Considerations for Summer Activities

Three tips for avoiding incontinence during the summer

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With the ushering of – presumably – another scorching Colorado summer, young active women are most likely focused on things other than incontinence, yeast infections and injuries to the pelvic floor. Typically, urogynecologic-related issues are often regarded as a problem of the older, post-menopausal woman. Several studies, however, have demonstrated that common urogynecologic conditions are frequent in young nulliparous athletes.

Simple activities can led to major problems

We try to stress the fact that overuse of the pelvic floor muscles or levator ani (which assist in stabilizing the abdominal and pelvic organs) can lead to serious injury. If these muscles are constantly under tension from Pilates classes, for example, they may spasm and cause pelvic pain; spasms of the levator ani are often caused by trauma or sexual abuse.

We often attempt to treat levator ani spasms with physical therapy of the pelvic floor to teach patients how to relax those muscles.  Occasionally, urogynecologists will inject the levator ani muscles with local anesthetic or Botox to break the spasm cycle.

Swimming considerations

Patients who workout in a pool often remain in their wet, warm bathing suit afterwards.  Staying in your suit can lead to chronic yeast infections with discharge, itching and discomfort.  Yeast that are normally found in the air become trapped next to the skin in an environment that favors growth.  I also often see this condition in patients who chronically wear pads for discharge.

After bathing, I advise my patients to dry their genitocrural folds completely with a towel and, if available, use a hair dryer to make sure all moisture has evaporated before putting their clothes on.  For patients with chronic yeast infections, there are multiple treatments including topical and oral medications.

Before you leap …

For women, urinary incontinence is associated with a variety of activities, most likely to manifest during movement and increased pressure on the pelvic floor. It’s a primary goal of urogynecologists to help women stay active and healthy for their whole lives, instead of merely leading a more sedentary lifestyle without incontinence.

Bouncing on the trampoline is a fun summertime activity that can, unfortunately, lead to urinary incontinence. In one study, thirty-five members of the Swedish trampoline team who had never had a baby were observed (Eliasson et al., 2002) and 80 percent of the participants leaked urine when training for the sport. It was discovered that the g-forces from bouncing 10 to 20 feet in the air were enough to change the patient’s anatomy over a long period of time so severely that they leaked when they were not on the trampoline.

Similarly, 26 percent of female Air Force crews who sustained 9 g noted incontinence (Fischer and Berg, 1999).  We suggest that future Olympic trampolinists and pilots are able to pre-contract their pelvic floor muscles before they perform a g-force flip.

Skydiving is another exciting event that may lead to urinary incontinence. Researchers (Davis and Goodman, 1996) found that nine of 420 nulliparous female soldiers who entered airborne infantry training developed severe incontinence.  The parachute jumper who impacts on landing has a much greater chance of leaking urine.

How can you prevent urinary leakage during exercise?

1.)  It’s recommended that athletes empty their bladder completely before exercising.  Similar to nurses and teachers, we expect that athletes will often have a full bladder due to their schedule (though an empty bladder is ideal).

2.)  Stress urinary incontinence can be treated with pelvic floor muscles exercises. We advocate for athletes to use resistance devices to do a “super Kegel.” In such instances, a weighted cone is placed in the vagina and the patient is asked to hold the cone in place with her levator ani muscles while she ambulates.

3.)  For a simple solution, place a “super” or large tampon in the vagina prior to exercise. This can elevate and slightly obstruct the urethra at the time of increased intra-abdominal pressure.  This method has been studied (Glavind, 1997) and research showed six women with stress urinary incontinence were dry when they did 30 minutes of aerobics with a tampon in place. Devices that act as a “cork” to plug the urethra have been introduced in the past, however are inconsistent in the market.

The bottom line?

There is no evidence directly linking strenuous exercise to prolapse and incontinence.  Although the prevalence of pelvic floor dysfunction is high in elite athletes, many do not leak during sports. Elite women athletes at risk may develop these conditions with physical exercise unmasking the diagnosis earlier in life.  A consistent focus on form and training will be beneficial to all athletes.