Incontinence in Female Athletes: Understanding the Causes and Unlocking Better Performance

Urinary incontinence — involuntary leakage of urine — is often dismissed as a “normal” consequence of athletics. But for many female athletes, it’s a real, common, and treatable issue that impacts confidence, performance, and long-term pelvic health. This post explains why it happens, who’s most at risk, and how targeted strategies can transform both athletic performance and quality of life.

What Is Urinary Incontinence in Athletes?

Urinary incontinence (UI) refers to accidental urine leakage during everyday tasks or physical activity. In female athletes, the most common type is stress urinary incontinence (SUI) — leakage that occurs during movements that increase pressure inside the abdomen, such as running, jumping, or lifting. (PubMed)

While UI affects women of all ages, it’s surprisingly prevalent in sports settings. For example, systematic reviews show that, across different sports, UI affects about 36% of female athletes, and athletes are significantly more likely than non-athletes to experience these symptoms. (PubMed) While this is common, it's a red flag that demonstrates that the core and pelvic floor are not functioning properly. Ignoring this issue could increase risk for sports injuries and cause chronic performance limitations.

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Why Female Athletes Are Particularly Vulnerable

1. High-Impact Movements and Pelvic Floor Load

Activities that repeatedly force both feet off the ground — such as running, trampolining, gymnastics, and basketball — create repeated spikes in intra-abdominal pressure. Over time, this stress can overwhelm the ability of the pelvic floor muscles to maintain continence. (PubMed)

Example: In trampolining and similar sports, studies show UI prevalence as high as 80% — markedly higher than in low-impact athletics. (PubMed)

2. Pelvic Floor Muscle Fatigue and Dysfunction

The pelvic floor works with the deep core, hips, and glutes to maintain bladder control. When these systems aren’t coordinated under load — especially at high training volumes — the pelvic floor can fatigue and fail to respond quickly enough to pressure changes. (PMC)

3. Low Energy Availability and Performance Stress

Women with low energy availability — when calorie intake doesn’t meet training demands — are at higher risk of UI, possibly due to altered neuromuscular control and hormonal changes. MDPI

How Incontinence Can Affect Performance

Urinary incontinence isn’t just a physical symptom — it has performance, psychological, and behavioral consequences:

• Increased risk of injuries: Incontinence isn’t just a pelvic floor problem. It’s often a whole-body issue, linked to hip and core weakness, and faulty movement patterns. Your core, hips, glutes, and pelvic floor muscles work together as a team to support your spine, maintain stability, and control pressure during high-impact activities.

  When one part of this system underperforms—such as weakened hip stabilizers or an underactive deep core—it places too much stress on the pelvic floor, leading to incontinence. This instability can also contribute to lower back pain, hip or groin injuries, poor athletic technique and slower recovery times.

• Confidence decline: Anxiety about leakage can distract from performance.

• Training avoidance: Some athletes reduce training intensity or alter techniques.

• Quality of life impact: UI can interfere with competition and daily routines. PMC

In elite Gaelic sports athletes, over 60% reported UI, and many reported modifying training habits or using coping strategies like fluid restriction or absorbent protection. PubMed

What Actually Helps: Evidence-Based Strategies

🟢 Pelvic Floor Muscle Training (PFMT)

Pelvic floor exercises remain the cornerstone of managing UI. Studies show that structured PFMT can significantly reduce symptoms and improve muscle coordination during high-impact movements. (Cureus)

Example: A volleyball cohort experienced a major reduction in urine loss and improved pelvic floor contraction strength after a 16-week training program. (Cureus)

🟢 Neuromuscular & Core Strength Integration

Training that incorporates the deep core and hip stabilizers alongside PFMT may achieve more resilient pelvic support during dynamic sport activities. PMC

🟢 Sport-Specific Technique Adjustments

Coaches and clinicians can adjust jump, landing, lifting, and sprint techniques to modulate intra-abdominal pressure and pelvic floor demand.

Why Solving Incontinence Leads to Better Performance

Fixing incontinence is not just about avoiding accidents—it's about unlocking your full athletic potential. When your pelvic floor and core muscles are coordinated and strong, you’ll experience:

✅ Improved running and jumping mechanics

✅ Greater trunk stability

✅ More power during lifts

✅ Reduced risk of injury

✅ Better focus during training and competitions

Breaking the Silence

Many athletes don’t disclose incontinence to coaches or clinicians due to embarrassment, delaying effective care — yet early intervention often yields better outcomes. Incontinence in athletes is treatable, and you shouldn’t have to train around it. With a detailed physiotherapy assessment, we can identify underlying muscle imbalances, create a personalized pelvic floor and core strengthening plan, and guide you toward confident, high-performing movement—without leakage.

Book a Physiotherapy Appointment Today

Whether you’re a recreational athlete or a competitive performer, your body deserves to work efficiently and powerfully. If you're experiencing any signs of incontinence during exercise, book a private, professional physiotherapy consultation today. Together, we’ll rebuild your core strength, prevent future injuries, and help you get back to performing at your best.

This article forms part of our wider collection of physiotherapy-led insights on injury recovery, movement health, and performance.

References

1. Prevalence of UI in female athletes; meta-analysis shows ~36% rate and higher risk compared with sedentary women. PubMed

2. Systematic review: high prevalence of UI in specific sports, especially high-impact disciplines. PubMed

3. UI mechanisms and risk associations in elite female athletes. PubMed

4. Wide prevalence range of UI among adolescent and adult female athletes. PMC

5. Physical therapy approaches (PFMT) shown to reduce UI symptoms. Cureus

6. Sports-specific prevalence and sport biomechanics insights. PubMed

7. Female athletic pelvic floor dysfunction overview. PMC

8. Pelvic floor and UI impact on sport commitment and participation. fitrightwomenshealth.au

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