“What? Treatment of my low back pain can keep me from leaking urine when exercising?” Yes! Recent evidence confirms a relationship between low back pain and urinary incontinence, and our physical therapists have found success in treatment of these problems.
Urinary incontinence is defined as any involuntary leakage of urine. There are different types of urinary incontinence, the most common of which, and the type affecting female athletes, is stress urinary incontinence (SUI). SUI is defined as the involuntary leakage of urine on effort or exertion, such as sneezing, coughing, or jumping.
Urinary incontinence, most often perceived as a problem in older women, commonly affects young elite female athletes and has been documented in girls as young as junior high and high school. Prevalence rates vary between 10-55% in women ages 15-64. The prevalence of SUI in young female athletes ranges from 0% in golfers to 80% in trampolinists. SUI is shown in research to occur in 28% of female college athletes and 2/3 of female college gymnasts. The highest incidence of incontinence is in high-impact activities such as jumping, landing, and running, which includes sports such as track and field, gymnastics, cheerleading, volleyball, and basketball. SUI is a threat to women and athletes’ health since it may limit their participation in athletics/fitness activities, and it is a barrier to healthy self-image and esteem.
Common understanding of the cause of SUI is a weakness in the pelvic floor muscles (PFM) that cannot overcome the increase of intra-abdominal pressure that occurs during high-impact activities such as jumping or coughing. Studies reveal that in women with SUI there is an interruption in nerve conduction to the PFM. Standard treatment of the problem has traditionally been PFM strengthening, often called Kegel exercises, which does have some success (44-69% cure rate).
In our practice, we have clinically found the best results for treating SUI are achieved by treating the underlying nerve pathology, which is sourced in the low back. Sports with high-impact activities also can cause compression to the lumbar spine and result in nerve inflammation and low back pain. Studies show a relationship between low back pain and urinary incontinence. Treatment of the low back may include manual therapy, home exercise, and body mechanics education. The best results are achieved by addressing the root cause of nerve inflammation in the low back. Success will be limited if only addressing PFM strength.
To sum up, the cause and treatment of the embarrassing issue of urinary leakage may be as simple as addressing the common ailment of low back pain.
Polly Holcomb, DPT