1/4 hour Neuro #39: "The Link Between Urinary Incontinence and Sports"

Introduction

Hello everyone and welcome to the Neuro quarter hour! In this edition, we are innovating by welcoming guests on specific topics. Today, we are addressing a common issue among athletes: urinary incontinence during physical exertion. To enlighten us, Marine, a physiotherapist specialized in the pelvic floor, joins us alongside Romain.

Marine will bring her expertise on this problem that affects many athletes. Urinary incontinence during sports practice is an important topic, and it is essential to understand why it occurs and how to address it.

Understanding the Causes of Urinary Incontinence in Athletes

In the face of urinary incontinence during sports, there are two main causes: a pelvic floor that is either hypotonic (relaxed) or hypertonic (too tense). The symptoms being similar in both cases, it is crucial to determine the nature of the problem to apply the appropriate treatment.

Hypotonic or Hypertonic Pelvic Floor: The Differences

A hypotonic pelvic floor is a distended and relaxed pelvic floor. In this case, the internal organs are no longer sufficiently supported, which can lead to leaks. Conversely, a hypertonic pelvic floor is too contracted and rigid. It loses its elasticity and ability to rebound, acting like a "concrete slab" that no longer functions properly.

The difficulty lies in the fact that both conditions can cause urinary leaks. Only an accurate diagnosis will guide rehabilitation.

How to Diagnose the Condition of Your Pelvic Floor?

The diagnosis of the condition of your pelvic floor, whether hypotonic or hypertonic, is generally performed manually by a professional. It is important not to self-diagnose based on inappropriate exercises.

The "Stop-Pee" Test: To Be Used with Caution

The "stop-pee" exercise (interrupting the urine stream) can serve as a quick test to evaluate your ability to retain urine. If you find it difficult to stop the stream, you may be dealing with a hypertonic pelvic floor. If you can hold it at least a little, it is more likely to be hypotonic. However, this exercise should not be practiced regularly as it can lead to urinary retention issues.

In any case, it is recommended to consult a healthcare professional (doctor, gynecologist, midwife, specialized physiotherapist) to obtain a reliable diagnosis and personalized support.

Urinary Incontinence: An Issue That Affects More Than Just Women

Contrary to popular belief, pelvic floor issues and urinary incontinence are not exclusively female problems. Although men do not have the same anatomical issues of organ descent, they have a pelvic floor and can also suffer from dysfunctions.

In men, these issues may arise later, especially after prostate surgeries. Those who have not properly utilized their pelvic floor may face difficulties in regaining their post-operative continence. There are also cases of pelvic hypotonia or hypertonia observed in men.

Athletes Particularly Exposed

Some sports put more strain on the pelvic floor and can exacerbate these issues. Runners, equestrians, trampoline enthusiasts, or CrossFit practitioners, where there is a lot of bouncing and heavy lifting, are particularly at risk. In these activities, the pelvic floor is either too relaxed and unable to maintain, or too tense and loses all its elasticity, unable to absorb shocks.

Preventing and Rehabilitating the Pelvic Floor

The way to retrain the pelvic floor will depend on its condition (hypotonic or hypertonic). Rehabilitation is simpler for a hypotonic pelvic floor, primarily requiring strengthening.

Exercises for the Hypotonic Pelvic Floor

For a hypotonic pelvic floor, repeated contraction and relaxation exercises are beneficial. One can imagine lifting and relaxing the pelvic floor or holding contractions. Techniques such as hypopressive exercises, found in Pilates or the Gasquet method, are very effective. By pulling in the abdomen on exhalation, a suction effect is created that lifts the organs and tones the pelvic floor.

Approach for the Hypertonic Pelvic Floor

For a hypertonic pelvic floor, the primary goal is relaxation. The focus is on perineal massage, which can be performed by professionals or oneself. It is essential for the pelvic floor to regain flexibility before being able to reintroduce healthy contractility and the ability to relax. "Stop-pee" exercises or the use of Kegel balls are contraindicated in this case, as they would increase tension.

The Pelvic Floor and Posture: An Unexpected Link

There is a close link between posture and the condition of the pelvic floor. For example, a retroverted pelvis can promote a hypertonic pelvic floor, while an anteverted pelvis could be related to a hypotonic pelvic floor.

Moreover, postural imbalances, such as one shoulder being higher or an unbalanced gait with one foot hitting the ground harder, can lead to asymmetry in the pelvic floor. For example, the right side of the pelvic floor may become hypertonic if that leg is more engaged. The pelvic floor is meant to be relaxed at all times and contract only when needed, not to maintain posture continuously.

Gait analysis and the integration of primitive reflexes can reveal interesting insights for rehabilitation. A brain imbalance or a Residual Neurological Pattern (RNP) issue can also influence posture and, consequently, the condition of the pelvic floor.

The Importance of Breathing

Breathing plays a fundamental role in pelvic floor function. Correct diaphragmatic breathing, especially during hypopressive exercises, allows the organs to rise and creates a natural suction of the pelvic floor. Conversely, poor management of exhalation, such as pushing down while exhaling during childbirth, can force the abdominals and weaken the pelvic floor's natural rebound.

Understanding this link is essential to optimize rehabilitation and prevent urinary incontinence issues, especially among athletes.