First of all, you should know that 30%-40% of women have problems with urine leakage while exercising, to the point where it bothered them. That is a very high percentage, if you think about it. For example, in the 2009 Pints to Pasta race, there were 1,239 female finishers. If 30%-40% of those women had exercise-induced urinary incontinence, that would mean that somewhere between 371 and 496 women felt uncomfortable due to urine leakage. However, the number was probably not that high, because “The main problem [with exercise-induced urinary incontinence] is that is often limits women from doing activities that they would otherwise participate in, because of the worry and inconvenience that the incontinence causes.” So, there were probably many women who wanted to run a race, or even just run with friends, who didn’t because of exercise-induced urinary incontinence.
Second of all, you should know that there are treatments –things you can do yourself, as well as both surgical and non-surgical options that you can talk to you doctor about – for exercise-induced urinary incontinence. All women are encouraged to do Kegel exercises, which strengthen the female pelvic muscles. Women who are significantly overweight may find that losing weight will make a difference. Dr. Smith also warns against being “over hydrated,” which is something your doctor can help you determine:
“It is certainly important for athletes to be well hydrated, but it is not uncommon that incontinence is the result of being “over hydrated.” Studies show that most women are “full” and need to empty their bladder when there is 8-12 oz of urine in their bladder, and a woman is adequately hydrated when she makes about 70 oz of urine in a 24-hour period. Obviously how much someone drinks in a day in order to make 70 oz of urine varies a lot with their level of activity, how hot it is, etc. But the point is if someone makes a lot more urine than this in 24 hours then they are over hydrated.”
“This isn’t necessarily a bad thing, but it does mean that it is possible to urinate and empty the bladder and then have it be full again in a short period of time. Anyone who leaks with straining activities when their bladder is full (more than 8-12 oz) needs to drink less and void more; it is an excess fluid problem, not a bladder problem. When consulted about incontinence issues, we have a patient complete a ‘voiding diary’ which asks them to keep track for 24 hours about their fluid intake and output. It is a tedious chore, but often is very revealing and helpful to learn that they can improve their bladder function by making simple adjustments in fluid intake.”
Talking with your doctor is also important because, according to Dr. Smith, “There are women who leak only with prolonged exercise, or perhaps with persistent coughing with a bad cold. These individuals may be helped by using a support device to provide some additional support to their urethra during these occasional situations. Wearing a tampon, a diaphragm or an incontinence support device called a pessary that can be inserted when needed and then removed can be a big help.” She adds that exercise-induced urinary incontinence is more common as women age, and also more common in women who have given birth.
Kristin, a Portland-area runner since 1995, is a 41-year old mother of two children who recently talked to her doctor about her exercise-induced urinary incontinence. Kristin was willing to be interviewed as well, because “I think the more women that talk about it will help others wondering why they can’t be more active.”
Kristin recounts her experience: “I tried to start running a few years after my (now 16-year-old) daughter was born but had issues with leakage right away. I mentioned it to my mom and she said ‘that is what happens’ after having a child. I figured it was too soon to try running and talked myself out of it. I did the same thing again after my son was born, but again had problems and at that point was too embarrassed to discuss it with anyone including my husband. I decided in 2001 to learn how to cope with it. I should have bought stock in panty liner companies! That is when I started learning what I needed to do to deal with it.”
For Kristin, exercise-induced urinary incontinence was at the forefront of her mind every day and during every run. “I had to stop any liquid intake at least eight hours before running and use the restroom at the very last minute before running. Even then if I kept the pace over 10 minutes per mile, I could only go for maybe 2- 3 miles before it would start leaking. If I was closer to a 9 minute per mile pace I would feel leaking with every step.”
The constant symptoms caused Kristin to change her running program. Even though she was used to the leakage, she was still embarrassed to run around others. “It was what made me stop coming to track workouts with the group.”
At first, she was embarrassed to talk with her doctor about it, because she’s spent years talking herself out of bringing it up. “I finally decided to suck it up and mention it, as I really hadn’t heard many other runners saying they had problems with it. I had started to think that maybe something was wrong with me.” But she did finally muster up the courage to ask her doctor about it, and the response was better than she could have imagined.
“When I brought it up, my doctor was great! She said there was a test we could do that would determine if it was something that could be fixed with Kegels or if the bladder hammock (a surgical option) would work. I figured that since I did Kegels all the time, maybe the other option would work for me.” At her next appointment, a test was done in which she had to fill her bladder and then was monitered for signs of leaking. In Kristin’s case, it was determined that she had stress-induced incontinence, but that surgery would be beneficial in this particular case. (Note: Each woman should talk to their own doctor to find out which options are best for them.)
A few months after her surgery and follow-up treatment, Kristin is ecstatic and wants other women to talk to their doctors if they have exercise- or stress-induced urinary incontinence. She says, “I feel great! It was so worth it!” Kristin was also sure to follow the post-operation directions to the letter, which meant less physical contact (her husband was very supportive, she says) and to wait until she was healed before starting to run again. “I’ve started back slowly with my training – slowing things way down and really watching my total miles by increasing mileage very slowly. I don’t have any leakage.” This includes a long run of 8 miles (with a drink of water only 45 minutes before the run) and two speed workouts.
Kristin urges other women with leakage to seek medical help. “It was worth every bit of it. I encourage any woman that is having issues to talk to their doctor. It isn’t normal for leakage to happen and I think a lot of times women are too busy to put themselves first.”
The bottom line is that women should not be embarrassed or ashamed if they have exercise-induced urinary incontinence, and that any woman who is concerned about this or experiencing any symptoms of urine leakage should definitely contact their primary care provider. At Kaiser Permanente, physicians are encouraged to ask their female patients about it, instead of waiting for the woman to bring up what she may see as an embarrassing condition. It’s important, too. “A study done at Kaiser Permanente in Portland Oregon (Olsen, A et al. Obstetrics and Gynecology 89: 501-6,1997) shows that 1 in 11 women have incontinence with or without pelvic organ prolapse severe enough to require surgery over the course of their lifetime,” says Dr. Smith.
Dr. Smith suggests women seeking more information talk to their doctor and visit the following web sites:
- mypelvichealth.org, which is organized by the American Urogynecologic Society
- National Kidney and Urologic Diseases Information Clearinghouse
- nafc.org – The National Association for Continence
RunOregon note: We are so proud of our friend Kristin for talking to her doctor. It’s a joy to have you back on the roads! Thanks for answering our questions!