Fitness : The Bane of Female Athletes Too, Incontinence Can Be Treated

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More than two-thirds of female gymnasts say it happens frequently. Twenty-eight percent of female college athletes have experienced it at some point when participating in their sport. And among people older than 60, some 40% of women and 20% of men suffer from it.

Urinary incontinence, the once-taboo topic of involuntary urine leakage, has come out of the closet in recent years. But while many people are now aware that incontinence affects a large proportion of older Americans, few realize that it is also a significant problem for female exercisers of all ages. And many sufferers don’t know that doing simple exercises can help them stay dry.

“People often think incontinence is a normal part of aging or childbearing,” says behavioral psychologist Kathryn Burgio, a professor of medicine at the University of Alabama at Birmingham. “Many think it’s something they just have to learn to live with.”


Fewer than half of people with the problem seek help, Burgio says, in part because they don’t realize incontinence can be treated. Numerous options are available, ranging from behavioral strategies to medications and surgery. One of the most effective therapies is a series of simple exercises that strengthen the pelvic floor muscles, which hold the bladder and several other organs in place.

Burgio’s study of 197 older women with incontinence found these exercises, along with some other behavioral techniques, significantly more effective than drug treatment in reducing accidents. The study, published in the Journal of the American Medical Assn. earlier this year, concluded, “Behavioral treatment is a safe and effective, conservative intervention that should be made more readily available to patients as a first-line treatment.”

Yet many women who leak during sports or other activities are unaware that help exists. Some wear sanitary pads during exercise and others stop exercising entirely. “It’s important not to give up exercise, since one risk factor for stress incontinence is being overweight,” says Ingrid Nygaard, associate professor of obstetrics and gynecology at the University of Iowa. For some people, she says, the loss of 20 to 30 pounds can mean the difference between being wet and being dry.

Physically active women are more likely than sedentary women to experience incontinence, says Nygaard, whose study of 290 female exercisers ages 17 to 68 found that one in three leaked during exercise. The problem is most common in high-impact sports, such as running and basketball, since repetitive bouncing can increase abdominal pressure and transmit the impact to the bladder. But participating in high-impact sports doesn’t predispose women to developing incontinence in later life, according to Nygaard’s recent study of female Olympians, published in the journal Obstetrics & Gynecology.

For female athletes with “exercise incontinence,” Nygaard often prescribes a vaginal device--either tampons or pessaries--to elevate the bladder and help avoid leakage during activity. Tampons are available over the counter; pessaries are available in the United States by prescription only. But even those who use such devices should still do pelvic floor exercises, which can dramatically relieve the problem.

Known as Kegels (after Los Angeles gynecologist Arnold Kegel, who developed them in the 1940s), the exercises help strengthen muscles of the pelvic floor and boost people’s skill in contracting them. Unfortunately many people do them wrong, say these experts, who note that the muscles to be worked are the same ones that slow or stop the stream of urine.


However many people mistakenly strain or “bear down,” which does not isolate the right muscles. A properly done Kegel should feel like you’re inwardly lifting and squeezing. (If you have trouble locating and isolating the pelvic floor muscles, consult your physician about referral to a continence clinic, physical therapist or biofeedback practitioner.)

Burgio offers the following exercise guidelines for men and women:

Squeeze the pelvic floor muscles as you count 1-2-3, then relax them as you count 1-2-3. For the first two weeks, try to do 15 repetitions of “squeeze and relax” three times a day. Do one set of 15 while lying down, one set sitting and one set standing.

Over the next 10 weeks, work up to squeezing for 10 seconds, then relaxing for 10 seconds. Do 15 exercises at a time, three times a day, for a total of 45 exercises a day. Set a timer for five minutes (15 exercises times 20 seconds per exercise) or use an exercise diary if it’s helpful.

Don’t give up too soon. It takes about eight to 10 weeks of exercising before you’ll start to notice a difference. Once your muscles become strong enough, you can do a maintenance program by fitting these exercises into your daily routine.

“I personally do them when I’m standing in line,” says Burgio, who also does Kegels when driving her car. “When you build these exercises into your life, you never have to think about them. You’ll just do them in the automatic way you brush your teeth.”

A Resource Guide for Sufferers

* The National Assn. for Continence provides education, advocacy and support to the public and health professionals. Call (800) BLADDER or visit their Web site:


* “Let’s Talk About Bladder Control for Women” is a public health awareness campaign conducted by the National Kidney and Urologic Diseases Information Clearinghouse. Call (800) 891-5388 or visit their Web site: