Urinary incontinence and sports: which activities can worsen it and which can help

It is estimated that 20% to 30% of women practicing sports at a high level experience urinary incontinence. The onset of this issue is often promoted by abdominal pressure exerted on the pelvic floor muscles, especially during specific athletic activities.

For example, sports such as volleyball and athletics cause sudden increases in intra-abdominal pressure, which can lead to unexpected urine leakage or worsen incontinence if it is already present. If adequate pelvic floor muscle control is not developed, intensive abdominal exercises may cause leakage when the pressure on the perineum becomes excessive.

“Those who practice volleyball and athletics,” explains the specialist, “should perform exercises to strengthen the pelvic floor, which otherwise becomes hypotonic compared to the rest of the body and is therefore unable to withstand the effort.”

Another helpful measure is wearing absorbent underwear specifically designed for urine leakage, in order to feel comfortable in any situation.

Sports not recommended for urinary incontinence include:

• volleyball;
• athletics;
• weightlifting;
• some types of gymnastics;
• alpine skiing.

These sports place significant strain on the pelvic floor muscles, which may weaken due to repeated stress caused by a marked increase in intra-abdominal pressure.

On the contrary, sports recommended for urinary incontinence include:

• brisk walking;
• trekking;
• jogging;
• swimming;
• cycling;
• golf;
• rowing;
• sailing;
• yoga.

These sports involve less stress on the abdomen and do not exert high pressure on the perineum.

Clinically, three different types of urinary incontinence are distinguished:

Stress urinary incontinence

Stress urinary incontinence consists of urine leakage following an increase in intra-abdominal pressure due to coughing and/or sneezing, but it may also be caused by urinary sphincter dysfunction and/or alterations in the pelvic floor muscles.

The main predisposing factors include pregnancy, obesity, menopause, smoking habits, and physiological aging.

Urge urinary incontinence

In urge urinary incontinence, leakage is the direct consequence of a sudden and compelling urge to urinate, caused by overactivity of the bladder detrusor muscle. This disorder does not have a single specific cause, but its onset may be promoted by urinary tract infections, the presence of bladder stones, or bladder tumors.

Mixed urinary incontinence

The most common form of urinary incontinence is mixed incontinence, where leakage occurs both during physical exertion and due to detrusor muscle overactivity.

“A correct diagnostic assessment during the urogynecological examination allows us to identify the most appropriate therapeutic approach,” explains the specialist.

Depending on the causes that contribute to its onset, urinary incontinence can be treated in different ways.

• Rehabilitation therapy involves performing specific exercises combined with electrical stimulation: a solution aimed at strengthening the pelvic floor muscles and the urinary sphincter.
• Drug therapy aims to treat detrusor muscle overactivity, provided that this overactivity is not secondary to an underlying disease. In the latter case, treatment should target the root cause.
• Laser treatment is a minimally invasive, fast, and effective option indicated for people with mild stress urinary incontinence.
• Surgery can selectively correct the alteration that caused urinary incontinence.

“There are several options,” concludes Dr. Alrabi. “Patients may undergo endoscopic treatments to reinforce the urinary sphincter through periurethral injection of various substances, minimally invasive procedures, and even more complex surgeries.”