“No matter how hard I try to hold back, it’s like my body is opening the floodgates. » Diane, 29, is passionate about running, whether on the road or on trails. To prepare for competitions, she does up to five outings per week, for an average of around 70 km per week. But “for two or three years”, his training has been regularly disrupted by “urinary leaks or inability to control himself”. “It’s especially when I do interval training and high-intensity races that it happens. Even when going to the toilet just before, it happens,” she laments. Surprised, especially since she has “never had a pregnancy”, she seeks to understand on the Internet. “I saw it could happen. Women don’t talk about it among themselves. In any case, I never talked about it to those around me. »
It is precisely to fight against the “taboo” of this largely unknown pathology that Pierre Nevoux, surgeon at the Nantes-Atlantis Urological Clinic, now wishes to raise awareness among the female public practicing sport. “Urinary incontinence in women is really a weak point, much more widespread than one might think. It concerns all ages, including young athletes. It is estimated that around 15% of recreational sports practitioners are affected. A figure which can rise to 70% among certain high-level athletes. » Some disciplines are much more exposed than others: gymnastics, athletics, racket sports, volleyball, handball, running… “In fact, these are all high impact sports and strong abdominal pressure. The pathology is, for example, extremely widespread among trampoline practitioners, much less so in swimming. », notes Pierre Nevoux.
“There’s no point in stopping hydrating”
But what exactly are we talking about when we talk about incontinence in athletes? “This is stress incontinence, caused by a relaxation of the support structures of the urethra, which leads to an opening of the bladder neck. The symptom is sudden urinary leakage, which manifests itself in a few drops or more depending on the case. It generally occurs during a significant contraction, or even during a cough or sneeze,” explains the urologist.
Eating disorders, smoking, alcohol, coffee and spices are considered aggravating factors. On the other hand, there is no link with the quantity of water consumed. “Even an almost empty bladder can experience a leaking problem. So there is no point in stopping hydrating during sport. On the contrary, it is dangerous for the body,” warns Pierre Nevoux.
When faced with incontinence, most athletes adapt as best they can, most often by using periodic protection. But some will give up and stop all physical activity. “You should know that if it happens, it is not inevitable. There are solutions, insists the specialist. When you twist an ankle or break an arm, you talk about it without any problem, you know who to talk to. But when it comes to urinary leakage, we keep that to ourselves. This is why you must dare to consult a doctor or a urologist. » It takes an average of seven years between the first symptoms and making an appointment.
Physiotherapy exercises or operation
Once stress incontinence is proven (the medical diagnosis may reveal another type of incontinence), the medical response is often perineal rehabilitation with a physiotherapist. “The physiotherapist will teach the patient to know her body better and propose an exercise program aimed at strengthening the perineum. Exercises which can then be repeated on a daily basis,” explains Pierre Nevoux. Behavioral therapy can also be “helpful”.
If this fails, the solution almost always lies in surgery. “The most commonly practiced technique consists of placing a strip, that is to say a fragment of flexible tissue of around ten centimeters which will support the urethral canal. » The operation is carried out under anesthesia and only requires half a day of hospitalization. “It works really well. The leaks stop almost overnight,” assures the practitioner.
Angelina, addicted to fitness and running, confirms. “Two weeks after the operation, I was sand yachting and surfing. At the end of the fourth week, I resumed my training as before. I no longer have any problems, it’s day and night. » Diane undertook perineum rehabilitation exercises on her own, after looking on the Internet. “I’m not sure it works. I would have to decide to consult,” she confides.
And the men? Do they also experience difficulty controlling their bladder during exercise? “Very very little,” reports Pierre Nevoux. They are much less exposed because their perineal support is much stronger. They have nothing to do with it, it’s simply a question of anatomy. »