Management of Urinary Incontinence While Jogging
Start with pelvic floor muscle training (PFMT) as first-line therapy, as this is the most effective non-surgical treatment for stress urinary incontinence during high-impact activities like jogging, with cure rates of 44-69% in controlled trials. 1
Understanding the Problem
Urinary incontinence during jogging is predominantly stress urinary incontinence (SUI), occurring when increased intra-abdominal pressure from ground impact exceeds urethral closure pressure. 1, 2
- Among female athletes, prevalence of UI during high-impact activities ranges from 0-80%, with running/jogging being one of the most problematic activities alongside jumping and skipping. 1, 3
- SUI is the most common type in female athletes (64.4%), while male athletes experience primarily urge incontinence. 2
- Over 50% of elite female track and field athletes report UI, with even higher rates when considering leakage events during training. 2
First-Line Treatment: Pelvic Floor Muscle Training
Implement supervised PFMT with a specialist physiotherapist for at least 3 months, as this addresses the underlying pelvic floor weakness that allows leakage during impact activities. 4, 5
- PFMT has demonstrated cure rates (defined as <2g leakage on pad tests) of 44-69% in randomized controlled trials. 1
- A "stiff" and strong pelvic floor positioned at optimal level is crucial for counteracting abdominal pressure increases during high-impact activities. 1
- Biofeedback and electrical muscle stimulation can serve as adjunctive therapies to enhance PFMT effectiveness. 5
- Athletes require much stronger pelvic floor muscles than non-athletes due to the extreme forces generated during running. 1
Immediate Adaptive Strategies
While undergoing PFMT, implement these evidence-based management techniques:
- Void immediately before exercise (used by 93.2% of physically active women with UI). 3
- Use vaginal mechanical devices such as pessaries or tampons during jogging, which can prevent leakage during high-impact activity. 1, 5
- Schedule voiding breaks during longer runs (62.7% of active women use this strategy). 3
- Consider protective pads during exercise (used by 49.2% of women with exercise-related UI). 3
Important Caveats
Avoid fluid restriction as a primary strategy, as only 37.3% of women use this approach and it may compromise hydration during exercise. 3
- Do not decrease activity intensity or avoid running entirely unless symptoms are severe, as 50% of women report that leakage impacts their activity level, with 90.3% decreasing intensity and 80.7% avoiding specific activities. 3
- Jumping activities (vertical and horizontal jumps, jumping jacks) cause more leakage than continuous running, so these may need temporary modification during treatment. 3, 2
- Female athletes specializing in vertical jumps show lower UI prevalence compared to horizontal jumps, middle-distance running, and sprint/hurdles events, suggesting that repetitive horizontal impact may be more problematic. 2
When Conservative Management Fails
If PFMT and behavioral modifications fail after 3-6 months:
- Consider referral to urogynecology or female urology specialist for evaluation of more complex interventions. 4
- Third-line therapies include neuromodulation, neurotoxin injections, and surgical options, though these lack high-grade evidence in athletic populations. 5
- Pharmacologic management with antimuscarinics or β-3 agonists is not recommended for stress urinary incontinence during exercise, as these medications are indicated for urge incontinence/overactive bladder, not SUI. 6, 5
High Interest in Treatment
88.1% of physically active women express interest in receiving treatment for UI, with highest interest in pelvic floor physiotherapy (84.6%), despite 35.6% not knowing available treatments exist. 3 This presents an opportunity to proactively screen and treat joggers with UI symptoms, as many women do not volunteer these symptoms despite significant impact on quality of life. 7