Lets say that again to let it sink in. 28-80% of ALL female athletes experience urinary incontinence.
This information is pretty shocking to me. I had been well aware that around 1 in 3 female athletes had leakage, but up to 80%?! I do see some athletes for stress urinary incontinence, but not THAT many.
So lets break some things down.
1) High impact and high intra-abdominal forces/pressure WILL put a significant strain on the pelvic floor muscles.
2) Often in our society, we place a disproportionately large emphasis on the abdominal component of the core system. In working on rock hard abs and always sucking our guts in, our pelvic floor often gets more pressure put upon it.
3) Education on how to engage ALL of our core muscles along with proper breathing strategy is honestly absent in pretty much every sport at every level. So by the time Suzy gets to the more advanced levels of gymnastics or basketball in late high school, she could have been gut clenching and breath holding at the worst times along with bearing down (instead of bracing up) with her pelvic floor muscles for a decade.
4) We don't usually stretch enough. Have you ever been to a running race around the starting line? All of those runners milling around before the start time and doing absolutely NO STRETCHING? I have. Anything from 5K to marathon, its all the same. And after? Pretty similar. For women, having poor hip extension along with tight hip flexors is recipe for more bladder leakage with running.
So those are some of the WHYS if you will to explain how so many women are experiencing an issue that is really NOT NORMAL.
Now onto WHY women are NOT BEING TREATED for this in higher numbers.
1) Embarrassment. Lets face it. It is not exactly high on our list to actually go talk to a professional about how you cannot finish a race or practice for gymnastics or basketball without leaking. But isn't it equally embarrassing to have to dodge your friends right after to go to the bathroom and change your clothes? Maybe you didn't bring extra clothes. And wearing a urine pad?
2) Normalization: Many many women are told by their peers and or mothers/grandmothers that leakage is a normal part of life. Especially after we have kids. BOTH ARE WRONG. Leakage is a sign that things are out of balance. Just like knee pain caused by weak hip muscles or achilles pain from too tight of calf and foot muscles.
3) Fear: Fear of the unknown. What would a person do for someone with leakage? Not understanding what can be done, how a person is evaluated, what is treatment like can stop anyone in their tracks. Maybe it's just better dealing with the leakage than going to see someone?
Now it's time to turn things around. The first step is to clear up the misconception that none of your friends would have ANY idea about what you are going through. 30-80% of our friends likely understand what this is all about because THEY are experiencing the same thing.
And I mean no offense to our mothers and grandmothers here, but I am NOT COOL with telling my friends and my daughters that bladder leakage is just a part of getting older. I really can't tell you just how many past patients and friends have told me that this is what their mother or female relative told them. We HAVE TO STOP THE CYCLE somewhere.
GETTING HELP. You know what? The specialist physical therapists that know how to resolve this issue are girls too. They often have experienced many of the things that their patients are going through. That is often why they have chosen to specialize in this area of healthcare. They first had to learn to heal themselves when often there was no referral to a women's health physical therapist or one available in their town. I myself have been on the same journey with pelvic floor dysfunction.
We then become righteously indignant and feel it is our mission to help other women resolve their issues and prevent them from experiencing the shame they may feel in thinking they are the only ones going through this. Or to be that person that can help, that they themselves did not have.
So that results in us being a tad protective of our patients. I have gone to great lengths to step outside of the traditional PT outpatient hospital or non hospital orthopedic clinic. I found a space that was beautiful, quiet, healing and safe. I listen. I educate. We address all other issues first like tight hip flexors, getting good breath coordination, teaching her how to document or journal her eating and drinking habits to find clues that can help reduce bladder irritation. Assessing pelvic floor muscles (the gold standard in getting to the heart of the issue) only happens AFTER a lot of education, discussion and is ALWAYS the patient's choice to do so. And you better believe that we do as much as possible to make our patients feel comfortable with everything as if it was US in their place (because we may have been there too).
If the patient is younger, we often avoid internal assessment and work on all other aspects of the imbalance of the pelvis.
So if you or your friend have been dealing with bladder leakage with your sport or activity of choice, don't keep telling yourself that this is normal or keep buying your urine panty liners on Amazon. GET HELP. If you are in the Portland or Vancouver WA area, I would love to chat with you. If not, I am connected with the women's health world and can likely connect you with someone who is fabulous in your area.
Wouldn't it be great if the next generation of girls were not told that they have to just LIVE with bladder issues and pelvic floor dysfunction? That their mentors and moms told them how they had a similar issues but got better AND can guide them to a women's health PT that could help them?
HELP ME BE PART OF THE CHANGE.
Learn about your body. Learn how to get YOUR BODY healthy and balanced again so that you don't have to experience bladder leakage with recreation and fitness. I can help. And then YOU CAN HELP your friends and young girls and daughters in your family NOT HAVE TO GO THROUGH WHAT YOU DID without getting help.
I would love to hear your story. Let's chat.
(1) Heath A, Folan S, Ripa B. et. Al. Stress Urinary Incontinence in Female Athletes. Journal of Women’s Health Physical Therapy. 2014;38(3):109.