Athletic Training and Sports Health Care

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Pearls of Practice 

Screening for Urinary Incontinence in Female Athletes

J.C. Andersen, PhD, ATC, PT, SCS; Beth Andersen, MS, PT, ATC

Abstract

Dr Andersen is from the Department of Health Sciences and Human Performance, The University of Tampa, and Ms Andersen is from St. Joe’s and Plant City Clinics, Physiotherapy Associates, Tampa, Fla.

The authors have no financial or proprietary interest in the materials presented herein.

Address correspondence to J.C. Andersen, PhD, ATC, PT, SCS, Department of Health Sciences and Human Performance, Box 30F, The University of Tampa, Tampa, FL 33606; e-mail: jcandersen@ut.edu.

Urinary incontinence (UI) is defined as any unwanted loss of urine that causes a social or hygienic problem.1 Urinary incontinence is a common health symptom among females and can occur across a broad age range. A review of the available evidence suggests that up to 82% of women can be affected by this condition.1 Given this observation, female athletes and other physically active individuals likely experience UI in their activities of daily living and in their sport and physical activity.2–5

The social costs of UI symptoms often discourage help-seeking behaviors, and only approximately 25% of American women with UI are estimated to speak with a physician about this health symptom.1 Given that UI is found across a wide spectrum of people, sports health care practitioners are uniquely positioned in their injury prevention and health promotion role to screen for and identify those individuals with or at risk for UI. The purpose of this article is to provide practitioners with an understanding of the types of UI and to provide a framework for preparticipation screening for the identification of UI in female athletes.

Clinicians should recognize that several types of UI can occur. Stress urinary incontinence (SUI) is typically defined as loss of urine during activities such as sneezing, laughing, coughing, running, or jumping.1,2 Urge urinary incontinence (UUI) is defined as loss of urine accompanied by a sudden strong sense of urgency. Mixed urinary incontinence (MUI) is defined as loss of urine with characteristics of both SUI and UUI.1,2

Several potential mechanisms for SUI include urethral hypomobility, pelvic floor muscle damage, chronic stress to pelvic floor, and decreased estrogen levels.1 For UUI, the likely mechanism is considered to be detrusor (ie, bladder smooth muscle) instability, which is typically idiopathic in nature and may involve altered autonomic control.1 The MUI mechanisms are a combination of SUI and UUI. The observation that multiple mechanisms can contribute to the development if UI is of value to clinicians seeking ways to identify patients with or at risk for UI.

Epidemiologic data indicate a significant prevalence of UI in female athletes at multiple levels of competition (ie, high school through elite).2–5 Bo and Borgen2 reported a SUI prevalence of 41% and a UUI prevalence of 16% in their athletic study participants. They also reported that 20.4% of athletes with disordered eating reported UUI, whereas 15.5% of healthy athletes reported UUI. Furthermore, 15% reported urinary leakage to be a problem and 5% reported it was a moderate to severe problem. More recent studies demonstrate a prevalence of UI in female athletes ranged from 28% to 49% in high school and college athletes3,4 to 52% in elite athletes.5

In addition, these studies have reported SUI prevalence of 56% in gymnastics,5 30% to 43% in volleyball,4,5 50% in soccer,4 and 25% to 58% in track and field.1,4,5 The available evidence also indicated that of those who experienced UI during sport, 95% did so during training versus 52% during competition.5 Also, most participants in studies of athletes and other active females were nulliparous (had not borne offspring), suggesting that sport activity is a risk factor for developing UI.2–5

Current evidence clearly supports the notion that UI is an important…

Dr Andersen is from the Department of Health Sciences and Human Performance, The University of Tampa, and Ms Andersen is from St. Joe’s and Plant City Clinics, Physiotherapy Associates, Tampa, Fla.

The authors have no financial or proprietary interest in the materials presented herein.

Address correspondence to J.C. Andersen, PhD, ATC, PT, SCS, Department of Health Sciences and Human Performance, Box 30F, The University of Tampa, Tampa, FL 33606; e-mail: jcandersen@ut.edu.

Urinary incontinence (UI) is defined as any unwanted loss of urine that causes a social or hygienic problem.1 Urinary incontinence is a common health symptom among females and can occur across a broad age range. A review of the available evidence suggests that up to 82% of women can be affected by this condition.1 Given this observation, female athletes and other physically active individuals likely experience UI in their activities of daily living and in their sport and physical activity.2–5

The social costs of UI symptoms often discourage help-seeking behaviors, and only approximately 25% of American women with UI are estimated to speak with a physician about this health symptom.1 Given that UI is found across a wide spectrum of people, sports health care practitioners are uniquely positioned in their injury prevention and health promotion role to screen for and identify those individuals with or at risk for UI. The purpose of this article is to provide practitioners with an understanding of the types of UI and to provide a framework for preparticipation screening for the identification of UI in female athletes.

Types of Urinary Incontinence

Clinicians should recognize that several types of UI can occur. Stress urinary incontinence (SUI) is typically defined as loss of urine during activities such as sneezing, laughing, coughing, running, or jumping.1,2 Urge urinary incontinence (UUI) is defined as loss of urine accompanied by a sudden strong sense of urgency. Mixed urinary incontinence (MUI) is defined as loss of urine with characteristics of both SUI and UUI.1,2

Several potential mechanisms for SUI include urethral hypomobility, pelvic floor muscle damage, chronic stress to pelvic floor, and decreased estrogen levels.1 For UUI, the likely mechanism is considered to be detrusor (ie, bladder smooth muscle) instability, which is typically idiopathic in nature and may involve altered autonomic control.1 The MUI mechanisms are a combination of SUI and UUI. The observation that multiple mechanisms can contribute to the development if UI is of value to clinicians seeking ways to identify patients with or at risk for UI.

Prevalence of Urinary Incontinence in Female Athletes

Epidemiologic data indicate a significant prevalence of UI in female athletes at multiple levels of competition (ie, high school through elite).2–5 Bo and Borgen2 reported a SUI prevalence of 41% and a UUI prevalence of 16% in their athletic study participants. They also reported that 20.4% of athletes with disordered eating reported UUI, whereas 15.5% of healthy athletes reported UUI. Furthermore, 15% reported urinary leakage to be a problem and 5% reported it was a moderate to severe problem. More recent studies demonstrate a prevalence of UI in female athletes ranged from 28% to 49% in high school and college athletes3,4 to 52% in elite athletes.5

In addition, these studies have reported SUI prevalence of 56% in gymnastics,5 30% to 43% in volleyball,4,5 50% in soccer,4 and 25% to 58% in track and field.1,4,5 The available evidence also indicated that of those who experienced UI during sport, 95% did so during training versus 52% during competition.5 Also, most participants in studies of athletes and other active females were nulliparous (had not borne offspring), suggesting that sport activity is a risk factor for developing UI.2–5

Clinical Application

Current evidence clearly supports the notion that UI is an important health issue for many female athletes. Furthermore, UI is especially significant to those athletes engaged in sports that require repetitive, forceful bounding, jumping, or tumbling and may place female athletes at increased risk for UI.1,2 Also, a large proportion of female athletes appear to avoid seeking help with their UI symptoms.1,3 Therefore, the preparticipation medical history questionnaire could be a useful tool in identifying athletes experiencing UI or at risk for developing UI.

In the Table, several questions for inclusion on the medical history questionnaire are presented. Responses to the first 2 questions are valuable in screening for SUI, whereas responses to the third question aid in screening for UUI. The fourth question relates to the severity of UI, if present, and would be useful in guiding decisions on intervention or referral to other members of the sports medicine team. By taking an active approach to inquiring about UI, clinicians may assist female athletes in overcoming any hesitancy in seeking help for these health symptoms.

Proposed Preparticipation Medical History Questions

Table: Proposed Preparticipation Medical History Questions

References

  1. Figuers CC. Physical therapy management of pelvic floor dysfunction. In: Irion JM, Irion GL, eds. Women’s Health in Physical Therapy. Baltimore, MD: Lippincott Williams & Wilkins; 2010:115–143.
  2. Bo K, Borgen JS. Prevalence of stress and urge urinary incontinence in elite athletes and controls. Med Sci Sports Exerc. 2001;33:1797–1802. doi:10.1097/00005768-200111000-00001 [CrossRef]
  3. Carls C. The prevalence of stress urinary incontinence in high school and college-age female athletes in the Midwest: Implications for education and prevention. Urol Nursing. 2007;27:21–24.
  4. Dockter M, Kolstad AM, Martin KA, Schwial LJ. Prevalence of urinary incontinence: A comparative study of collegiate female athletes and non-athlete controls. J Womens Health Phys Ther. 2007;31:12–16. doi:10.1097/01274882-200731010-00003 [CrossRef]
  5. Thyssen HH, Clevin L, Olesen S, Lose G. Urinary incontinence in elite female athletes and dancers. Int Urogynecol J. 2002;13:15–17. doi:10.1007/s001920200003 [CrossRef]

Proposed Preparticipation Medical History Questions

Do you now or have you in the past year experienced unwanted urine leakage when you laugh, cough, or sneeze?YesNo
Have you experienced unwanted urine leakage during participation in your sport?YesNo
Do you ever feel a strong urge to urinate followed by urine leakage?YesNo
If you answered yes to any of the above, how would you describe the amount of urine you usually leak? Circle one.Few dropsSmall amountSoaks pad/underwearVery wet/soaks clothing
Authors

Dr Andersen is from the Department of Health Sciences and Human Performance, The University of Tampa, and Ms Andersen is from St. Joe’s and Plant City Clinics, Physiotherapy Associates, Tampa, Fla.

The authors have no financial or proprietary interest in the materials presented herein.

Address correspondence to J.C. Andersen, PhD, ATC, PT, SCS, Department of Health Sciences and Human Performance, Box 30F, The University of Tampa, Tampa, FL 33606; e-mail: .jcandersen@ut.edu

10.3928/19425864-20110826-02

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