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Urinary Stress Incontinence in High-Level Female Athletes: A Taboo to Overcome



Urinary stress incontinence, often downplayed and taboo, affects a significant number of high-level female athletes. What exactly is it? It’s an involuntary leakage of urine that occurs during exertion, typically during coughing, sudden movements, or athletic activities that increase intra-abdominal pressure. This phenomenon is now widespread, still taboo but increasingly discussed, especially in the sports community.






The hidden side of high-level sports

High-level female athletes are often perceived as role models of strength, determination, and self-control. However, behind this idealized image lies a little-known and stigmatized reality: urinary stress incontinence. A health problem affecting 50% of athletes (urinary stress incontinence in high-level female athletes - source in footpage), but one that remains largely undiscussed.


For several years, teams have sought to quantify this effect through studies based on questionnaires completed by numerous athletes, in sports such as gymnastics, trampoline, basketball, and tennis. Unfortunately, the phenomenon is very common, even among young female athletes. In Eliassen et al’s 2022 study, where 35 elite trampoline practitioners were surveyed, all girls over the age of 15 reported urinary leakage during exertion.


Besides well-known risk factors such as BMI, age, and pregnancies, several factors specific to athletic practice have been identified for urinary stress incontinence (USI):


Intensity: There’s a strong correlation between the prevalence of USI and the level of athletic activity. Competitive sports pose a higher risk of urinary leakage during exertion compared to amateur sports. Additionally, leaks are more frequent and intense during high-impact and repetitive exercises compared to endurance activities.

Type of activity: High-impact physical activities like running, trampolining, team sports, gymnastics, tennis, etc., pose a higher risk of USI.

Eating disorders: There seems to be a link between eating disorders in athletes and urinary stress incontinence. This can be explained by a hormonal imbalance affecting the tone of the pelvic floor muscles.


Consequences on performance and mental health:

Urinary stress incontinence can have devastating physical and psychological repercussions on female athletes. Besides obvious discomfort and loss of confidence, this condition can affect concentration and performance, potentially leading athletes to quit sports. The psychological aspect has often been overlooked in discussions about USI, as athletes face pressure to perform at their best while managing sometimes embarrassing health issues. The risk of developing self-esteem issues and anxiety shouldn’t be underestimated.


Despite this, there’s been an increasing number of awareness campaigns led by various institutes, sports federations, clubs, and high-level athletes advocating for improvement in this area. However, there’s still a long road ahead, as a recent survey shows that 80% of women find it difficult to discuss USI with their peers, and one-third find it challenging to talk to their doctors. Nonetheless, many are aware of the connection between sports and urinary incontinence and the possibility of undergoing pelvic floor rehabilitation.


Management

Urinary stress incontinence can be managed both preventatively and therapeutically. Management involves pelvic floor rehabilitation, abdominal strengthening, and lumbo-pelvic static work. The overall goal is to regain control over intra-abdominal pressure during exertion, promoting a reflexive locking mechanism during physical activity.


The efforts of INSEP to break the silence:

A recent article in Le Parisien (“It has become a reason for consultation”: INSEP wants to break the taboo on urinary stress incontinence - source footpage) highlights INSEP’s efforts to address urinary stress incontinence, recognizing it as an increasingly common reason for consultation among high-level female athletes. INSEP, playing a central role in athlete training and monitoring in France, is working to destigmatize this issue. They’ve implemented initiatives to raise awareness among athletes, coaches, and healthcare professionals. Information sessions and workshops are held to openly discuss the issue and encourage athletes to seek help. Educational videos, available via QR code in medical facility rooms, illustrate pelvic floor and abdominal movements during sports activities. These videos, coordinated by Carole MAITRE, a gynecologist and sports physician at INSEP, explain the anatomy and stresses experienced by the abdominal cavity during each phase of sports activities. They highlight the crucial importance of coordination between deep muscles (pelvic floor and transverse abdominal) and superficial muscles (rectus abdominis). Athletes can easily visualize the importance of anticipatory co-activation of pelvic floor and transverse abdominal muscles to reduce urinary leaks during exertion.





The healthcare professionals working with female athletes are trained to recognize signs of urinary stress incontinence and provide appropriate support. The goal is to create an environment where female athletes feel comfortable discussing their health issues without fear of judgment. A positive step for the future of women's sports!


The need for increased awareness

While INSEP is making significant strides in breaking the taboo, it's essential that awareness of urinary stress incontinence extends to the entire sports community. Sports federations, clubs, and governmental organizations must also play an active role in promoting understanding and empathy towards this reality.

Public awareness is equally crucial in changing perceptions about urinary stress incontinence. The media, in particular, can help demystify this condition by offering balanced and informed coverage, highlighting the stories of athletes struggling with this issue.




Resources: 

Gynecologist Paper – Carole MAITRE. https://insep.hal.science/hal-02063639/document

Scientific Articles on ISU quantification on athletes population:

  • Nygaard JE, Thompson FL, Svengalis SL, Albrigh JP. Urinary incontinence in elite nulliparous athletes. Obstet Gynecol 1994;84:183-7.

  • Thyssens HH, Clevin L, Olesen S, Lose F. Urinary incontinence in elite female athletes and dancers. Int Urogynecol J Pelvic Floor Dysfunct 2002;13(1):15-7.

  • Bo K, Borgen JS. Prevalence of stress and urge urinary incontinence in elite athletes and controls. Med Sci Sports Exerc 2001;33 (11):1797-802.

  • Eliasson K, Larsson T, Mattsson. Prevalence of stress incontinence in nulliparous elite trampolinists. Scand J Med Sci Sports 2002;12: 106-10.

  • Caylet N, Fabbro Peray P, Mares P, Dauzat M, Prat-Pradal D, Corcos J. Prevalence and occurrence of stress urinary incontinence in elite women athletes. Can J Urol 2006; 13(4):3174-9.

  • Salvatore S, Serati M, Laterza R. The impact of urinary stress incontinence in young and middle age women practicing recreational sports activity: an epidemiological study. Br J Sports Med 2009;43: 1115-8

Le Parisien newspapers article :


Website “la medecinedusport.com” (in French):


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