Stress Urinary Incontinence (SUI) Factsheet

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Female athletes

You can read the information on this page or select the link below to view the PDF version of the factsheet.

Stress Urinary Incontinence Factsheet (PDF, 526KB, opens in new tab)

Introduction

As many as 1 in 4 women experience some degree of stress incontinence. The most common challenge is stress urinary incontinence (SUI) which involves urinary leaking with activity, stress or coughing. Urinary incontinence often occurs in female athletes, especially those involved in high impact sports. It happens when the pelvic floor muscles that support the bladder become weakened. Weakened pelvic floor muscles cannot support the bladder and the urine outlet (urethra) as well as they should. The pressure is too much for the bladder outlet to withstand and so urine leaks out.

What is the pelvic floor?

The pelvic floor muscles lie across the base of your pelvis to help keep the pelvic organs in the correct position. The muscles are held in place by ligaments that support organs, especially when there is an increase of pressure in the abdomen that occurs with lifting, bending, carrying, and straining. This is called intra-abdominal pressure (IAP) and when it increases the pelvic floor and abdominal muscles brace so that the internal organs such as the uterus and bladder are not pushed downwards. The pelvic floor muscles work to help keep the bladder and bowel openings closed to prevent unwanted leakage (incontinence) and they relax to allow easy bladder and bowel emptying.

How does the pelvic floor work?

The muscles of the pelvic floor are kept firm and slightly tense to stop leakage of urine from the bladder and wind or faeces from the bowel. When you pass water or have a bowel motion the pelvic floor muscles relax. Afterwards, they tighten again to restore control. The muscles actively squeeze when you laugh, cough, lift or squeeze to help prevent any leakage.

Symptoms

Any activity that causes intra-abdominal pressure can result in stress urinary incontinence; these activities include:

Laughing
High Impact Exercise
Coughing
Repeated Heavy-Lifting

The amount of urine that passes is usually small, but stress incontinence can sometimes cause you to pass larger amounts, particularly if your bladder is full.

Why do problems occur?

Remember, 1 in 4 people of all ages & walks of life experience stress incontinence. Most causes of stress incontinence are due to weakened pelvic floor muscles. Stress incontinence is even more common in women who have had children.

Heavy or repeated lifting – causes an increase in abdominal pressure (IAP) which may put your pelvic floor muscles under strain. It also affects many women who have not given birth – especially athletes who are involved in high impact exercise, particularly if you have not increased your exercise programme carefully over time.

Pregnancy and Childbirth
Chronic Constipation
Heavy or Repeated Lifting
High Impact Activity
Chronic Respiratory Conditions
Menopause

Treatment

Exercising your pelvic floor muscles can strengthen them so they can provide the correct support. This will improve your bladder control and improve or stop the leakage of urine. Like any other muscles in the body, the more you use and exercise them, the stronger the pelvic muscles will feel.

Finding your pelvic floor

It is not always easy for women to find their pelvic floor muscles. Exercising them should not show at all ‘on the outside’. Please find a step by step below on how to find your pelvic floor. Before you start – it is important to avoid the following when performing pelvic floor exercises:

Pulling in your tummy excessively
Tightening your buttocks
Squeezing your legs together
Holding your breath

Step 1

Sit comfortably with your knees slightly apart. Now imagine that you are trying to stop yourself passing wind from the bowel. To do this you must squeeze the muscles around the back passage. Try squeezing and lifting that muscle as if you really do have wind. You should be able to feel the muscle move. Your buttocks and legs should not move at all. You should be aware of the skin around the back passage tightening and being pulled up and away from your chair. Really try to feel this squeezing and lifting.

Step 2

Now imagine you are sitting on the toilet passing urine. Picture yourself trying to stop the stream of urine. You should be using the same group of muscles that you used before, but don’t be surprised if you find this harder. (Do not try to stop the stream when you are actually passing water as this may- if repeated– cause problems with correct emptying).

Step 3

Now, try to tighten the muscles around your back passage, vagina and front passage and lift up inside as if trying to stop passing wind and urine at the same time. It is very easy to bring other incorrect muscles into play, so try to isolate your pelvic floor as much as possible by not squeezing your legs together, not tightening your buttocks and not holding your breath. The lower tummy can very gently be drawn in as if pulling away from the zip of tight trousers. In this way most of the effort should be coming from the pelvic floor muscles.

Improving your pelvic floor muscles

So, you have found your pelvic floor muscles – how do you improve them? Pelvic floor muscle exercises (sometimes called Kegels) should include long, held squeezes as well as short, quick squeezes (only a second or two!) Ensure you let the muscle ‘go’ or ‘RELAX’ after each squeeze. You should work the muscles until they tire and do this regularly to make your pelvic floor muscles stronger and more effective. See the beginners pelvic floor exercises below for more info! The practice should take no longer than listening to your favourite song!

Beginners Pelvic floor exercises

Short squeezes:

Lie, stand or sit, with your knees slightly apart
Quickly squeeze the pelvic muscles around your rectum and vagina
Hold for 2 seconds, and release

Long squeeze:

Lie, stand or sit with your knees slightly apart
Slowly tighten the pelvic muscles around your rectum and vagina
Squeeze both areas as hard as you can
Hold for 10 seconds and relax

Aim to be able to do 10 long squeezes, holding each squeeze for 10 seconds, followed by 10 short squeezes.

You can follow a video of these exercises here: Pelvic Floor Exercises for Women - YouTube (Link opens in new tab)

Top tips!

You may need to start with ‘little and often’ if you find that you can only hold the squeeze for a short time, or only do a few before the muscles tire.

You should do your pelvic floor muscle exercises at least 3 times each day. You may find it easier to start your programme when you are sitting or lying down.
Build up your exercise routine gradually over the weeks and months. You should notice an improvement in 3 - 5 months and then keep practising your pelvic floor muscle exercises once a day to maintain the improvement.
As your muscles improve, aim to do your exercises in other positions such as standing up. Eventually you can practise using these muscles whilst doing activities such as walking and bending.
Get into the habit of doing your exercises during normal day to day activities. For example, whilst cleaning your teeth or waiting for a kettle to boil. Or set a reminder on your phone!
Tighten your pelvic floor muscles when you feel you might be about to leak - pull up the muscles before you cough, laugh, sneeze or lift anything heavy. Your control will gradually improve.

Be aware!

If you experience pain when exercising your pelvic floor muscles, or if you have abdominal or pelvic pain after doing the exercises you should seek specialist advice from a specialist physiotherapist or women’s health doctor. If you require further support or have ongoing pain with exercises or activity, and are SIS supported please contact: femaleathletehealth@sisport.com. Alternatively, please contact your local GP.