What is Stress Urinary Incontinence (SUI)?
It is a topic that is not commonly discussed outside of a gynecologist’s or urologist’s office. SUI is defined as “…the complaint of involuntary leakage on effort or exertion, or on sneezing or coughing.” Prevalence rates are between 10 and 55% in women between the ages of 15 and 64 years. It is common among a population with risk factors of increasing age, female gender, vaginal delivery, obesity and smoking. However, SUI also accurs in collegiate athletes that have never been pregnant, with a prevalence rate of 28%.
It is misleading to think that physically fit women do not suffer from SUI. However, data reveals that there is no significant difference in prevalence between athletes and non-athletes of a specific sport. SUI can occur during various physical activities, but it is more frequent in exercises that involve chronic, repetitive motion, high impact landings, jumping, and running. Common sports include gymnastics, basketball, track and field, bodybuilding, horseback riding, volleyball, and tennis.
SUI is diagnosed when urine leakage occurs simultaneously when there is an increase in abdominal pressure and a weakening of the pelvic floor muscles (PFM) that prevents the stabilization of the urethra. Other risk factors for SUI in females beyond pelvic floor anatomy include eating disorders and amenorrhea (lack of menstrual period) caused by rigorous exercise, which may result in low estrogen levels. Jumping, landing, and dismounts as in gymnastics are common activities that require a sudden increase in intra-abdominal pressure. The PFM must be able to contract quickly and forcefully to withstand the repetitive pressure of the abdominal organs on the pelvic floor.
Data shows that young females receive limited education regarding PFM strengthening. Therefore, it is important for coaches, teachers, and healthcare providers to provide appropriate education or refer to proper resources.
How physical therapy can help
The pelvic floor muscles are muscles just like the biceps, hamstrings, and quadriceps are. They are, however, one of the only muscle groups that lie transversely in the body, acting as a “hammock” to support the abdominal contents and reproductive organs. When muscles get overstretched, fatigued or do not contract timely, they can cause dysfunction or injury. And just like the other muscles in the body, they can be retrained. One in three women who perform pelvic floor contractions (more popularly known as a kegel) do not perform it correctly. A women’s health physical therapist is trained to educate a woman regarding performing a proper pelvic floor contraction. Educating a woman about how to perform the contraction, how frequent, how long, and when can aide in the prevention of SUI.
Attached are some common tips I like to give my patient about how to do a pelvic floor muscle contraction correctly:
The author of this article is Charlene Somera, PTA, DPT, from Athletico Niles/Northwest Chicago.
Bo K. Prevalence of stress and urge urinary incontinence in elite athletes and controls. Med Sci Sports Exerc. 2001; 33(11): 1797-1802.
Figuers CC. Pelvic Floor Muscle Activity and Urinary Incontinence in Weight-Bearing Female Athletes vs. Non-Athletes. J. of Women’s Health Phys Ther. 2008;32(1): 7-11.