Urinary Incontinence is Common Among Teen Athletes—Here's How to Help

Common cultural narratives typically characterize urinary incontinence or leakage as a postpartum issue. The research, however, tells a different story. A study published in 2021 looked at the data from nine different studies that focused on urinary incontinence in female athletes under the age of 19. It found that an average of about 49% of female adolescent athletes experienced urinary incontinence.

It's distressing enough to think that approximately half of these young athletes participating in sports are leaking urine. What's worse is researchers found that 87% of them will not mention it to their coaches.

More open conversations about leaking during sports performance could help to shrink the stigma and empower people of any age to find help. Read on to learn what causes urinary incontinence in athletes, how it impacts sports participation, and how you can help.

Causes of Urinary Incontinence in Teen Athletes

Stress urinary incontinence, the leaking that occurs with exertion, can happen regardless of age. A weak pelvic floor is most often responsible for the incontinence that athletes experience. Research published in International Urogynecology Journal found that intra-abdominal pressure and its impact on the pelvic floor during physical exertion can lead to stress urinary incontinence in athletes.

In order to stay dry during exercise, your body relies on your pelvic floor muscles to generate tension that helps to hold your urethra closed, keeping urine inside. The pelvic floor is an often overlooked part of your core system, which includes your deep abdominal muscles, your back muscles, and your diaphragm (the muscle we use to breathe).

Your core has important functions for the strength and stability of your entire body. If the pelvic floor isn't working efficiently in the system, it can't do its job when it's needed most, during high-impact exercise.

High-impact sports that include running, landing, or jumping are the most likely to cause leaking.

Impact on Sports Participation

A young woman named Taylor told me that despite leaking during gymnastics practice starting at 16 years old, she didn't mention it to anyone except her doctor—when she was 21. Others have had similar experiences. While many of them eventually mentioned it to their parents, it was only after experiencing symptoms silently on their own, worried that something was wrong with them.

As a pelvic floor physical therapist, I've seen how urinary leakage causes people to change their lives in big and small ways. People give up running long distances, stop engaging with their gym community, only wear black leggings, and stay far away from trampolines. You can miss out on life's fun and playful things if you're worried about holding your bladder.

My goal as a physical therapist is to get someone who is leaking back into the movement they love with the people they love. Once the leaking has improved, my patients often wish they had known pelvic floor physical therapy could help with incontinence sooner. There's a sadness that comes with knowing how much time was spent avoiding beloved sports and activities.

I feel a similar sadness thinking about how so many adolescents choose their extracurriculars around activities that won't make them pee their pants or how they are trying to deal with the issue. For example, Olivia, 18, told me, "The leakage didn't change my sports activities in terms of participation, but I did have to wear a maxi pad all the time, and that was embarrassing."

How to Help Teen Athletes With Urine Leakage

The good news is that urinary incontinence can be resolved. The trick is getting teens to open up about the problem, so start the conversation and work on building solutions with them.

Ask about it

Urinary leakage in adolescent athletes is very common. Even more common is their hesitancy to talk about it with their coaches and parents out of embarrassment. Asking without judgment can help to normalize the experience and let your teen know you're here to help and that they're not alone.

Promote cross training and general strength building

There is more and more pressure for young athletes to pick a single sport at earlier ages. However, with earlier skill specialization and less movement variability, muscle groups may not get their fair share of work or strength.

Growth spurts involve bones rapidly changing in size. Sometimes muscles need time and support to keep up. The pelvic floor doesn't work in isolation—making sure that its teammates (the abdominal muscles, glutes, back muscles, and inner thigh muscles) are all strong and working well together can make a significant difference in leaking.

See a pelvic floor physical therapist

Barring any infection or abnormality of the urinary tract, lack of coordination of the pelvic floor muscles is the most likely culprit in leaking for teen athletes. Working with a pelvic floor physical therapist to promote whole-body strength and coordination can help.

In the same way you rely on coaches for information about your form when you strike out at the plate, you need coaching when it comes to leaking. It's possible to play hard without peeing.

The Bottom Line

Urinary leakage can be embarrassing and scary for teens. Despite how frequently it occurs, it can feel isolating, particularly when young people think they need to change their sports participation to stay dry. Opening up a conversation, normalizing their experience, supporting their athletic endeavors through full body strength building, and engaging the help of a pro can all help empower athletes to find a path forward.