Sport, physical activity and urinary incontinence
Keywords:Impact sports, Jumping, Pelvic floor muscles, Urinary leakage
Objective. The objectives of this systemic review are to examine the troublesome problem of urinary leakage during competitive sport and vigorous physical activity, to look at how far this risk is modulated by regular exercise and by the maintenance of physical fitness, and in the light of the underlying patho-physiology, to consider the role of specific pelvic exercises and other practical approaches to managing this problem.
Methods. The Ovid/Medline data-base was searched from1996 to July 2016. The MeSH term "Urinary incontinence" yielded 18,399 hits. Physical activity-related terms included "exercise" (113,883 hits), "physical exertion" (12,304 hits), "sports" (103,824 hits), "athletes" (5483 hits), or "physical fitness" (15,473 hits), for a total of 169,522 unique articles. Combining the 2 searches identified 243 articles. A review limited to human studies that provided abstracts, without restriction of language, identified118 relevant articles that dealt with athletes and military personnel with physically demanding work (34), physical activity and fitness (16), risk factors, particularly obesity (15), methods of diagnosis (11), methods of treatment (38) and incontinence in old age (5). This material was supplemented by a search of reference lists and personal files.
Results. Leakage of urine during sport has commonly been determined by questionnaire, although there are objective methods of assessment such as weighing fluid accumulation in perineal pads Nine studies of athletes (mostly at the recreational level) and 2 reports on women with demanding military employment found rates of incontinence very similar to those anticipated in the general population of comparable age. However, 20 other studies of athletes, usually at a higher level of competition, and 2 further studies of military personnel noted that a high proportion of competitors were affected by leakage of urine of varying amounts during competition, with complaints being most frequent from participants in impact sports such as gymnasts, trampolinists, ballet dancers and runners. The increased risk of leakage persisted 10 years after ceasing competition, but was not seen 20-30 years later. In young adults, a high level of habitual activity sometimes involved impact activities, and thus an increase in the risk of incontinence, but the risk was reduced in older adults who were active and maintained a good level of fitness- perhaps because of control of obesity, a major risk factor for urinary leakage. The underlying pathology seems a weakness of the pelvic floor, and leakage can often be reduced by pelvic floor exercises; in some studies, the benefit of such treatment has been enhanced by biofeedback.
Conclusions. Urinary incontinence is rarely discussed by those who are affected, but it is a cause of much social embarrassment, with anxiety reducing the performance of top athletes and reducing habitual physical activity in many older women. Symptoms can often be dramatically reduced by pelvic muscle training, and it is important to encourage affected individuals to persist with such treatment.
How to Cite
Terms of Publication
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the Health & Fitness Journal of Canada’s right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
- The Contributor (author(s)) represents and guarantees that the Contributor is the sole proprietor of the work and the Contributor has full power to make this Agreement and grant that the work does not infringe the copyright or other proprietary right of any other person; and the work contains no libellous or other unlawful matter and makes no improper invasion of the privacy of any other person. The Contributor also represents and is responsible for the accuracy of the work.
- The Contributor will read, correct, and return promptly galleys and page proofs to the Editor (or designate). The Contributor will be responsible for the completeness and accuracy of these corrections. If the Contributor does not return galleys and page proofs within the schedule agreed upon with the Editor (or designate), the Publisher may proceed without the Contributor corrections.
- When applicable, the Contributor agrees to obtain written permissions and letters of agreement for all matter contained in the work that is protected by existing copyright, paying any permission fees for the use of text or illustrations controlled by others, and furnishing the Publisher with written evidence of the copyright owner’s authorization to use the material.
- When applicable, the Contributor agrees to obtain written permission for inclusion of any photographic materials involving a human subject, and provide the Publisher with written evidence of the subject’s authorization to use this material. In the case of subjects who have not reached the age of majority, the Contributor agrees to obtain and furnish the Publisher with written permission from the parent and/or legal guardian.
- The Contributor may draw on and refer to material in the work in preparing other articles for publication in scholarly and professional journals and papers for delivery at professional meetings, provided that credit is given to the work and to the Publisher.
- This agreement may not be changed unless the Contributor and the Publisher agree to the change by means of a formal addendum signed by the Contributor and the Publisher’s representative.
- This agreement shall be construed and governed according to the laws of the province of British Columbia and shall be binding upon the parties hereto, their heirs, successors, assigns, and personal representatives. Should any formal proceedings related to this agreement be brought, such formal proceeding may be brought only in the province of British Columbia.
By submitting an article to the Health & Fitness Journal of Canada the Contributor has accepted and agreed to all terms outlined in the copyright notice.