Masters Athletes and Incontinence

Introduction

Urinary incontinence has a high prevalence amongst the older population in general and particularly in older athletes, with prevalence rates up to 60%. The condition presents as a significant barrier to sports participation and socialising socialisation. Risk factors include being overweight, lack of general fitness, persistent straining or heavy lifting, chronic constipation or cough and, for women, childbirth. There are at least 2 types of urinary incontinence; stress urinary incontinence (SUI) and urge urinary incontinence. Stress urinary incontinence is the most prevalent in older athletes and occurs where there is involuntary leakage of urine during coughing, sneezing, lifting, or exercise. But fear not, there are ways we can beat it including Kegal exercises.

The Problem

A recent review of urinary incontinence in athletes reported that SUI appears to have a higher prevalence in athletes than the general population. It also appears the prevalence is higher in running and jumping-based sports, compared to lower impact activities. This may be due to progressive fatigue of the pelvic floor muscles. During high impact activities the repetitive strain on these muscles may result in fatigue, possibly leading to SUI. In support of this progressive fatigue theory, one study reviewed showed that the prevalence of SUI is greater in the latter part of a training session or competition event.

The Solution

There are a number of potential solutions to the problem.

  1. All athletes, regardless of age or gender should undertake a pelvic floor assessment with a trained professional in order to prevent or manage the risk of SUI.
  2. Where needed, further consultation with your family doctor may be valuable. They may recommend a referral to a Urologist, Urogyeanocologist or specialist continence physiotherapist.
  3. Athletes, particularly female athletes should ensure pelvic floor exercises, sometimes called ‘Kegal exercises’ are performed regularly and correctly.

Pelvic floor exercises are deceptively easy to perform but are often performed incorrectly. The following brief instructions may assist. However, you should seek the advice of a trained professional if you are unsure.

  1. Correctly identify the muscles that need to be exercised by sitting or lying comfortably with the muscles of your thighs, buttocks and abdomen relaxed.  Tighten the ring of muscle around the back passage as if you are trying to control diarrhea or wind, and then relax.
  2. Practice this movement several times until you are sure you are exercising the correct muscles. Alternatively, when passing urine, try to stop the flow mid-stream, and then restart it. You should feel an inward, upward lifting sensation, followed by a relaxation. Women may feel a tightening of the vagina; men may feel a tightening of the scrotum.
  3. Exercise these muscles by tightening and drawing in around the anus and the urethra at the same time, lifting upwards and inwards. Hold for a count of five, breathing normally, and then relax.
  4. Rest for at least 10 seconds, and repeat the ‘lift, hold and let go’ sequence for up to 10 repetitions.
  5. Do NOT hold your breath, or tighten the buttocks, thighs or abdominal muscles.
  6. Repeat this program three to five times every day.

Remember ‘Perfect Practice makes Perfect’ and seek help if needed. You might also want to check out these websites for more detailed information:

Source: Popova-Dobreva, D; (2011). Urinary Incontinence among athletes. Bulletin of the Transilvania University of Brasov Series VIII: Art • Sport • Vol. 4 (53) No. 1

Written by Masters Athlete supporter Rob Stanton who is an Accredited Exercise Physiologist and co-founder and Director of Vector Health. Rob has over 15 years experience in the assessment and prescription of exercise for masters athletes, rehabilitation and in the management of chronic disease. He is a former coach of Australian Powerlifting teams and has worked with athletes from grass roots to Olympic level. Rob can be contacted by email at rob@vectorhealth.com.au for help with resistance training and conditioning programs.