Most runners have become accustomed to some of their sport’s most unpleasant side effects, like broken or bruised toenails, chafing and a sometimes unreliable bladder. But women runners, in particular, are dealing with a side effect that they may be hesitant or a little embarrassed to talk about: leaking urine during exercise.
If this sounds familiar, you’re not alone. One in three women report stress urinary incontinence during exercise or sports. Many women are familiar with or may have experienced urinary incontinence, the unintentional loss of urine. Stress urinary incontinence is a type of urinary incontinence that occurs during physical exertion like laughing, sneezing, coughing, lifting or—yes—exercise.
Stress urinary incontinence (SUI) occurs commonly among women who participate in moderate or high-impact activities like jumping, running or routines that involve rotational movements. "During physical activity, there is a sudden increase in intra-abdominal pressure, which can cause the bladder and urethra to move downwards within the pelvic floor and result in urinary leakage," explains Marc R. Toglia, MD, chief of female pelvic medicine and reconstructive surgery at Main Line Health.
The pelvic floor consists of a group of muscles that support the pelvic organs, including the bladder, urethra, vagina and uterus. When the pelvic floor muscles are working properly, they provide support to these organs and can prevent urinary leakage. However, these muscles can become weak and poorly coordinated with the skeletal muscles of the body, particularly as a result of pregnancy, delivery, and weight gain or sports injury.
At best, untreated UI can be inconvenient and embarrassing. But for some women, with stress urinary incontinence and loss of pelvic muscle strength may result in a significant decrease in their quality of life by restricting social activities, exercise, travel and personal relationships.
It doesn’t have to be this way, says Dr. Toglia. “There are so many options for treatment, both conservative and surgical. Women don’t need to suffer in silence or stop doing the things they enjoy.”
Physical therapy can help reduce SUI symptoms
Mild cases of SUI can be managed by strengthening your pelvic floor muscles with kegel exercises. These exercises are performed by contracting the pelvic floor muscles to provide closure around the anus, vagina and urethra. During a pelvic floor contraction, a woman will feel an upward lifting sensation around the vagina and anus.
Physical therapy that involves pelvic floor muscle training may be helpful for women who have not been successful performing pelvic floor exercises on their own. Many insurers will cover these types of treatments if you're referred by a provider who has documented your symptoms and can demonstrate that you have not had success improving your UI symptoms with a home strengthening program. Most women will notice an improvement in their symptoms within four to 12 weeks after initiating daily pelvic floor exercises, and can expect as much as a 50 percent reduction in UI episodes. But, if your symptoms continue, make an appointment with a specialist for further evaluation and treatment.
Other physical therapy treatment options include biofeedback with transvaginal electrical stimulation, a treatment that stimulates the pelvic floor muscles to contract and relax. This method can help strengthen your pelvic floor muscles and reduce SUI episodes, and can also be effective in reducing symptoms of urinary urgency.
Lifestyle changes to manage SUI
Another effective way to manage your SUI symptoms is by managing your weight. Just like those high-intensity workouts, carrying too much weight can put pressure on your pelvic floor and weaken those muscles.
"SUI is more common in women with a body mass index that is greater than 30,” says Dr. Toglia. “For some women, aggressive weight loss can help minimize episodes of stress incontinence.” Talk to your doctor about a healthy weight for you, and some suggestions for some low-impact exercises that will help you manage your weight without the side effects of UI.
In addition, be mindful of when and how much water your drink. Instead of drinking large quantities of water at once, try drinking smaller amounts more frequently throughout the day.
If lifestyle changes like these aren’t working for you, talk to your health care provider about other options. Surgical treatments such as mid-urethral slings, urethral suspensions and injections may be an option for you. A 2013 trial that compared the results of pelvic floor therapy with surgical treatments found that the surgical treatments were associated with higher rates of improved or cured UI. Surgery is often effective and is performed in an outpatient surgical setting, which allows you to return home and resume the activities you enjoy more quickly and comfortable.
Although SUI can be an uncomfortable side effect of an active lifestyle, it’s an easily treatable one that shouldn’t keep you from working out or enjoying the activities you love.
At Main Line Health, our pelvic medicine team offers both surgical and nonsurgical treatments to help get you back to living more fully. Don't wait to get help. Learn more about pelvic conditions, and find the right doctor for you. To schedule an appointment with a specialist at Main Line Health, call 1.866.CALL.MLH (225.5654) or use our secure online appointment request form.