Incontinence and the (strong) athlete
As I mentioned above, I had never really been a big gym girl. The gym can be a very intimidating place. Some choose to avoid going to the gym, due to fear or intimidation that they will injure themselves or do the lifts incorrectly. Others choose to avoid the gym because they simply don’t know what they should or should not be doing. In some cases, women avoid the gym or heavy exercise due to urinary incontinence.
Incontinence with exercise is often not discussed among friends. In my experience, as a physical therapist, I have had patients tell me they used to enjoy lifting weights, but once they started to experience incontinence, they stopped altogether. Another patient once told me she stopped running after having children, which she enjoyed greatly, because she leaked with running long distances. Within the crossfit community, it is almost acceptable for women to leak with double unders.
So why is stress incontinence so common among women and why is it never discussed or corrected? The incontinence industry makes millions of dollars each year marketing to women that their incontinence can be minimized with proper undergarments. Surgeons promise quick fixes with one procedure. Medication is prescribed to stop the bladder spasms. However, the problem is not necessarily fixed, the surgery fails, the medication has side effects, and the lifetime expenditure on incontinence products is staggering.
Athletes with pelvic floor dysfunction are an interesting population. Female athletes, are athletes for a reason - they are strong. So why would someone who is strong, or able to participate in long endurance activities, leak? Let me explain it to you.
It’s all about the pressure. In women, our pelvic floor muscles act as a support system to our pelvic organs. With exercise, we strengthen our bodies, but neglect our pelvic floor. With heavy lifts, or exercise that involves impact (think jumping, running), bracing is key to maintain a stable base in order to execute the lift or protect our bodies from ground reaction forces. If we brace our abdominals, but neglect our pelvic floor, the pressure has to escape somewhere. The muscles involved in a strong brace with lifts include the back muscles, the abdominals, the diaphragm, and the pelvic floor. Some individuals are not able to safely brace their back, so they may experience a herniated disc. Some have difficulty bracing their abdominals, and develop a hernia. Ever heard someone grunt or yell with a heavy lift? That is pressure escaping through the glottis at the top of the canister. In many cases, I have found female athletes have very tight or overactive pelvic floor muscles, as a compensatory mechanism to maintain continence. However, when the muscles are chronically too tight, they are then unable to properly contract to maintain continence and protect against increased pressure.
So how do we fix the problem? Pelvic floor physical therapy can help, by determining the state of the pelvic floor muscles, the ability to contract or brace the entire core canister, and teach you how to safely brace with exercise. By learning how to better manage your pressure system, you can absolutely resume running post partum or get back to the rack. Don’t allow yourself to give up something you love simply because you are embarrassed or accept incontinence as “normal”, as it is so often portrayed. Find a physical therapist trained in pelvic floor dysfunction to evaluate, educate and treat the dysfunction so you can resume what you love doing.
