Urinary Incontinence in Women Powerlifters: New Study

Key Points:

  • Urinary incontinence in women powerlifters is a common condition.
  • Female powerlifters who know how to flex their pelvic floor muscles or have undergone a pelvic floor exam are less likely to experience severe urine leakage.
  • Women experiencing urinary incontinence during training or competition have found plenty of strategies to combat the problem.

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Urinary incontinence in athletes, often called athletic incontinence, is more common than most people realize. Non-athletes are often unaware that athletic incontinence is even a problem during physical activity. Sometimes, the athletes themselves don’t know how common it is and feel more or less alone with their situation.

“Athletic incontinence” is not an official term for urinary incontinence in athletes. It’s a general term to describe an unintentional loss of urine experienced during exercise by active women. It often happens to young elite female athletes who aren’t otherwise incontinent. They don’t have the common risk factors for urinary incontinence, like obesity, having given birth multiple times, or a medical history of urinary infections.

Athletic incontinence is most prevalent in high-impact activities with plenty of jumping and running. For example, 80 % of trampolining females report urinary incontinence during training or competition. Women engaging in low-impact exercises, like Pilates or yoga, don’t experience it as often. Still, up to 25% of them do, even when they are continent in everyday life.

As you can imagine, urine leaking or splashing during training and competition impacts the quality of life. Some women ignore it and see it as part of the activity. Still, it’s a real problem for others, preventing them from enjoying their sport, even discouraging some from participating due to anxiety and shame. Women weightlifters and powerlifters might find urine leakage even more problematic than some. You compete as an individual, alone on the podium, wearing tight clothing.

Speaking of powerlifting and urine, a brand new study looking at urinary incontinence in women powerlifters recently appeared. In a recent StrengthLog article, I covered athletic incontinence in general. I briefly mentioned an earlier pilot study with female powerlifters, but here we are with more research.

Let’s jump right into the new study and find out what it’s all about!

New Research: Urinary Incontinence in Competitive Women Powerlifters

We’re looking at a new Australian study investigating urinary incontinence in female powerlifters at a competitive level. The objectives of this study were as follows:

  • Determine if load, body position, and fatigue increase the risk of urinary incontinence during training and competition.
  • Investigate how prevalent urinary incontinence is among competitive women powerlifters.
  • Determine the participants’ confidence in performing a pelvic floor contraction, essential for effectively training the pelvic floor muscles.
  • Identify which activities provoke leakage and the measures female powerlifters take to manage it.

How Was The Study Designed?

The new study builds on feedback from the one I mentioned in my previous article about athletic incontinence. That was a pilot study, a small-scale preliminary investigation, in the form of a survey, investigating the prevalence of urinary incontinence in women powerlifters. The survey contained a limited number of questions, focusing mainly on sport-specific risk factors. It didn’t cover BMI and parity (the number of pregnancies carried by a woman for at least 20 weeks). Those are known risk factors for bladder leakage in general.

This follow-up is from the same team of researchers. It’s also a cross-sectional survey but substantially expanded compared to the previous one. This one investigates when leakage happens: during everyday activities, training or competition, or training and competition. The researchers also looked at which exercises are most likely to trigger incontinence. In addition, they quantified the results using the Incontinence Severity Index. The ISI is a tool to assess the severity of urinary incontinence.

Meet the Participants

Women powerlifters between the ages of 20 and 89 competing in all three lifts, the bench press, the squat, and the deadlift, were eligible to participate in the study. That’s the age span between the youngest participants in the earlier pilot study and the maximum age group commonly used in powerlifting records. 

The researchers found women powerlifters who wanted to participate in two ways. First, they sent recruitment letters to the email address of intermediates found by Googling English speaking countries and powerlifting. They also asked Facebook groups with female powerlifters to post a link to the survey. 

Those methods resulted in 778 women responding to the survey. Unfortunately, the researchers had to discard 154 of the replies right off the bat, as they didn’t fill out the entire form. They also removed another 142 candidates because they didn’t compete in all three lifts, one of the requirements for participation. Lastly, the researchers had to exclude two more women, as they were younger than the minimum age to participate. In the end, they ended up with 480 surveys from competitive women powerlifters. Not bad for a powerlifting study.

The 480 powerlifters remaining after the digital culling were, on average, 35 years old, 1.64 meters in height, with a body mass of 74 kg and a BMI of 27.6. Those are average numbers. The most senior participating woman was 45 years old, the heaviest weighed 92 kg, and the highest recorded total was close to 400 kg. A little more than a third of the women had given birth, 70% vaginally and 21% by cesarean section. The remaining 9% had given birth both ways.

Results

Almost half of the participants reported urinary incontinence at some point in their lives. Nearly half of women, 44%, said they had experienced it during the three months before the study. Close to 18% of the women experienced incontinence for the first time after taking up powerlifting. However, they were only incontinent during training and competition, not everyday activities. In contrast, 25 women said they used to be incontinent during daily activities, but the problem went away when they started powerlifting.

Thirty percent of the women reported urine leakage during maximum lift attempts in competition, while 40% said it happened during maximum lift attempts in training. Sixty women found sumo deadlifts problematic, while 169 women experienced leakage during high rep training. Close to 80% of them only experienced incontinence during heavy sets, and 65% found the final reps more problematic.

The majority of the participating women powerlifters felt confident they could contract their pelvic floor muscles, and 14% of them had undergone a pelvic floor assessment to determine strength and function. Among the women with urinary incontinence, 66% felt confident performing pelvic floor exercises. Out of these women, 21% had undergone a pelvic floor assessment.

The deadlift was the most problematic exercise, triggering urinary incontinence more frequently than the squat and the bench press. The incontinent women also experienced more severe leakage during the bench press, especially compared to the bench press. The bench press didn’t lead to severe symptoms of urinary incontinence at all, only drops at most.

urinary incontinence

Activities That Trigger Urinary Incontinence

After compiling the survey, the researchers compiled a list of things that triggered urinary incontinence in the women.

urinary incontinence triggers
Click on the picture for a larger version.

Methods to Prevent or Reduce Urinary Incontinence During Training and Competition

Many of the women participating in the survey had figured out various methods to prevent, or at least mitigate, urinary leakage during training and competition. The list is too long to fit on this page, but you can find it in its entirety here:

Self-care practices competitive women powerlifters engage in to prevent, reduce or contain leakage of urine

Many strategies involve warming up and preparing for the lifts, activating the pelvic floor muscles, and focusing on lifting technique and bracing.

It’s a list of strategies developed through trial and error. Almost no research covers these things, and there are no guarantees that these tips will help you specifically. However, self-reported solutions are often helpful. They might serve as a base for future research, and other lifters can benefit from the insights.

Risk Factors for Urinary Incontinence During Training and Competition

Among general risk factors for urinary incontinence, only age, BMI, and parity correlated with incontinence among women powerlifters in this study. The only powerlifting-specific risk factor correlating with incontinency frequency and severity was the competition total of the participants. That is the ISI score I mentioned earlier coming into play.

Load

The survey results showed that the more weight lifted, the higher the risk for urine leakage. The participants with the highest total reported the most severe leakage, and the deadlift was the most problematic exercise. The deadlift is where you usually expect a powerlifter to handle the most weight. Previous research supports all these findings.

Around 36% of the women powerlifters participating in this study reported incontinence while squatting. That’s a higher number than previously reported in female weightlifters and CrossFit athletes. That might be because powerlifters handle such a heavy load in training and competition compared to weightlifters and CrossFit participants. There are some differences in powerlifting lifting techniques compared to the other two sports. Still, more likely, the greater risk of urinary incontinence stems from powerlifters lifting heavier, be it in a specific set, during a workout, or over a more extended period of training.

An interesting observation in both this study and the previous pilot study is that some women could lift heavier and heavier weights without provoking urine leakage as they got stronger. They only experienced incontinence when lifting close to their maximum. As they became stronger from training, they could handle progressively heavier weights without leaking. They were still incontinent, but only at a higher lifting weight.

Body Position

Even though the total weight lifted was the main factor provoking leakage, some women reported body position as another trigger factor. Intra-abdominal pressure changes depending on your body position during a lift and is a potential trigger for urine leakage. The bench press does not place pressure downwards on the pelvic floor during physical movement, which the deadlift and the squat do. Indeed, almost none of the women reported the bench press triggering urine leakage.

For athletes trying to avoid urinary incontinence during training and competition, general recommendations are to avoid exercises and movements that put downwards pressure on the pelvic floor. However, that recommendation is not very useful if you compete in the deadlift and the squat. That would be avoiding the problem, not solving it.

Some women found the sumo deadlift to be more problematic than regular deadlifts. That’s an observation backed by earlier research, not a new finding. Also, using a lifting belt and performing other exercises that increase intra-abdominal pressure, like sit-ups and the front squat, provoked urine leaking in some women.

Fatigue

Several women powerlifters who filled out the survey reported that fatigue triggered incontinence. When they hadn’t recovered adequately from the previous workout, if a set took a long time to complete, and if a particular set required grinding the weight up, the risk of leakage was higher. A third of the women experienced incontinence during high-rep sets, especially during the last few reps of a heavy set. Even though the total weight lifted and your body position during the lift might be the significant risk factors, fatigue can also trigger urine leakage.

Pelvic Floor Training and Pelvic Exams

Research shows that, in general, the strength of the pelvic floor in female athletes is greater than in untrained women. However, that doesn’t necessarily mean they have greater pelvic floor endurance. That is one reason why pelvic floor exercise recommendations for athletes probably shouldn’t be the one-size-fits-all variety. If you keep doing strengthening exercises when your pelvic floor muscles are already more than strong enough, you might be wasting your time. When combined with your regular training, it might also result in pelvic floor muscle fatigue instead. In that case, a prudent approach would have been to learn how to relax the pelvic floor muscles properly instead.

While women athletes might have a stronger pelvic floor than untrained women, the incidence of UI is three times higher in athletes. Strong pelvic muscles aren’t the only solution to bladder control during resistance training and physical exertion.

A majority of the women in this study felt confident they knew how to perform pelvic floor exercises correctly. Previous research shows that up to 65% of all women don’t know how to flex their pelvic floor muscles. Most of the participating women powerlifters had not undergone a pelvic floor exam or confirmed their ability to contract the proper muscles. Those who had were the ones scoring lowest on the ISI scale. They had the least problems with urine leakage during training and competition. According to the researchers, this finding supports recommendations that female athletes, especially incontinent ones, undergo a pelvic floor exam and confirm that they can correctly perform pelvic floor exercises. Health care providers can guide you to a physical therapist focusing on women’s health for such an examination.

Summary

It’s always nice to see new powerlifting research, especially when it’s an important study like this one.

  • Urinary incontinence is prevalent in women’s powerlifting. Close to half of the women reported urine leaking in training or competition during the three months before participating in the study. That places powerlifting somewhere in the middle between yoga at the low end and trampolining at the upper end.
  • Compared to related sports like weightlifting and CrossFit, female powerlifters seem to experience incontinence more often. Previous research suggests that the prevalence of UI in women’s weightlifting is below 40%. The reason could be as simple as the fact that powerlifters involve very heavy lifting. It could also be that powerlifters experience incontinence when lifting to a higher degree, not necessarily during everyday activities. If leakage only happens occasionally or only during maximum lift attempts, you’re probably more likely to tolerate it. Currently, no research explores such potential differences between sports.
  • The deadlift was the most problematic exercise. Women experienced incontinence in the deadlift more often and severely than the squat and the bench press. The squat ranked below the deadlift, and the bench press provoked minimal leakage.
  • The heavier the lift, the higher the risk of leakage. That observation feels logical. It correlates with deadlift being the most problematic exercise, as most lifters can handle the most weight in the deadlift. During a lift, other significant risk factors include wearing a lifting belt, bracing, and lifting technique. Risk factors not directly related to powerlifting include cardio, high-rep training, and insufficient recovery after a training session.

There are a few limitations to the study. For example, recruitment using email and social media gave the subject of the survey away. Women powerlifters with experience of urinary incontinence could have been more likely to participate. That might skewer the results a bit and overestimate the prevalence compared to the actual number of female lifters experiencing athletic incontinence. Also, a survey can’t confirm cause and effect. You get an association between a risk factor and urinary incontinence, but you can’t be sure a specific factor triggered it. All in all, though, it’s a well-conducted study. Hopefully, it can help spread awareness of and knowledge about urinary incontinence in a sport often underrepresented in scientific research.

Do you experience athletic incontinence? Do you find the deadlift to be the most problematic exercise? Are the tips and tricks the women in the study shared helpful? Maybe you have some of your own you’d like to share? You can do so in the StrengthLog Forum on Facebook, and there is also a post specifically about this article. You are more than welcome to become a member, if you aren’t already, and to share your experiences. The more people talk about this topic, the more we can spread awareness. Sometimes women lifters even give up the sport entirely because of UI, and that’s a real shame.

More reading:

Urinary Incontinence in Athletes and Exercise: More Common Than You Think

Reference

Sports Medicine – Open volume 7, Article number: 89 (2021). Urinary Incontinence in Competitive Women Powerlifters: A Cross-Sectional Survey.

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Andreas Abelsson

Andreas has over 30 years of training experience and is a highly appreciated writer and educator on exercise, fitness, and nutrition. Few people stay more up to date and have a better grasp of the field of exercise science than Andreas.