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Urinary Incontinence in Elite Athletes |
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Urinary Incontinence in Elite Athletes
Kathryn Bewyer, MPT
April 29, 2004
My Double Life
n 50% ortho
n 50% women’s health
n Musculoskeletal pain during pregnancy
n Pelvic pain
n Lymphedema/post-mastectomy
n Incontinence/prolapse
Definition- Stress Incontinence
n “…when intravesical pressure exceeds that of the urethra with no
simultaneous detrusor contraction.”
n “…involuntary loss of urine during coughing, sneezing, or phsyical
exertion such as sporting activities, heavy lifting, or sudden changes
in position.”
(Bo, Borgen, 2001)
Prevalence- General Population
n 20-40% of community-dwelling women over 65 years old are incontinent.
n 1/2 of young, nulliparous women will experience occasional loss of
urine
(Practical Urogynecolgy, 1993)
Prevalence- Athletes
n PE students (N=75)
n Exercising 3x/wk
n Mean age 29.3 yrs
n 7 parous
n 31% prevalence
(Bo et al, Scand J. Sports Sci, 1989)
n Nutrition students (N=30)
n Sedentary
n Mean age 22.3 yrs
n 3 parous
n 10% prevalence
Prevalence- Athletes
Athletes (8hrs/wk)
§ N= 572
§ Mean age 21.5 yrs
§ BMI 21.6
§ Parity 5%
§ 41% prevalance UI (NS)
§ * 49.5% prevalance UI in eating disordered
§ * 38.8% prevalence UI in healthy athletes
Controls
§ N= 574
§ Mean age 24.2 yrs
§ BMI 22.7
§ Parity 33%
§ 39% prevalance UI (NS)
(Bo et al, Medicine & Sci in Sports & Exercise, 2001)
Prevalance- Athletes
n Elite female athletes (N= 291)
n Mean age 22.8 yrs
n 8% parity
n 43% experienced leakage during sport
n Varied 17-56%
(Thyssen et al, Intl Urogyn J., 2002)
Prevalence - Athletes
n UI elite college varsity athletes (N= 144)
n Mean age 19.9 yrs
n All nulliparous
n 28% reported urine loss during their sport
n Varied 0-67%
(Nygaard IE, Thompson FL, Svengalis SL, Albright JP, 1994)
Prevalence- Athletes
n Not statistically associated with ht, wt, menstrual regularity,
duration or position in sport.
n 18% leaked urine with ADL’s more than rarely.
n Total of 49% women were incontinent either with sport or ADL’s.
Anatomy
n Stable Bladder
n Striated urethral mm, levator ani
n Connective tissue/collagen
n Normal neuromuscular control
Normal Continence Mechanism
§ Pressure System
§ Normally, bladder neck/urethra are held closed by muscles that
maintain urethral pressure higher than bladder pressure.
§ As bladder fills, it accommodates (no rise in bladder pressure), until
stretch receptors indicate time to void.
§ When it is appropriate time to void, bladder (detrusor) contracts, and
muscles relax (micturition reflex).
Stress Incontinence Mechanism
n Intra-abdominal pressure->vesical pressure exceeds urethral closure
pressure
n Normally- pressure distrubuted evenly to bladder and to LA and
urethral sphincters = bladder neck stays closed, no leak
n Symptomatic- urethra not supported in a manner conducive to closure
n Garden hose analogy
Why the high prevalence in athletes?
n Force propagation through feet?
n Levator ani fatigue?
n Connective tissue differences?
n Estrogen levels?
n “Continence threshold”
Does being an athlete predispose for future incontinence?
§ High Impact (N=53)
§ Mean age 46.2 yrs
§ 60.7% parous
§ BMI 24.1
§ 35.8% prevalence during sport
§ 41.1% prevalance of any incontinence (NS)
(Nygaard, Obstetrics and Gynecology, 1997)
n Low Impact (N=44)
n Mean age 42.4 yrs
n 83.3% parous
n BMI 22.7
n 4.5% prevalence during sport
n 50% prevalence of any incontinence (NS)
What to do?
n Pelvic floor muscle exercises
n Pessary
n Address eating disorder?
n Shoe wear?
Thank You
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