Even Elite Athletes Leak (but shouldn’t)

It isn’t too often we hear athletes discussing leaking, known as stress urinary incontinence (SUI), during their training or competition but it is all too common. Studies1 have shown that 28-80% of female athletes leak, including 25-28% of high school and college athletes2 aged 12-22. The higher the impact level in the sport the more likely an athlete is to have SUI, including 80% of trampolinists, 56% of gymnasts, 45.5% of cross country skiers and runners3, and 30% of hockey players1 to name a few. Although leaking is common in many sports it is not normal and means that there is an underlying dysfunction of the pelvic floor.

The pelvic floor functions to hold up the internal organs, provide stability and structure to the spine and pelvis, and control bowel and bladder function. There are a few ways that pelvic floor dysfunction can occur: from becoming weak (as with pregnancy, menopause/aging, inactivity), from damage/trauma (childbirth, cancer treatments), from medical conditions, or if the muscles are overactive so they cannot contract and relax properly. Overactive muscles can occur when the muscle is weak or strong but for most elite athletes pelvic floor dysfunction occurs when these muscles are strong enough but can’t compete with the intra-abdominal pressure (IAP) created by the abdominals, back, and diaphragm.  

Think of the core as a canister: the abdominals and back muscles make the sides, the diaphragm and glottis make the top, and the pelvic floor is the bottom. If you increase pressure in the canister that pressure will want to escape so it can fail somewhere, be it the back with disk injuries, hernias in the abdomen, letting go of breath when not wanted, or leaking through the pelvic floor. Athletes are often highly trained in their abdominals and the force of the abdominal contraction combined with breathing cause a downward IAP placing stress on the pelvic floor. Add to that gravity from impact activity and failure will occur if the muscles cannot contract and relax as they should.

 In athletes with SUI it is important to check the mobility of the ribs and diaphragm, that the deep layer of the core (transversus abdominus) is firing properly and internal obliques aren’t pressuring down the pelvic floor, and assess the mobility/contractility of the pelvic floor itself. With youth internal assessment of the pelvic floor is not an option so working on breathing, mobility and strengthening elsewhere is how we address athletic SUI.

Here in Whistler we see many elite athletes, but the regular population is often just as active as an elite athlete with all the biking, skiing, snowboarding, running, CrossFit, boot-camps, skateboarding, air bag and trampoline activities we do. Seeing a pelvic floor therapist can help to assess if there are any failure spots anywhere in your canister and develop a plan to make sure all the parts work together.


By Dana Elliott, MScPT

Dana is an orthopaedic and pelvic floor therapist that has been treating locals and athletes at Back in Action since 2012.


  1. Heath, A.; Folan,S.; Ripa, B.; Varriale, C., et al. Stress Urinary Incontinence in Female Athletes. Journal of Women’s Health Physical Therapy. 2014 Sept/Dec; 38(3): 104–109.
  2. 2. Carls C. The prevalence of stress urinary incontinence in high school and college-age female athletes in the midwest: implications for education and prevention. Urol Nurs. 2007 Feb. 27(1): 21-24, 39.
  3. Pos ́wiata A, Socha T, Opara, J. Prevalence of stress urinary incontinence in elite female en- durance athletes. J Hum Kinet. 2014; 44(1): 91-96.