Pelvic floor dysfunction in runners – a new treatment approach

There is no shortage of research showing that female athletes are at a higher risk of stress urinary incontinence (SUI) than the general population. One study found that over 50% of female athletes under the age of 40 experienced urinary leakage during their chosen sport. What may be surprising is that among athletes, runners carry the highest prevalence of urinary leakage, with a further analysis showing women running three or more times per week were at greater risk.

Although these numbers indicate a significant problem in the running community, only 16% of women seek treatment for SUI. Perhaps in part due its perception as something inevitable, or intractable. This lack of understanding is problematic, as it feeds into the belief that urinary leakage is something to be tolerated, rather than something to be treated.

SUI occurs when pressure from the abdomen increases and the necessary counter pressure at the urethra is insufficient to avoid the loss of urine. The physiology of SUI is complex in runners, with emerging research suggesting that weakness of the pelvic floor muscles may not be solely to blame, and rather overactivity, or increased mobility of other structures are likely to play a key role.

Despite this, most women will experience symptom relief through pelvic floor training. For 1 in 3 of us however, pelvic floor training alone does not improve this problem. In this group, management options include the use of containment solutions (such as Wearever reusable underwear), or even being considered for an invasive procedure.

The truth is, the United Kingdom is behind countries such as Canada and The United States in our approach to Women’s Health. In these countries, the 33% of women for whom pelvic floor training is ineffective routinely use temporary intravaginal devices. These devices are not surgically implanted, nor do they capture urine after a leak has happened. Rather, the device applies a gentle counter pressure on the urethra during a moment of exertion such as running or jumping. This is enough in the majority of women to significantly reduce if not entirely stop any urinary leakage whilst in place.

What has gained particular interest from the Women’s Health community is that these devices can be entirely self-managed, as they are inserted like a tampon, and removed it in the same way. The ability of women to self-manage an intravaginal device offers a potentially revolutionary solution to the 33% of female athletes, who have failed to resolve urinary symptoms despite pelvic floor rehabilitation.

One of these devices had a published a Randomised Control Trial showing a significant reduction in SUI during use, with a second study supporting the ease of use and tolerability for women. The overwhelming majority of people using the Uresta device had continued to do so far beyond the study period, choosing to use the system to control their urinary symptoms during aggravating activities such as running.

“  Since having the pessary [e.g. Uresta], it’s given me the freedom to get back into keeping fit and doing physical activities…without the worry of any embarrassing accidents.  “

If you are experiencing stress urinary incontinence, the NHS Squeezy App is a brilliant resource to get the ball rolling with pelvic floor exercises. If you are struggling to locate and/or contract your pelvic floor, a Women’s Health Physiotherapist will be able to help you. If you have been unable to resolve urinary leakage during exercise, a device such as Uresta could enable worry-free running in a way which enables you the freedom to self-manage and without committing to a permanent treatment option.

For more information visit: MyPelvicHealth.co.uk and Uresta.uk

Hannah Montague

Specialist Physiotherapist