Female Athletes Experience More Stress Urinary Incontinence than their Nonathletic Counterparts

Since the passing of Title IX in 1972, which protects people from sex discrimination in education or activity programs receiving federal funding, the number of females participating in sports has greatly increased. The National Federation of State High School Associations states that in 2011 nearly 3.2 million girls are participating in high school sports.

Unfortunately, a consequence of this increased participation in sports is a higher prevalence in urinary incontinence (UI) and stress urinary incontinence (SUI) in female athletes. Borin et al looked at the ability of nulliparous female athletes to generate intracavity perineal pressure in comparison to nonathletic women. The study demonstrated that higher mean pressures were generated by nonathletic women in comparison to the athletic women group and that lower perineal pressures in the athletic women were also related to number of games per year and time spent on sport specific workouts and strength training workouts.

UI and SUI are underreported in the general population and also in the athletic population. As health care professionals it is important to screen for UI and SUI in our clients. Physical therapy interventions using pelvic floor muscle rehabilitation have shown to decrease the severity of UI and SUI (Rivalta et al, Hulme). Rivalta used internal methods to improve the function of the pelvic floor muscle. Hulme’s success was achieved through activation of the pelvic floor muscles’ extrinsic synergists.

Pilates is often used in physical therapy as a therapeutic tool to improve lumbar stability with studies showing increases in abdominal strength (Sekendiz), trunk extensor endurance (Sekendiz) and to improve posture (Kloubec). Pilates is often also used in pelvic floor muscle rehabilitation and can easily be modified for low level clients. For example the use of resistance can assist supporting the weight of the leg. Practical proof, while lying supine in neutral lumbar spine position, stretch an arm and a leg away from center, notice the difficulty to maintain neutral spine. Now hold a resistance strap, which is also attached to the foot, and notice how maintaining neutral lumbar spine is easier to maintain (pictured above).

Pilates can also be modified for the higher level client or more athletic client. The use of arc barrels, BOSUs or the Hooked on Pilates MINIMAX (pictured belowy) allow the athletic client to achieve an inverted position, unloading the pelvic floor muscles. In the inverted position, pelvic floor muscles may be activated as intrinsic and/or extrinsic synergists of the pelvic floor muscles are also activated. These types of exercises may be more appealing to the athletic client ensuring continuation of the exercise post discharge from physical therapy.

Borin LC, Nunes FR, Guirro EC. Assessment of pelvic floor muscle pressure in female athletes. PMR. 2013; 5(3):189-193.
Hulme, Janet. Beyond Kegels 3rd edition, 2012 Phoenix Publishing Co. Missoula, Montana
Kloubec JA. Pilates for improvement of muscle endurance, flexibility, balance and posture. J Strength Cond Res. 2010;24:661-667.
Rivalta M, Sughunolfi MC, Micali S, De Stafani S, Torcasio F, Bianchi G, Urinary incontinence and sport. First and preliminary experience with a combined pelvic floor rehabilitation program in three female athletes. Health Care Women Int. 2010;31(5);330-334.
Sekendiz B, Altun O, Korkusuv F, Akin S, Effects of pilates exercise on trunk strength, endurance and flexibility in sedentary adult females. J Bodyw Mov Ther. 2005;9:52-57.