High School and College Athletes Experience Leakage, Too
When people think about urinary incontinence and pelvic floor issues, they imagine pregnant people, postpartum parents, and older folks. But that’s not the whole story. High school and college athletes here in Austin, TX and across the country experience leakage at surprisingly high rates. One survey-based study found that 29% of college athletes reported urinary leakage, with another study finding even higher rates in high school girls.
For these girls and young women, urinary incontinence is not just a physical symptom. Girls and women with leakage experience higher rates of depression and anxiety, as well as challenges in body image and self-esteem. Many younger athletes feel embarrassed or ashamed, making them less likely to share their symptoms with coaches, trainers, or healthcare providers. Leakage can impact the performance of these young athletes, but more importantly, it can impact their long-term physical and mental health and well-being.
The good news? Small changes can make a world of difference.
As pelvic floor physical therapists in Austin, TX, we work with high school and college-aged athletes who are surprised to learn that leakage is common and treatable. In this blog post, we’re going to dive into why leakage is so common in these athletes, what Austin girls can do to address leakage, and how pelvic floor physical therapy can help you stay dry during exercise.
Whether you are a high school athlete or the parent of one, a college student, or an adult who has been dealing with leakage since your younger years, know that help is available. Lady Bird PT offers pelvic floor physical therapy that can make a lasting difference and improve performance, confidence, and overall well-being.
Which sports experience the highest rates of leakage?
Across females of all ages, leakage is significantly more common in athletes than their sedentary counterparts, and young athletes are no different. The prevalence of leakage also increases with higher impact sports like gymnastics, cheer, and volleyball as compared to swimming or golf.
Rates of leakage in activities like trampolining, gymnastics, and volleyball have been reported to be as high as 60-80% of participants, with rates ranging from 20-50% of sports like running, basketball, and soccer.
Why is leakage so common in high school and college athletes?
A number of factors contribute to leakage in young female athletes. One of the most common causes of leakage is a lack of coordination of the pelvic floor muscles. Your pelvic floor is made up of postural muscles - meant to engage and relax independently as we move through space and sports. But these are muscles we don’t typically think about or touch, so sometimes they go haywire.
Your pelvic floor muscles are supposed to naturally relax and lift with every breath you take, but sucking in your gut, wearing compressive pants, clenching your glute and jaw, and shallow breathing from stress can all get in the way of this reflexive movement. Without these muscles getting to do their thing at baseline, they have a much harder time doing their thing during the higher needs of athletic performance.
Additional factors that contribute to leakage in young athletes:
Poor intra-abdominal pressure management: At rest, there is a certain amount of pressure within your abdomen. This pressure rises with physical activity, and an inability to manage this pressure appropriately can cause overload on the pelvic floor. In order to account for this pressure, the muscles surrounding your abdomen, including your pelvic floor, need to be strong and coordinated enough to meet the demands of this increased rise in pressure during exercise. Without the ability to effectively manage this pressure, it can overpower your pelvic floor, contributing to leakage.
Pelvic floor muscle restrictions: In order to function optimally, your muscles need to be strong, coordinated AND flexible. If you find yourself constantly sucking in your core, clenching your glutes, or wearing tight or restrictive clothing across your abdomen, these habits may contribute to a lack of flexibility in your pelvic floor. Restricted movement in these muscles, more so than true weakness, is a common cause of leakage in young athletes. If you have pain with tampon insertion, gynecological exams, or any other penetration, tension is something we need to consider.
Lack of sufficient pelvic floor or surrounding muscle endurance: Your pelvic floor doesn’t work in isolation - it works alongside your abdominals and hip musculature. While a true lack of strength is less likely the cause of leakage in young female athletes, a lack of endurance in the pelvic floor, hips and core can contribute to these symptoms. If leakage onsets towards the end of practice or competition, this is an important factor to consider.
Suboptimal movement patterns: The way we move can significantly alter the amount of stress placed on the pelvic floor. The way you breathe, jump, and move can influence ground reaction force – the force exerted by the ground on your body when you land. This force travels up through your ankles, knees, and hips into your pelvic floor. Even a strong pelvic floor can be overloaded, leading to leakage. Sometimes, all we need to do is adjust movement strategies to reduce this force.
Low energy availability: This occurs when athletes underfuel and overtrain. Without sufficient caloric intake to match the effort output during training, athletes can find themselves in a state of low energy availability. Athletes experiencing LEA are more likely to experience urinary incontinence. Read more about this in a post written by our friend Dr. Julie Wiebe here.
Connective tissue disorders: Connective tissue disorders are significantly higher in girls and women than their male counterparts. When someone has a connective tissue disorder, their soft tissue like ligaments, tendons and fascia provide less support to internal structures. In the case of the pelvic floor, this can look like less passive support for your bladder, rectum, and uterus. With less passive support, the pelvic floor muscles need to compensate in order to create stability. That can lead to overuse of the pelvic floor, contributing to symptoms like leakage. Learn more about connective tissue disorders and pelvic floor symptoms here.
What can young athletes do to address leakage?
Figuring out the origin of your leakage is the key to an effective treatment approach.
If low energy availability is the root cause of your symptoms, you may need to begin with dietary modification to increase your caloric intake. This could be started independently, but working with a registered dietitian may be necessary for others.
If pelvic floor muscle tension is the root cause, we need to begin with pelvic floor muscle relaxation exercises and treatment.
If a lack of muscular endurance is the issue, you may need to begin with a physical assessment to determine where the weakness is stemming from in order to focus your efforts in the right place.
The first step needs to be identifying the root cause of your symptoms and, from there, we can create an effective and comprehensive plan.
How can pelvic floor physical therapy in Austin, TX help you?
At Lady Bird Physical Therapy, keeping patients comfortable and in charge of their care is our top priority. We are a team of experienced, evidence-driven clinicians dedicated to providing top-notch, compassionate pelvic health care.
When you’re our patient, you will feel an intentional shift from the traditional clinical experience. We strive to welcome all of our patients in a warm, affirming, and approachable way while delivering real, life-changing results.
During an initial visit with Lady Bird PT, your pelvic floor physical therapist will ask you questions about your leakage, like when you first noticed your symptoms, what causes them, and if anything makes them better. We may also ask questions about your practice and competition schedule, your nutrition, sleep, and stress. Most importantly, we’ll talk about your goals and priorities.
From there, our physical exam will be tailored to your symptoms and goals. While an internal pelvic exam may be recommended for some who have previously had a gynecological exam, it will not be for others who haven’t yet seen a gynecologist. An internal pelvic exam with a PT does not include stirrups or a speculum and is never required. So much information about your body and symptoms can be gathered by simply asking the right questions and assessing your movement.
From there, we’ll create a plan together. This plan typically includes some combination of bodywork, exercise, and tweaks to your day-to-day habits. On average, we expect to see a significant improvement in bladder control within 4-6 visits.
Leakage is common, but it’s treatable. If you’re an athlete in Austin experiencing urinary incontinence, you are not alone—and pelvic floor therapy can help.
If you’ve had leakage since you were young, what does that mean for you as an adult?
Our team at Lady Bird Physical Therapy specializes in women’s health and every day, we see women across all ages for symptoms like pain with sex, heaviness in the pelvis, back and hip pain, and of course, urinary leakage. One of the first questions we ask patients when they come in for their first pelvic floor PT for leakage is “when did this start?” It’s not uncommon for an adult to tell us that while leakage has gotten worse in recent years, prompting them to come see us now, they’ve actually leaked since childhood.
Symptoms that are ignored tend to get louder over time, and leakage is no different. Fortunately, even if your leakage began years ago, there is so much that we can do to help improve your bladder control, athletic performance, and confidence.
Working with our team of expert pelvic floor physical therapists in Austin, TX can get you back to feeling dry, confident and strong. No matter how long you’ve been experiencing leakage, it’s not too late.