What is Urinary Incontinence in Sport
Urinary incontinence refers to the involuntary leakage of small or large amounts of urine. In female athletes, the most common type is stress urinary incontinence, which occurs when pressure inside the abdomen exceeds the support capacity of the pelvic floor.
This often shows up during activities such as:
- Running or sprinting
- Jumping or landing
- Heavy lifting
- High-impact sports like volleyball, basketball, CrossFit, cheerleading, or gymnastics.
Incontinence does not only affect women who have given birth or gone through menopause. In fact, many female athletes experience urinary leakage even if they have never had children.
Why does this happen?
- Repetitive impact in sport puts strain on the pelvic floor.
- Poor abdominal pressure control puts stress on the pelvic floor and other abdominal structures.
- Discoordinated breathing patterns increase pressure downward on the pelvic floor.
- Suboptimal lifting mechanics.
Therefore, understanding the “why” is the first step toward improving your symptoms.
Why is the Pelvic Floor Important?
The pelvic floor is a group of muscles that form a sling at the bottom of the pelvis. Think of it as a supportive hammock that helps control your bowels and bladder, support pelvic organs, contribute to core stability, and manage intrabdominal pressure.
In athletes, the pelvic floor must be both strong and adaptable to frequent pressure changes with activities like running or jumping. That means it needs to contract quickly during impact and adequately relax between efforts.
However, many women ineffectively train or neglect the pelvic floor when training for their sport which can cause a dysfunction. A pelvic floor dysfunction can include leakage during impact in your sport or activity, increased pressure in the pelvic floor, increased urgency to go to the bathroom, difficulty going to the bathroom, among other symptoms.
Active individuals often assume that if they are experiencing urinary leakage, it means that their pelvic floor is weak, which is a common misconception. Sometimes, strong and active individuals experiencing leakage actually have an overactive or poorly coordinated pelvic floor. This is why it is important to get assessed by a pelvic floor physiotherapist to determine the cause of your symptoms and create the right treatment plan for you.
Why Are Athletes at Risk of Urinary Incontinence?
Female athletes place high demands on their bodies. While training improves strength and endurance, it can also expose weaknesses in pressure management.
Several sport-specific factors increase risk:
- High-impact loading without enough recovery time.
- Bracing strategies that increase intra-abdominal pressure.
- Breath-holding during lifts, contact, running, or jumping.
- Muscle fatigue reduces pelvic floor responsiveness.
For example, if an athlete lifts heavy weight while holding her breath, intrabdominal pressure increases and pushes downward on the pelvic floor. If the pelvic floor is not strong or coordinated enough to counteract this force, it can result in pelvic floor dysfunction.
Over time, this leads to symptoms such as:
- Leakage during workouts, games, practices, or activity sessions.
- Increased bracing and fear of certain movements that cause symptoms.
- Reduced confidence in competition.
Breathing, Abdominal Pressure Control, and Performance
Breathing plays a central role in pelvic floor function. When breathing patterns are uncoordinated, it is difficult to control abdominal pressure. When taking a breath in, the diaphragm moves down and the pelvic floor should lengthen with equal pressure distribution between the tissues. When exhaling, the diaphragm moves up, and the pelvic floor should rise. However, many athletes develop poor breathing patterns which can impact the pressure system in the abdomen causing increased pressure downward on the pelvic floor musculature.
Pelvic floor physiotherapy looks to help you retrain your breathing mechanics to help improve things such as:
- Abdominal pressure control
- Continence during high-load tasks
- Overall athletic efficiency
In other words, better breathing supports better performance.
Lifting Mechanics
Proper lifting mechanics protect the pelvic floor just as they protect the spine. Athletes do not need to avoid heavy lifting, but they need to lift efficiently and safely.
Some common strategies to improve abdominal pressure control and lifting mechanics may include:
- Exhaling during exertion
- Coordinating pelvic floor activation with movement
- Modifying stance or load temporarily
- Gradual exposure to impact
The goal is to improve confidence in your sport, reduce leakage, and improve performance over time. During physiotherapy you may learn to adapt the movements you already perform to perform them more efficiently.
How Does Pelvic Floor Physiotherapy Look to Help?
Pelvic floor physiotherapy focuses on the pelvic floor anatomy and dysfunctions associated with the pelvic floor. Sheridan at Nova Physiotherapy is certified in pelvic floor assessment and treatment and can help you determine the right step to improving your symptoms. In a pelvic floor assessment, Sheridan will look at:
- Pelvic floor strength, endurance, and coordination
- Breathing strategies
- Lumbar, abdominal, and hip strength
- Posture and movement patterns
- Sport-specific demands
Based on your findings, Sheridan can create a unique plan that will integrate skills into real-life and sport-specific movements.
Your treatment may include:
- Pelvic floor muscle training (strengthening or relaxation)
- Breathing retraining and abdominal pressure control strategies
- Coordinating core and pelvic floor activation
- Educational tips
- Progressive return-to-sport strategies
The goal of pelvic floor physiotherapy for female athletes is to help you feel confident in your sport rather than restricted.
Benefits of Pelvic Floor Physiotherapy for Athletes
The benefits of pelvic floor physiotherapy extend far beyond continence. Gaining more awareness and control of the pelvic floor can also improve core control, help with injury prevention, and increase confidence and performance in your sports and activities. Addressing your symptoms early on can also help prevent chronic issues later on in life.
Urinary incontinence should never stop you from participating in your sport or activity. With the right education, assessment, and training, you can move freely and confidently again.
If you or someone you know experiences leakage during sport, consider pelvic floor physiotherapy. Sheridan at Nova Physiotherapy is here to guide, support, and empower you every step of the way. Let's get you booked in HERE!
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