muscles can injure them. Followed by weakened external muscles that are unable to compensate.  For instance, it is not normal for gymnasts to leak every time they land a flip- it could be caused by breath holding during tumbling along with core weakness. (Bo, 2008)

There are some older studies (in the 90’s!) that show the prevalence of incontinence in high school and collegiate female athletes. In one study, it shows that the greater the “flatness” of one’s foot, the more susceptible one is to have urinary incontinence during their sport. This makes sense… if having a flat foot can give you instability; there is a chance your pelvic floor may kick in at a higher level to compensate. This is when pelvic floor dysfunction can occur.

In a more recent study, research shows that young female athletes in high impact sports are at a higher risk for incontinence. Using a specific questionnaire, the study identified stress incontinence in 25% of those participating and 90% never shared the problem with anyone. It seems that there is a lack is a lack of education in our young athletes. We know there is so much devotion going to ACL prevention, but what about taking preventative measures for incontinence for young females? (Carls, 2007) Interestingly enough, in these studies, the information the young athletes knew about incontinence was only coming from the media and most did not know their pelvic floor was a muscle group or how to engage it!

Even though pregnancy is the main risk factor for incontinence, women should be learning about potential signs and symptoms in their earlier years. Why not teach an athlete how to appropriately engage their pelvic floor if you are teaching them to engage their abdominals?!   (Dockter et al. 2007)

What are some tips we can share with our high school and collegiate level females?

• Posture, posture, posture. You can start by sitting up properly in class which can improve your core stability
• Make sure you understand how to contract and relax your pelvic floor appropriately.
• Stay limber. Easy yoga poses can help with back and lower extremity flexibility.
• Watch your breath holding. Holding breath can increase abdominal pressure, which can weaken your pelvic floor muscles.
  • When running, deep breaths can allow your pelvic floor muscles to work to their deepest potential.
• Muscles get stronger by using them! Use your pelvic floor muscles with your sport. (Bo, 2008)
• Be mindful of your bladder habits.  Always sit on toilets, let yourself finish completely.  Be sure to space out voids to at least 2 hours between.

Bo, K. Sundgot-Borgen, J. 2008. Are former female athletes more likely to experience urinary incontinence later in life than non-athletes?

Carls, C. 2007. The Prevalence of Stress Urinary Incontinence in High School and College-Age Female Athletes in the Midwest: Implications for Education and Prevention., Urol Nurs. 27(1):21-24,39.

Dockter, M., Kolstad, A., Martin, K., Schiwal, L. 2007. Prevalence of Urinary Incontinence: Comparative Study of Collegiate Female Athletes and Non-Athlete Controls. Journal of Women’s Health Physical Therapy, 31:1.