Sport, physical activity and urinary incontinence

Abstract

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.