University of California Irvine Medical Center

URGENT MATTERS
Urinary incontinence is a big hurdle
for some female athletes.

In an age when sex is discussed as openly as the weather, urinary incontinence is a well-kept secret. Affecting up to 15 million American women, it plagues not only the old, but the young. More than two-thirds of female gymnasts say they’re affected by urinary incontinence frequently. And 28 percent of women college athletes have experienced "accidents" when participating in their sport.

"Few people realize that incontinence is a significant problem for female athletes," says Dr. Regina Hovey, a urologist at UCI Medical Center. To avoid embarrassment, some women wear pads or adult diapers when they exercise. Others simply drop their sport.

But it doesn’t have to be that way. Today, doctors can cure or improve 90 percent of all urinary incontinence problems.

INCONTINENCE GUIDE
Stress incontinence. A sudden loss of urine when pressure is exerted inside the abdomen, as during coughing or exercising.

Urge incontinence. An urgent need to urinate, coupled with a sudden loss of urine, due to involuntary bladder contractions.

Overflow incontinence. A constant dribble of urine caused by a weak bladder. Uncommon in women.

Staying dry
To treat urine leakage, the type of incontinence must first be identified (see "Incontinence Guide" on this page).

"Women who engage in high impact sports are especially susceptible to stress incontinence," says Hovey. "Activities such as basketball or soccer increase pressure inside the abdomen and impact the bladder, causing a sudden release of urine."

Next, the cause of the problem must be pinpointed. "There are dozens of reasons for incontinence," explains Hovey. "They range from hormonal changes and weak pelvic-floor muscles to diabetes and urinary infections." Once other possibilities are ruled out and the type of incontinence is confirmed, treatment can begin. If stress incontinence is the culprit, a wide range of treatment options are available. They include:

Weight loss and dietary changes. Limiting fluid intake and eliminating bladder stimulants such as coffee and alcohol can relieve symptoms for some women. And in overweight individuals, weight loss can sometimes improve the problem.

Kegel exercises. These simple pelvic-floor exercises reduce urine leakage in three out of four women with stress incontinence. Another 20 percent are completely cured. Kegels work by strengthening the muscles responsible for urine control and retraining the pelvic floor.

Biofeedback. When women can’t identify the muscles needed for Kegels, biofeedback can help. Electronic monitoring teaches patients which muscles to contract to prevent leakage.

Bladder training. By learning how to urinate on schedule, women athletes can improve their ability to "hold it" when exercising.

Devices. Several aids such as a diaphragm-like device called a pessary can put a stop to embarrassing accidents during athletic events for some women.

Hormones. Low estrogen levels in menopausal athletes may weaken the sphincter muscle that controls urine flow. Replacement hormones can strengthen and tone the sphincter.

Collagen. If less invasive methods fail, collagen injections can "bulk up" the urethra---the tube through which the urine is excreted from the bladder. The collagen-enhanced urethra requires less strength to close.

Surgery. There are several surgery options to reposition the bladder and strengthen pelvic muscles. They have a greater than 85 percent success rate.

Need help for incontinence? For referral to a urologist, call toll free 1-877-UCI-DOCS