We all know that exercise is good for our health. Yet for many people living with pelvic floor disorders (PFDs), being physically active isn’t simply a matter of motivation—it can be uncomfortable, embarrassing, or even something they avoid altogether. As we continue to encourage people to move more, it’s important to recognise the barriers that PFDs can create. 

Pelvic floor disorders (PFD) arise from dysfunction of the pelvic floor muscles (PFM), including weakness (e.g., urinary incontinence, prolapse), overactivity (e.g., non-relaxing PFM), or impaired coordination. As these disorders may overlap each other, it is always important that an individual assessment is performed by an educated therapist within the field of pelvic health. 

Urinary Incontinence – prevalence and burden 

Urinary incontinence (UI) is defined by the International Continence Society (ICS) as the involuntary loss of urine. Globally, it is estimated that more than 400 million people live with urinary incontinence, with an economic burden within the European Union 2023, including costs of absorbent pads, medication, health care consultations, and sick leave, was estimated at €69.2 billion in 2023.

Different Types  

7 different types of UI are recognized, the most common are these 5 main types: Stress, mixed, overflow, urge, and functional. 

1. Stress urinary incontinence 

Stress urinary incontinence (SUI) is defined by the International Continence Society (ICS) as the involuntary loss of urine during activities that increase intra-abdominal pressure (IAP), such as jumping, landing, or coughing is one of the most prevalent PFDs in women, affecting 24–45% of those over 30 years. Common among athletes and this is something that I will be writing about in depth as I find incontinence in athletes very interesting from a pelvic health perspective but also a musculoskeletal and sports medicine perspective. 

2. Urge Incontinence

Urge urinary incontinence involves the involuntary leakage of urine, usually accompanied by a sudden and difficult-to-control urge to urinate. In some cases, leakage can occur without any sensation of urgency. The condition is caused by involuntary contractions of the bladder muscle (detrusor overactivity), which may occur due to bladder irritation or problems with the nervous system.

3. Mixed Incontinence

Mixed urinary incontinence combines the symptoms of both stress and urge urinary incontinence. Leakage may occur during physical activities, such as coughing, sneezing, or exercising, and may also be associated with a sudden, overwhelming urge to urinate. While both types are present, one is often more noticeable or bothersome.

4. Overflow Incontinence

Overflow urinary incontinence occurs when the bladder does not empty properly and becomes overly full, causing urine to leak. This can happen if the bladder muscle is too weak to contract effectively or if something blocks the flow of urine out of the bladder. Conditions such as spinal cord injury, multiple sclerosis, and diabetes can affect the nerves that control the bladder, while bladder outlet obstruction may result from an enlarged prostate, pelvic organ prolapse, urethral narrowing, or pressure from abdominal or pelvic masses. 

5. Functional Incontinence

Functional urinary incontinence is characterised by the involuntary leakage of urine due to physical, cognitive, or environmental barriers that limit an individual’s ability to reach or use a toilet in time. This type of incontinence is often referred to as toileting difficulty

Although these different types of urinary incontinence may share similar symptoms, getting the right diagnosis is essential, as the most appropriate treatment will depend on the underlying cause. Seek help with a gynecologist or pelvic health therapist i.e. Naprapath or Physiotherapist with adequate continuing education with pelvic health (= bäckenbotten). 

Urinary Incontinence and Quality of Life 

Quality of life is a multidimensional construct encompassing physical, psychological, social, and environmental domains that collectively reflect an individual’s perception of their position in life. Individuals with incontinence have been reported to have reduced quality of life, psychological distress, and withdrawal from physical and social activities.

A systematic review and meta-analysis including 24,938 participants across 24 studies found that urinary incontinence (UI) was significantly associated with poorer quality of life. Individuals with UI reported worse mental health outcomes, including higher levels of anxiety and depression, as well as changes in lifestyle and daily habits, such as avoiding or reducing physical activity or refraining from activities that may worsen UI symptoms. If we take in this information we need to understand that incontinence is so much more than just something that should be accepted as part of aging or parity! 

However, these findings should be interpreted with caution. Most of the included studies were cross-sectional and relied on self-reported outcomes, which limits the ability to draw causal conclusions. While the review demonstrates a strong association between UI and reduced quality of life, it cannot determine whether UI leads to poorer quality of life, whether poorer quality of life influences the perception or reporting of UI symptoms, or whether both are influenced by other factors. Additionally, self-reported data are susceptible to recall bias, with participants potentially under- or overestimating symptom severity, while volunteer bias may have resulted in greater participation from individuals experiencing more severe or bothersome symptoms.

A study of 180 female powerlifters and Olympic weightlifters by Skaug et al. (2022) found that stress urinary incontinence (SUI) had a substantial impact on sports participation. Nearly 88% of women with SUI (N = 74) reported that it negatively affected their performance, with fear of visible urine leakage and difficulty maintaining concentration being the most commonly reported concerns.

Furthermore, many women adopted strategies to manage their symptoms during training and competition, such as emptying their bladder before exercise, restricting fluid intake, or using pads or tampons to reduce the risk of leakage. Some also avoided certain exercises or training sessions altogether. Interestingly some had never discussed their symptoms with anyone, highlighting the stigma and silence that often surrounds stress urinary incontinence. 

What about non-athletes? How does UI affect women in the general population? In a qualitative study by Dakic et al. (2023) including a total of 23 women and 78% played sports on a recreational level. 96% of participants complained of UI. Interestingly, almost half (48%) of participants complained of anal incontinence – a PFD that is rarely talked about and will be a subject of discussion in further blogs. 

In a qualitative study different themes are presented taken from interviews with participants. In this study by Dakic et al. (2023) four themes that impact the ability to be physically active are presented (1) I can’t exercise the way I would like to (2) it affects my emotional and social well-being, (3) where I exercise affects my experience and (4) there is so much planning to be able to exercise. These findings reflect that UI not only impacts exercise and physical activity but also emotional and social well-being.

Women with mild to moderate symptoms were more likely to modify their exercise participation, often avoiding high-impact activities, endurance exercise, and heavy lifting, whereas those with more severe symptoms were also more likely to even reduce participation in low-impact activities such as swimming, hydrotherapy, and brisk walking. 

However, avoidance is seldom an optimal strategy as this may lead to further avoidance and from a health perspective may lead, in the long term, to isolation and loss of muscle mass, bone strength and lower quality of life. This highlights the importance of an individual assessment from a pelvic health therapist that also is knowledgeable regarding exercise and through this help and guide the individual in modifying and more importantly finding how to promote exercise, activity and impact!  

Furthermore, as health care providers we want to find ways to modify rather than avoiding it altogether. However, sometimes initial short term strategies may include resting from for example high intensity work outs, so that the individual can improve any weaknesses that have been assessed and impact function and continence. Depending on the underlying impairments, this may include optimising running or lifting technique, improving strength and load transfer, or undertaking targeted pelvic floor muscle training to improve strength, timing, and coordination.

Taken together, the evidence suggests that urinary incontinence is common among physically active women and female athletes and represents a significant barrier to exercise participation. As healthcare professionals, coaches, and trainers, we should recognise these challenges and help women develop effective strategies to remain physically active. Understanding this is particularly important given the well-established health benefits of regular physical activity.

However, it is important to remember that there are various types of incontinence and a correct diagnosis is crucial for management strategies.

Physical activity 

The World Health Organization (WHO) recommends that adults accumulate 150–300 minutes of moderate-intensity physical activity, or 75–150 minutes of vigorous-intensity physical activity, each week, in addition to muscle-strengthening activities on at least two days per week. Regular physical activity is strongly associated with numerous health benefits, including increased muscle mass and strength, improved glucose regulation, lower blood pressure, and a reduced risk of several chronic diseases, including certain cancers.

Despite these well-established benefits, physical inactivity remains common. In Sweden, evidence suggests that only around 30% of adults meet the World Health Organization recommendations for physical activity. Urinary incontinence can present an additional barrier to exercise, causing many individuals to reduce or avoid physical activity altogether. Understanding this relationship is essential for increasing awareness, supporting people with urinary incontinence and helping them remain physically active.

Furthermore, we need to work together interprofessionally! By this I mean beyond the enclosed health-care sector including urogynecologists, pelvic health therapists and also include personal trainers. Personal trainers are well educated in exercise and most importantly regression and progression! To regress i.e. modify may be the key factor to gradually then progress. Considering this, we need to also ensure that personal trainers have an adequate education in exercise physiology, anatomy, understanding how different exercises, different positions, different equipment etc, may impact the pelvic floor muscles and eventually exacerbate UI.  

Further thoughts that we should consider are differentiating athletes that leak and general population along with parous and nulliparous,  as these may not have the same etiology or management. More on this incredibly interesting subject!

References:

Abrams, P., Cardozo, L., Wagg, A. and Wein, A. (eds) (2017) Incontinence. 6th edn. Bristol: International Continence Society. Available at: https://www.ics.org/publications/ici_6/Incontinence_6th_Edition_2017_eBook_v2.pdf (Accessed : 9 August 2026).

Bishop, C., Rodriguez-Cairoli, F., Hagens, A., Bermudez, M.A., Van Kerrebroeck, P.E.V. and Collen, S. (2025) ‘Prevalence, socioeconomic and environmental costs of urinary incontinence in the European Union’, European Urology, 88(2), pp. 123–133.
Available at: https://doi.org/10.1016/j.eururo.2025.25.025

Dakic, J.G., Hay-Smith, J., Lin, K-Y., Cook., J, Frawley, H.C. (2023) ‘Experience of playing sports or exercising in women with pelvic floor symptoms: A Qualitative Study’, Sports Medicine -Open, 9(25). Available at: https://doi.org/10.1186/s40798-023-00565-9

Frawley, H.C., Shelly, B., Morin, M., Bernard, S., Bø, K., Digesu, G.A., Dickinson, T., Goonewardene, S., McClurg, D., Rahnama’i, M.S., Schizas, A., Slieker-ten Hove, M., Takahashi, S. and Voelkl Guevara, J. (2021). ‘An International Continence Society (ICS) report on the terminology for pelvic floor muscle assessment’. Neurourology and Urodynamics, 40(5), pp.1217–1260. Available at: https://doi.org/10.1002/nau.24658

Dohrn, I-M., Jansson, E., Börjesson, M. and Hagströmer, M. (eds.) (2021) FYSS 2021: Fysisk aktivitet i sjukdomsprevention och sjukdomsbehandling. 4th rev. edn. Stockholm: Läkartidningen Förlag AB

Grimes, W.R. and Stratton, M. (2023) Pelvic floor dysfunction. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available at: https://www.ncbi.nlm.nih.gov/books/NBK559246/ (Accessed: June 5, 2026)

Leslie, S.W., Tran, L.N. and Puckett, Y. (2025) ‘Urinary incontinence’, in StatPearls. Treasure Island, FL: StatPearls Publishing. Available at: https://www.ncbi.nlm.nih.gov/books/NBK559095/ (Accessed: August 1, 2026)

Pizzol, D., Demurtas, J., Celotto, S., Maggi, S., Smith, L., Angiolelli, G., Trott, M., Yang, L., Veronese, N. (2021)  “Urinary incontinence and quality of life: A systematic review and meta-analysis”. Aging Clin Exp Res 33, 25–35. Available at: https://doi.org/10.1007/s40520-020-01712-y

Skaug KL, Engh ME, Frawley H, Bø K. (2022) ‘Prevalence of pelvic floor dysfunction, bother and risk factors and knowledge of the pelvic floor muscles in Norwegian male and female powerlifters and Olympic weightlifters’. J Strength Cond Res 36: 2800–2807, 2022.