Incontinence: The Unspoken Secret of the Olympics?

That's because behind the scenes and the glamour of the Olympics, many athletes grapple with a taboo struggle that is never openly discussed - their bladder health. From the odd leak to a full pee mid-run, involuntary urine leakage during physical exertion is a common challenge, especially among female athletes. So how on earth do they manage their bladder at the peak of their careers?

Why do athletes leak so frequently? 

Stress incontinence is a form of urinary incontinence that occurs when physical activity or exertion increases intra-abdominal pressure, leading to involuntary leakage of urine. Due to the repetitive and high-impact nature of their training and competition, stress incontinence is prevalent among athletes because this can weaken the pelvic floor muscles responsible for bladder control.

A study published in 2022 found that "the prevalence of urinary incontinence among female athletes is significantly higher compared to non-athletic women". This increased prevalence is attributed to the strenuous activities athletes engage in, which place considerable stress on the pelvic floor muscles. Hormonal differences, childbirth, and intense physical training further exacerbate the issue, making it a common concern among female athletes especially as they age. 

How does it impact athletic performance?

The pressure to perform at peak levels can exacerbate stress incontinence, causing athletes to experience leakage at critical moments. This issue is widespread across various sports disciplines, affecting swimmers, gymnasts, runners, and many others.

For example, Paula Radcliffe, the renowned British marathon runner and world record holder, famously relieved herself during the 2005 London Marathon. Many of us will remember the attention Paula got when she felt the need to go… as she was running and it raised awareness, for the first time, the challenges long-distance runners face with bladder control in public discourse. As Radcliffe once said, "It’s not uncommon for runners to pee themselves during a race, especially if they’re pushing their bodies to the limit".

In gymnastics, the issue is equally common. The explosive movements and intense pressure on the abdomen during routines can lead to unexpected leakage. Beth Tweddle, a British gymnast and Olympic medallist, has discussed the prevalence of stress incontinence among gymnasts. As she said in a report by The Telegraph, "it’s common to feel urine flying through the air". But the truth is that when you find yourself leaking mid-somersault, it not only affects performance but also brings with it embarrasment and discomfort. Wet leotard on the pommel horse would be challenging for the best of us. 

But swimming might be the most common of all. Prolonged periods spent in water without immediate access to the loo can mean only one thing. While it’s not uncommon for swimmers to urinate in the pool, it can still pose psychological challenges. The Wall Street Journal reported that "swimmers may pee in the pool, but that doesn't make it comfortable or easy for them” .

What other factors contribute to incontinence in our Olympians?

The reasons behind stress incontinence in athletes are multifaceted. The intense physical training that elite athletes undergo can weaken the pelvic floor muscles over time. High-impact activities like running, jumping, or weightlifting can increase intra-abdominal pressure, placing extra strain on the bladder.

Hormonal factors, particularly in female athletes, also play a role. The hormone relaxin, which increases during menstruation and pregnancy, can lead to the relaxation of pelvic floor muscles. This, coupled with the repetitive strain of intense training, can increase the risk of incontinence. Childbirth can further contribute to pelvic floor weakness, making postpartum female athletes more susceptible to stress incontinence.

Kelly Holmes, a double Olympic gold medallist in middle-distance running, has openly discussed her experiences with stress incontinence. She’s spoken often about how common it is among female athletes, and called for the need for greater awareness and support for women in sports. Similarly, Megan Rapinoe, the American soccer star and World Cup winner, has mentioned occasional bladder leaks on the pitch and raised awareness that it’s not only high impact sports that can cause this common issue for athletes. 

So how do athletes cope?

Despite the challenges, many athletes find ways to manage their bladder health and continue competing at the highest levels. Pelvic floor muscle training, commonly known as Kegel exercises, is a widely recommended approach. These exercises strengthen the muscles that support the bladder and help with greater control, reducing the likelihood of leaks. Physiotherapists often include them in comprehensive training regimens for athletes dealing with incontinence.

Athletes may also use specialised clothing and pants or padding designed to absorb urine and reduce discomfort, similar to Jude’s leakproof pants. These allow athletes to focus on their performance rather than worrying about the embarrassment of potential leaks on an international stage (can you imagine?!).

But importantly, mental health support plays an important role in helping athletes cope with the anxiety and embarrassment that can accompany incontinence and which can affect performance. Sports psychologists can provide strategies and coping mechanisms to manage symptoms, and maintain focus during competitions to overcome any shame and taboo associated with leaks. 

Breaking the Silence: Raising Awareness

The topic of stress incontinence among elite athletes has long been surrounded by silence, with many athletes hesitant to discuss their struggles. However, in recent years, there has been a growing movement to raise awareness and destigmatise this issue. Athletes like Tori Bowie, the late American sprinter and long jumper, have shared their experiences, highlighting how intense training and competition can lead to bladder issues.

Highlighting these challenges can lead to better support systems and resources for athletes. Sports organisations can provide access to specialised physiotherapists and trainers who can help athletes strengthen their pelvic floor muscles. Creating an open and supportive environment can encourage athletes to seek help without fear of judgement - similar to our mission at Jude.