Urinary leaks during sport: what solutions?

Urinary leakage or sports incontinence concerns mainly women who practice an impact sportas running, trampolining or dancing. “Typically, urinary leakage affects the marathon runnersconfesses Professor Benoît Peyronnet, urological surgeon specializing in urinary incontinence at Rennes University Hospital and member of the French Urology Association (AFU). With each stride, the impact is very significant. Impact sports and sports involving abdominal hyperpressure are sports that cause incontinence in women..” Women are more affected than men because of their anatomy. The female urethra is short : it measures approximately 3 cm, an insufficient length to withstand an impact. The second reason why women are more affected than men is mechanical, as Dr Peyronnet explains. When everything is functioning normally, the supporting tissues of the urethra, on the anterior wall of the vagina, close mechanically during high pressure, such as coughing, jumping or laughing. However, certain factors, such as the practice of sport, obesity, pregnancy or childbirth, contribute to damaging these urethral support tissues. They become lax and no longer fulfill their role as flappers. This is how it happens stress incontinence. It’s a mistake not to think about treatments when a woman suffers from urinary incontinence…

Fitting a pessary or intravaginal device

The pessary is an intravaginal device which is mainly used for urinary prolapse, more commonly called “organ descent”. The pessary is a medical plastic ring or cube inserted into the vagina to hold the organs in place. Some forms have a reinforcement under the urethra which can reduce urine leakage during sporting activities. However, urinary incontinence in athletes is not the primary indication for the pessary. Furthermore, according to the specialist, this type of device can be quite painful and heavy in a young woman. “At home, we rather use the Diveen® device, an intravaginal device designed for young sporty women. Equipped with a silicone ring, it is placed like a hygienic tampon during sports, to prevent urinary leakage“, explains our interlocutor.

Electrostimulation of the perineum

Lperineal electrostimulator is a medical device connected to a probe that stimulates the muscles of the perineum. This painless technique helps strengthen the pelvic floor and combat stress incontinence. “Vaginal electrostimulation should be considered as one of the rehabilitation methods. It has scientifically demonstrated its effectiveness within a rehabilitation program, in addition to other methods. Alone, it has never demonstrated any benefit“, he warns.

The biofeedback technique

The technique of biofeedback is also a rehabilitation method which consists of establishing a link between the body and the mind in order to create an interaction between the two. “The intravaginal probe controls the degree of muscle contraction. The professional asks the patient to visualize when the pelvic floor is contracted, in order to help him strengthen his perineum. Biofeedback does not involve electrostimulation, rather it involves recording muscle activity“, describes our expert.

Physiotherapy to re-educate the pelvic floor

There perineal rehabilitation and pelvic is a complementary and natural approach which can prove effective in cases of stress incontinence. Pelvic floor physiotherapy consists of carrying out exercises alternating contractions and relaxations of the pelvic muscles. “Perineal physiotherapy works quite well in fairly young women“, indicates the urological surgeon.

Special hygienic protections

Wearing hygienic protection is a transitional solution, but which will not solve the problem of urinary leakage when playing sports. “This solution is expensive, not very ecological, and very uncomfortable for the patient. From a hygienic point of view, urinary maceration can cause skin irritations. Wearing sanitary protection is really not an ideal solution for the patient“, explains Doctor Peyronnet.

The vaginal cone

The vaginal cone or vaginal weight helps women strengthen the pelvic floor. The vaginal cones are devices that are placed in the vagina and can be used at home, during perineal rehabilitation exercises. “In my opinion, the vaginal cone is a small addition to rehabilitation to have fewer leaks, by promoting contraction of the perineum. Alone, it is not an effective solution in the long term.“, says the doctor.

Surgery for stress incontinence: the suburethral sling

The surgical treatment of sports incontinence consists of the placement of a suburethral sling. “The strip comes in the form of‘a polypropylene net placed under the urinary canal through a small vaginal incision. The installation of the sling is a simple and quick procedure, which is carried out as an outpatient surgery. For around thirty years, this surgery has shown excellent effectiveness in this type of incontinence.“. As Dr Peyronnet points out, There is controversy regarding this surgical technique. Overall, it is a very well tolerated method. Complications are very rare, but they can be severe and disabling for patients. “In practice, we can observe cases of erosion, with the strip which migrates into the urethra or into the bladder, or which is rejected at the level of the vaginaexplains the urological surgeon. The other problem rare East the appearance of significant neuropathic pain and difficult to take care of. These complications require removal of the strip. Of the 217,000 suburethral slings placed in France between 2013 and 2022, 2.7% of patients had to remove the sling within the first 10 years following installation. Today, there is a decree, dating from October 2020, strictly regulating the use of suburethral slings in France in order to minimize this risk of complications as much as possible. This surgical technique is therefore regulated in France, but also discussed before being carried out, the alternatives having to be clearly explained to the patient.“

The autologous strip

Other surgical techniques exist to treat stress incontinence, such as the autologous sling. “The objective is to strengthen urethral support by taking a bit of muscle tissue from the patient and then placing it under the urethra. However, muscle sampling can create pain. Furthermore, we are obliged toobstruct the urinary canal a little more. As a result, patients may experience difficulty emptying their bladder. Sometimes a catheter is needed for urinary flow. These problems are ultimately more frequent than the complications following the installation of a polypropylene sling“, explains the surgeon.

Periurethral balloons and the artificial urinary sphincter

These silicone devices have demonstrated their effectiveness. However, they are reserved for severe forms of stress urinary incontinence and are rarely used as first intention.

Fillers

The other alternative for urinary leakage caused by exercise is filling. “We inject a gel in the urinary canal to strengthen it. This procedure is quite easy and we rarely encounter problems. However, this technique is less effective than strips, especially in young athletic women.“.

Vaginal hormonal treatment

According to Professor Peyronnet, local hormonal treatments have demonstrated scientific effectiveness only in postmenopausal women, particularly in cases of atrophy of the tissues of the vulva and vagina. This topical (local) treatment consists of egg insertion or cream application several times a week in the vagina.

Thanks to Professor Benoît Peyronnet, urological surgeon specializing in urinary incontinence at Rennes University Hospital and member of the French Urology Association (AFU).