Did you know that more than 40% of elite athlete experience bladder weakness or incontinence during sport (1). The shocking but true fact is that elite athletes can fall into a high risk category for bladder leakage along with those of us who have had lots of babies, have experienced menopause, are overweight or deconditioned in the pelvic floor muscles. But why should some of the strongest amongst us suffer from bladder leakage? Turns out it is way more complicated than just “weak pelvic floor muscles”!


Which sports exactly?


Basketball, tennis, gymnastics, weightlifting and high energy interval training are the usual suspects when it comes to elite athletes suffering from urinary incontinence. So what do all these sports have in common? High ground reaction forces. The maximum ground reaction forces for various sports have been reported to be as high as 3-4 times a person’s body weight for running, 5-12 times a person’s body weight for jumping, 9 times a person’s body weight for landing after a double-back somersault, 16 times a person’s body weight during landing in long jumps and 9 times a person’s body weight in the lead foot in javelin throwing (2).

In other words… you have to be really, really strong in the pelvic floor muscles to withstand such forces and maintain closing pressure of the urethra (the tube that allows the flow of urine from the bladder to the outside world).


Another theory…


There is another theory as to why elite athletes may be susceptible to bladder leakage or urinary incontinence. It has to do with the way they train their bodies. When an athlete trains their body to be highly powerful and strong, particularly the core muscles, it can change the dynamics of the pelvic floor muscles and their ability to generate a pressure.


The pelvic floor muscles sit within our pelvis in an inverted dome shape. When they contract, they squeeze together around the front and back passages, and elevate upwards within the pelvis. Now imagine, the muscles are sitting in an already contracted state. They might have a high resting tone, have trigger points or muscle knots within the muscle fibers and they may be generally tense and overactive (in a similar way that our back or shoulder muscles can become tense and over active with excessively bad posture or heavy manual labour). In this particular state, the muscles will have a hard time squeezing and lifting within the pelvis, for the simple reason that they are already lifted and activated- they have nowhere else to go, and therefore, are unable to generate any more squeeze and lift pressure to protect against urinary incontinence.


Now there are tell tale signs if the pelvic floor muscles are overactive, or lack coordination, such as an interrupted stream when urinating, difficulty initiating urination or feelings of incomplete emptying when using your bladder or bowels. However, the only definitive way to assess these muscles is with an internal, vaginal examination, that your pelvic floor physiotherapist can perform.


A different kind of sports physio.


Elite athletes have built their bodies to be finely tuned and able to perform high energy and physically difficulty tasks. An elite athlete suffering from urinary incontinence may be affected by dysfunctional pelvic floor mechanics, the nature of their sport and the forces their body must content with, or a combination of both. When you consider it this way, you can see that working with elite athletes for bladder leakage or urinary incontinence is much the same as the way we work with other athletes who come in with sports injuries. It is just simply a different group of muscles, that like any other muscle in the body, can be trained and treated to perform at it’s best.


What to do about it.


If you think you may suffer from urinary incontinence as an athlete or during sport, it is best to visit a pelvic floor physiotherapist to assess your pelvic floor function and formulate an individual treatment plan for you. In the meantime, learning to contract and relax your pelvic floor is essential for good bladder and bowel mechanics. Giving your body the right fuel and avoiding risk factors for pelvic floor damage is also essential. You can find out about my top 10 tips for maintaining pelvic floor health and how to exercise your pelvic floor muscles by downloading our free eBook when you join our mailing list, available online at calmandconnection.com.au.


Coming up…

In my next blog I will be launching another edition of Calm and Connection Myth-busters. This time, I will tackle the common myths and misconceptions surrounding cesarean sections and physical recovery. Until then…


Be kind to yourself,

Julia Berger