URINARY LEAKAGE DURING EXERCISE:PROBLEMATIC ACTIVITIES, ADAPTIVE BEHAVIORS AND INTEREST IN TREATMENTFOR PHYSICALLY ACTIVE CANADIAN WOMEN
E. BRENNAND, S. TANG, E.RUIZ-MIRAZO, S. KIM-FINE;
Department of Obstetrics &Gynecology, Univ. of Calgary, Calgary, Canada.
Introduction: The prevalence ofleakage in a recreational exercise setting is estimated at 30%1.While it has been suggested that high impact activities are moreproblematic than low-impact activities2, there is scarcityof recent data regarding which specific activities/movements (such assquats, jumps, skips, weighted lifts, etc) cause women the mosttroublesome leaking during exercise routines. Most available data isrelated to elite performance athletes, and is likely not applicableto women performing recreational exercise. While incontinence isknown to be a barrier to exercise1, exact copingmechanisms of women experiencing exercise related UI have not beenreported. Additionally, awareness of treatment options in thispopulation has not been described.
Objective: Characterizewhich recreational exercise activities/movements are reported ascausing leakage most often. Report patient adaptive behaviors andmechanisms to manage exercise related leakage. Describe awareness oftreatment options for exercise related leakage, and which treatmentsare acceptable to a physically active female population.
Methods:Anonymous questionnaires administered to urban, Canadian women whoself-report routinely participating in physical exercise. Women wererecruited from both commercial exercise establishments and fromphysician offices. Surveys were completed electronically or on paper.We collected demographic information (age, parity, mode of delivery)as well as other characteristics (BMI, frequency and type ofexercise). We asked about which specific activities caused leakageand the degree of bother due to incontinence. We also enquired aboutadaptive behaviors to deal with urinary leakage and knowledge andinterest in therapies for incontinence.
Results: 59 womenreplied over a 6 month window. Mean age was 42.9 +/- 10.9 years, andmedian self-reported BMI was 23.5 (IQR 19.2 - 39.1). Majority(n=83.1%) reported being parous, with mean number of deliveries being2.49 +/- 1.67. Majority of women exercised more than 3 days per week(86.5%), with median number of days per week as 4 (IQR 2-6).
Themost frequently reported style of exercise were high-intesityprograms such as “crossfit”, bootcamps and interval training(61.0%), followed by running/jogging (40.7%), stretching, core andbalance activities such as yoga, pilates and balance ball (30.5%).The individual activities most likely to cause leakage were:skipping, trampoline, jumping jacks, running/jogging, and boxjumps.
In attempts to decrease leakage, 93.2% of women reportedthey void immediately before exercise and 62.7% reportedintentionally taking a voiding break during their work-out todecrease leakage. Some women (37.3%) reported fluid restrictionduring exercise as a method of leakage reduction. Approximately halfof women reported their leakage as impacting their activity level,most often by decreasing the intensity of the routine (90.3%) orcausing them to avoid certain activities altogether (80.7%). Half(49.2%) of women reported wearing leakage protection products duringexercise, although only half of them chose products designed forurine while the other half were utilizing menstrual pads. Most womenwearing pads (75.9%) reported some degree of bother while wearing theproduct.
Interest in receiving treatment for urinary leakage washigh in this study population (88.1%), although only two-thirds ofwomen knew treatment was available before participating in theproject (64.4%). Greatest interest was in pelvic floor physiotherapy(84.6%), although women also expressed significant interest in bothpessary and surgical management (63.5% each).
Conclusions:Women who experience urinary incontinence during exercise commonlyreport that high-impact activities cause the most leakage. Adaptivebehaviors such as pre-emptive voiding, washroom breaks, fluidrestriction and activity modification are common. Women frequentlyuse pad products during exercise, and report them as bothersome.Physically active women are interested in incontinence treatment, butmay not always be aware of the options available to them. Given thehigh interest in pelvic physiotherapy, there may be a uniqueopportunity for pelvic exercise to be linked to recreational exercisein an attempt to meet both needs in the physically active patientpopulation.
References: 1. Nygaard I, Girts T. Is UrinaryIncontinence a Barrier to Exercise in Women?. Obstet Gynecol2005;106:307-14.
2. Fozzatti C, Riccetto C, Herrmann V, BrancalionMF, Raimoni M, Hascif CH, et al. Prevalence study of stress urinaryincontinence in women who perform high-impact exercises. IntUrogynecol J. 2012; 23:1687-91.