Quick question: who suffers from urinary incontinence? If you said, “seniors and women who have had lots of babies,” you’re not wrong. But your answer is a little incomplete.
In fact, one of the fastest-growing populations with this issue is fit, younger women. Female athletes and women who exercise regularly are complaining of leakage, regardless of age and whether they’ve had babies or not. And it’s not just limited to incontinence when running for females –runners who do a lot of pavement pounding, it’s cross trainers, gymnasts, everyday women who hit the gym after work and on weekends.
So what’s going on down there? I went to two physical therapists to get some incontinence and excercise answers: Meagan Peeters-Gebler PT, DPT, CSCS, CMTPT, and Brianna Droessler-Aschliman PT, DPT, CMTPT (see their complete bios below). Both are experts in women’s health as well as accomplished athletes themselves.
Here are five things they told me to help prevent or reverse urinary incontinence:
According to Meagan and Brianna, one big reason for the uptick in leakage is the way we exercise. In order to control urination, our pelvic floor (the muscles and tissues that hold the bladder, uterus, bowel, and vagina in place) needs to be able to contract…and relax. But many modern exercise routines involve clenching the pelvic floor and abdominals and holding them tight (think crunches). But holding too tightly and for too long can spell trouble.
“We have this mentality that more is better,” Meagan says, “and that gripping and never letting go makes muscles stronger. Women need to learn how to do exercises properly – including elvie kegels – to first engage the pelvic floor and abdominal muscles and then to relax them. An overactive pelvic floor can cause problems just like a weak one can.”
Your posture can also result in an overactive pelvic floor, Brianna says. While many of us retain stress and tension in our shoulders, many women hold tension in their pelvic floor, keeping the abdominals tight. According to Brianna, “All the anxiety in our society can contribute to incontinence when we keep the pelvic floor too tight. Just like we need to let our shoulders drop, we need to learn how to relax those lower muscles and let the tension flow out.”
One way to know if you’ve overachieved on the pelvic-floor-tightness front is to be aware of any pain or leakage. If you experience pain during a pap test or pelvic exam, that’s a problem, says Bri. There should be no pain for younger women, not during the exam, not even when the speculum is being inserted in the vagina. If it hurts, that’s not OK and could be a sign of future pelvic-floor problems.
Additionally, pre-perimenopausal women who haven’t had kids should have no leakage. Zero, according to Meagan. If once a month a sneeze causes a little nether-mist, that’s a problem. It shouldn’t happen at all to women in this category.
If either of these happen to you, no matter what your age or risk factors, it’s time to talk to a doctor. “Start the conversation with your doctor now,” Meagan advises; “Ask for a referral to a pelvic floor specialist. Getting the right treatment early on can mean avoiding all sorts of difficulties a few years down the road.”
In addition to easing up on the crunches or other all-abs-all-the-time exercises, other athletes can reduce their risk by exercising the right way. If you’re a runner or do other high-impact exercise, increase your cadence (number of foot strikes per minute) to reduce bounce, says Bri. Don’t go as high or as low with each stride; shorten your stride so there’s less impact, and lean forward so your bladder is supported by your pelvic bones. If you’re a little heavier and hoping to run to lose weight, try to get some of the extra weight off first, to lessen impact. While extra weight is also a risk factor for pelvic floor issues, the damage done by running can be even greater, Bri says.
Not to the bathroom – to the doc. In a perfect world, Brianna and Meagan told me, women would go to a physical therapist (PT) for assessment and training before any issues arise. As Meagan said, “It makes an enormous difference when women are pro-active about their pelvic health. Consult with a physical therapist who specializes in this area, and stick with them. Go before you get pregnant, keep going during the pregnancy, and for sure get help with recovery after the delivery. Even if you don’t plan on having kids, you’re not guaranteed a trouble-free future. PTs can help you drastically reduce or even eliminate the risks.”
Learn more about physical therapy and incontinence issues or find a provider near you at the Orthopedic Spine Therapy website and Four Pines Physical Therapy.
Suffering from incontinence when you are running? A menopause-certified health coach can be helpful. Book 30 minutes for your personal consultation with a health coach.
Meagan is a physical therapist, strength and conditioning specialist and Ironman finisher who works and plays in Appleton, WI. In addition to treating in the better known PT realm of orthopedics, she also works extensively in the mysterious world of pelvic health (incontinence, pelvic pain, pain with intercourse). Her passion is educating women about their amazing bodies, and she finds great joy empowering self-improvement with conservative strategies. She especially enjoys treating female and endurance-sport athletes. When not in the clinic she can be found swimming, biking and running. She has even mastered the art of peeing on a bicycle…on purpose.
Brianna is a 2015 graduate who found her passion in pelvic health after an internship during PT school. At this time, she has been working closely with her co-worker/mentor to expand her skill set in the pelvic health realm. She is very passionate about this particular population because of its unique challenges. She spends time educating patients, and providing them with a comfortable and safe setting. At this time, she primarily treats female patients with incontinence, dyspareunia, and abdominal and pelvic pain. She enjoys spending time with her husband, training for various events, traveling, and being with family.
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