There are some actions in the life of an athlete that are mysterious: swimmers urinating in the pool, marathon runners drawing the line before the finish line, and women embracing laughter-leakage as “just life”. These societally normed events of urinary incontinence impact nearly 50% of active females and almost 30% of young female athletes. 5, Although urinary incontinence (UI) may seem insignificant, UI affects active women in a much larger way than just a temporary inconvenience. 5, 4 To further understand the implications of pelvic floor dysfunction, one must become familiar with common pathologies of UI, the effect of UI on the social and physical well being of women, and barriers to treatment.5, 6, 4, 10
Urine leakage is typically categorized in one of three ways: urge urinary incontinence, mixed urinary incontinence, or stress urinary incontinence.6 Bø K defines urge urinary incontinence as “involuntary leakage accompanied by or immediately proceeded by urgency” and describes mixed urinary incontinence as “involuntary leakage associated with urgency and also with exertion, effort, sneezing and coughing”. Herms et al., describes stress urinary incontinence as “an involuntary loss of urine during sudden increases in intraabdominal pressure such as during coughing, laughing, sneezing or exercise.” Each of these results from an inadequate performance of the muscles supporting the pelvic floor and/or inadequate urethral sphincter control.4, 6, 7 This insufficiency may be due to damage, weakness, chronic overuse/activity, inappropriate intraabdominal pressure distribution, repeated stress or neurological deficits. 2,4, 6, 7 Although slightly different in etiology, each of these dysfunctions can impact a woman’s quality of life. 6
“The World Health Organization defines quality of life as an individual’s perception of their position in life in the context of the culture and value systems in which they live, in relation to their goals, expectations, standards, and concerns.” 7 Urinary incontinence effects women’s expectations and standards of physical and social wellbeing.5, 6 Women may deviate from their desired workout plan, 5 or discontinue sport completely. 6 Participation in social activities may decline. 6 Furthermore, urinary incontinence can result in psychological distress. 2, 7 Furthermore, when individuals refrain from social and physical activities, risk of heart disease, high blood pressure, and osteoporosis all increase.6 Despite 30 to 50% of women having incidences of urinary incontinence with implications detrimental to health, it sadly remains a societal taboo.
Barriers to treatment include lack of awareness of the implications by coaches, trainers and athletes as well as limited intervention adherence. 3, 8, 9 This lack of awareness can contribute to lack of buy-in. Therefore when clinicians encounter disillusioned patients, the clinicians need to have an effective system to implement an intervention.8, 9 In addition to needing a substantive treatment plan, understanding patient motivation3 and decreasing forgetfulness will increase adherence. 10 Dumoulin et al. recommend that patients keep a journal of times exercised per day to aid in the recovery process. Assessing attitude and awareness of urinary incontinence are key to facilitating the best recovery possible. 3, 8
Where to go from here?
To the mall, to the pool, to the trampoline park! Okay, perhaps shouting about the prevalence of urinary incontinence to everyone everywhere is not the solution, but to further enhance the lives of women, health care professionals have the unique opportunity to facilitate open dialogue about urinary incontinence and pelvic floor health. Here are some questions to consider to further improve the individuals’ quality of life:
- What can be changed in current patient-practitioner interactions to reduce stigma, heighten awareness and alter treatment implementation techniques to better patient outcomes?
- What aspects of the human experience can health care professionals begin to consider when forming an intervention?
- What efforts can be put forth to illuminate the frequency of urinary incontinence?
- What are current strategies to treat and prevent pelvic floor dysfunction?
Urinary incontinence is not typically a choice topic for conversation, but health care professionals can build a bridge over the inconvenient leak separating women from the quality of life they desire. Stay tuned for a follow up segments featuring an interview with a women’s health expert as well as another article that will highlight current strategies to treat and prevent pelvic floor dysfunction.
References:
1: Wang YC, Hart DL, Deutscher D, Yen SC, Mioduski JE. Psychometric properties
and practicability of the self-report urinary incontinence questionnaire in
patients with pelvic-floor dysfunction seeking outpatient rehabilitation. Phys
Ther. 2013 Aug;93(8):1116-29. doi: 10.2522/ptj.20120134. Epub 2013 Apr 11. PubMed
PMID: 23580628.
2: Di Gangi Herms AM, Veit R, Reisenauer C, Herms A, Grodd W, Enck P, Stenzl A,
Birbaumer N. Functional imaging of stress urinary incontinence. Neuroimage. 2006
Jan 1;29(1):267-75. Epub 2005 Sep 8. PubMed PMID: 16150613.
3. Dumoulin C, Alewijnse D, Bo K, Hagen S, Stark D, Kampen MV, Herbert J, Hay-Smith J, Frawley H, McClurg D, and Dean S. Pelvic-Floor-Muscle Training Adherence: Tools, Measurements and Strategies—2011 ICS State-of-the- Science Seminar Research Paper II of IV. Neurourology and Urodynamics 34:615–621 (2015)
4. Figuers CC, Boyle KL, Caprio KM, Weidner AC. Pelvic floor muscle activity and urinary incontinence in weight-bearing athletes vs non-athletes. Journal of Women’s Health Physical Therapy, 31:1. Spring 2008.
5. Joy EA, Van Hala S, Cooper L. Health-related concerns of the female athlete: a
lifespan approach. Am Fam Physician. 2009 Mar 15;79(6):489-95. PubMed PMID:
19323362.
6: Bø K. Urinary incontinence, pelvic floor dysfunction, exercise and sport.
Sports Med. 2004;34(7):451-64. Review. PubMed PMID: 15233598.
7: Adamczuk J, Szymona-Pałkowska K, Robak JM, Rykowska-Górnik K, Steuden S, Kraczkowski JJ. Prz Menopauzalny. 2015 Sep;14(3):178-83. doi: 10.5114/pm.2015.54342. Epub 2015 Sep 30.
8: A Donaldson and CF Finch. Planning for implementation and translation: seek first to understand the end-users’ perspectives. Br J Sports Med April 2012 Vol 46: 306-307 originally published online October 17, 2011. doi: 10.1136/bjsports-2011-090461
9. Albers-Heitner P, Berghmans B, Nieman F, Lagro-Janssen T, Winkens R. Adherence to professional guidelines for patients with urinary incontinence by general practitioners: a cross-sectional study. J Eval Clin Pract. 2008 Oct Vol 14(5):807-11. Epub 2008 May 2. doi: 10.1111/j.1365-2753.2007.00925.x.
10. Borello-France D, Burgio KL, Goode PS, Ye W, Weidner AC, Lukacz ES, Jelovsek J-E, Bradley CS, Schaffer J, Hsu Y, Kenton K and Spino C. Adherence to Behavioral Interventions for Stress Incontinence: Rates, Barriers, and Predictors. Physical Therapy June 2013 Vol 93(6): 757-773. 21 February 2013. doi: 10.2522/ ptj.20120072
Duke R2P 