The athleticism at the 2012 Olympics and Paralympics was absolutely inspiring. I said “WOW” so many times I lost count. Some of the wows were for the stories of the athletes overcoming injuries or difficult circumstances to achieve their Olympic moment. Injuries got a lot of press this summer, and a LOT of tape. That colorful kinesiotape was everywhere! Hard to miss that an injury or vulnerability lurked beneath the surface.

But some injuries were invisible, well kept secrets that didn’t get any press…well, once. A female weightlifter from Ecuador leaked urine onto the floor during a lift. The story got some play on You Tube, not the kind of press you want or she was hoping for in her Olympic quest. But guess what, she was just the only one we saw, the unlucky one who forgot her pad that day. I guarantee she was not the only elite female athlete that leaked during an event. It is a very common problem in high level ( and not so high level) female athletes.

Thyssen et al (2002) surveyed 291 elite female athletes competing in a variety of sports from basketball to ballet, regarding their history of urine loss during participation in their sport or day to day activities. 151 reported leakage of some kind. Of the 151, five discussed it with a medical provider, and only six got pelvic floor training. Six. That’s 4.6% that actually sought and received treatment.

Call Ryan Seacrest….he missed the biggest story at the Olympics! Although I am not sure if the bigger story is that approximately half of the athletes were experiencing leakage or that only six actually sought treatment. But the take away should be that this is very common, but acknowledgement and seeking treatment is not.

The story really doesn’t stop there. Incontinence is just one way of identifying a pelvic floor insufficiency. It is a signal that an imbalance in the deep core system exists. The deep core is a closed pressure system, an insufficiency in any component will impact the capacity of the whole. With all the talk of the athletes core strength…this hidden issue among female athletes must be considered.

Some effort has been made to understand the issue. Kruger et al (2007)
looked at excursion of the bladder neck with a breath hold (valsalva) in athletes. The bladder neck of the athletes moved through a larger distance as compared to non-athletes. This was hypothesized to be a result of the constant impact of running, and jumping. The athletes also had a thicker pelvic floor muscle and assumed improved capacity to recruit the muscles. Perhaps this balanced the excessive excursion as they were not incontinent.

They may not have been incontinent but any hip pain? Or low back? How about osteitis pubis? A pelvic floor imbalance in the deep core system can contribute to other issues as well. Pain, joint instability and incontinence are all just signals that the system as a whole needs attention.

But how about we mere mortals, we non-Olympians? What is our take away message from these elite athlete studies for recreational athletes and fitness enthusiasts? The first study should wake us up to prevalence of incontinence among females who pursue fitness. The second study gives us a window into what happens overtime to pelvic floors that are asked to impact load repetitively, as they would for a committed runner. Add the effect of pregnancy and delivery on pelvic floor strength, function, and fascial integrity and the situation could be even more striking in terms of excessive motion, lack of organ support, and added vulnerability.

For those folks out there treating female runners who present with back pain (a common pelvic organ prolapse complaint) or even knee pain due to instability at the hip, the understanding of what is happening at the pelvic floor while they are running or holding their breath during resistance training is critical. The closed pressure system of the deep core may have a fault that must be addressed. If the abdomen had excessive excursion during impact loading or a breath hold, as practitioners we would treat that! We must understand and acknowledge what we cannot see in females that pursue fitness and sport.

We may not be able to see it, but there is much we can discern from a few questions and clinical insight. Ask your patients or add to your intake form: Do you experience unwanted leaking of urine with exercise or sport? Do you experience leaking of urine with lifting, sneezing, or laughing? Have you had any pregnancies? How many deliveries? What type of deliveries? Can you retain a tampon? All of these questions give you some clues as to the capacity of the deep core pressure system as a whole. One other clue, if you have treated their hip pain with more superficial measures and they aren’t responding the pelvic floor may be your culprit.

Wouldn’t it be great if at the 2016 Olympics/Paralympics, this wasn’t a story at all?

1. Thyssen H H, Clevin L, Olesen S, Lose G. Urinary incontinence in elite female athletes and dancers. Int Urogynecol J. 2002;13:15–17.
2. Kruger JA, Dietz HP, Murphy BA. Pelvic Floor function in elite nulliparous athletes. Ultrasound Obstet Gynecol. 2007; 30(1): 81-85.