Leaking affects One-third of Female Athletes

images[4]Thirty three percent (33%) of elite female athletes leak urine during training/competition. These girls/women typically do not tell anyone (coaches, parents, teammates) because they feel embarrassment and shame. They try to manage their leaking issues on their own by wearing pads, make frequent bathroom trips and even restrict fluid intake which does not address the cause of leaking. Pelvic physical therapy helps female athletes overcome leaking within 1-2 months of treatment so the athlete can focus on achieving their best performance.

Elite female athletes are typically between the ages of 15 and 39 years, train a minimum of 8 hours per week for their sport and qualify for aimages[9] high-level or national team.

Sports that involve jumping, high impact landings and running were the activities most likely to provoke urine loss.  Many of these athletes reported that leaking issues interfered with their mental focus to achieve top performance in their sport. The following are results from a number of studies regarding elite athletes and leaking:

95% of Female athletes who had an involuntary loss of urine experienced this during training and 50% experienced this during competition.

28 to 35% of high school and collegiate female athletes report incidents of leaking

88% of young trampolinists in one study had an incident or more of urine loss during their jumping activities.


Uncontrolled loss of urine, from a few drops to more, is called Stress Urinary Incontinence(SUI).

SUI is defined as the involuntary loss of urine during activities such as exercise, coughing, laughing or sneezing. Leaking occurs because the force from the abdominal region during laughing or lifting overcomes the strength of the pelvic floor muscles which surrounds the urethra to prevent leaking. The urethra is the hose-like structure that runs from the bladder. The pelvic floor muscles lie at the bottom of the pelvis surrounding the urethra keeping the urethra closed during activities. The pelvic floor muscles relax allowing the flow of urine when voiding.  If they are weak or uncoordinated, the pelvic floor muscles need to be retrained to be more functional and keep the athlete dry during sport.

Female athletes should be educated about leaking issues so they don’t feel shame and can seek help. Some questions to ask female athlete are:

Do you accidentally leak during training or competition?

Do you wear protective pads during training or sports matches?

Do you make frequent trips to the bathroom or go “just in case”?

Do you restrict your water/fluid intake for fear of leaking?

With the expert assessment and guidance by a pelvic physical therapist, female athletes learn that accidental leakage is mainly due to pelvic floor muscle dysfunction. They will learn self help techniques and exercises to retrain their pelvic floor muscles to attain full continence during their sport.




A prostatectomy is the surgical removal of all or part of the prostate gland. The prostate gland is located just under the bladder and has the urethra traveling thru it.  The urethra is a tube like structure that carries urine from the bladder to the penile opening.  When the prostate gland becomes enlarged, there is increased “squeeze” pressure around the urethra which restricts the normal flow of urine, causing discomfort and difficulty voiding.

There are three types of prostatectomy’s:  1) transurethral resection of the prostate (TURP), primarily performed to treat benign prostatic hyperplasia (BPH); 2) open prostatectomy which allows manual manipulation and open visualization through the incision; and 3) radical prostatectomy, the removal of the entire prostate gland along with some surrounding tissue in order to remove the entire cancer.

Robotic prostatectomy is a state-of-the-art procedure that has recently become the most common form of prostate removal.  With the latest technology, greater accuracy is gained, smaller incisions are made, shorter recovery period occurs and post surgical pain is lessened.

A prostatectomy, like any surgery, has possible complications and side effects. Due to the prostate’s location and anatomical components, incontinence and erectile dysfunction are possible side effects.  While it is common for men to experience some leaking for a few weeks post surgery while tissues heal, some men can experience symptoms for many months post op.

When the prostate is surgically excised damage to the cells/tissues that provide continence may occur.  The pelvic floor muscles must take the lead to maintain continence.  The pelvic floor muscles (PFM) are a group of muscles located the base of the pelvis that help control sexual, urinary and bowel function.  The PFM could present as either very weak, too tight or be uncoordinated, resulting in pelvic floor dysfunction.  If the PFM are weak, they cannot squeeze tightly, or contract fast enough around the urethra during a sudden sneeze, resulting in leaking. Some men may experience leaking only with coughing, laughing or lifting weight. Other men may experience constant dribbling throughout the day with increased leakage during physical activity.   If the PFM are too tense or restricted, both leaking and erectile dysfunction can occur as well.

A successful treatment option for men experiencing pelvic floor dysfunction following prostatectomy is physical therapy. The PT, who is specially trained in the pelvic floor, first evaluates the function of the PFM.  Flexibility, mobility and strength are measured via manual intrarectal exam (PFM are located approx one inch intrarectally).  Biofeedback assessment of resting tone, strength and endurance of the PFM are performed.   A study published from the World Journal of Urology titled “Evaluation of early pelvic floor physiotherapy on the duration and degree of urinary incontinence after radical retropubic prostatectomy in a non-teaching hospital” reviewed the effects that early pelvic floor re-education had on the degree and duration of incontinence. This study concluded that the time period towards continence after a prostatectomy procedure can be shortened significantly if pelvic floor re-education is started early in recovery.

Physical therapy treatment for incontinence and erectile dysfunction consists of manual therapy, neuromuscular re education (biofeedback), strengthening and coordination training.  Manual therapy improves extensibility of the PFM, enhancing endorphin production and blood flow.   Soft tissue work is a key component for many patients post prostatectomy. Men may subconsciously tighten their PFM all day, thinking this prevents leaking. However, constant tension causes the PFM to become tight and restricted resulting in further weakness/dysfunction.

Once the PFM are free of tension, manual quick stretch techniques are performed to promote strength, recruiting muscle fibers that may be inactive.  Biofeedback, which is first used to assess the PFM can also be incorporated into the treatment process.  The biofeedback hand held units read the electrical activity of the PFM, giving both the physical therapist and the patient quantitative information about the state of the muscles. Are the muscles too weak, too tight, have poor endurance?  Biofeedback training educates patient how to locate their PFM, lower the muscle tension and strengthen weakened  muscles.  A tailored home exercise program is taught to help men improve their PFM awareness during home/work/sport and empowers men to improve PFM function.

While working with one of the staff DPT (Doctor of Physical Therapy)  at EMH Physical Therapy and under the  guidance of Evelyn Hecht, PT, ATC  the first to offer pelvic floor rehabilitation in NYC 16 years ago,  most men with symptoms of incontinence  post prostatectomy can regain full continence in 2 to 3 months.


Cornel, E. B., de Wit, R., & Witjes, J. A. (2005). Evaluation of early pelvic floor physiotherapy on the duration and degree of urinary incontinence after radical retropubic prostatectomy in a non-teaching hospital . World Journal of Urology , 23(5), 353-355.



Constipation is a common disorder primary care physicians and gastroenterologists diagnose on a regular basis.   There are many causes, but when constipation is due to “pelvic floor dyssynergia”, which are restricted pelvic floor muscles around the anal region that contract instead of relax during attempted bowel movements, a licensed physical therapist, trained in pelvic floor dysfunction can reverse constipation and help you resume normal bowel function.

The pelvic floor is a group of muscles at the base of the pelvis that help control sexual, urinary and bowel function. These muscles, namely the puborectalis, levator ani and coccyxgeus must relax and contract properly to maintain urinary and fecal continence, sexual function and proper voiding habits. When the pelvic floor muscles fail to relax and contract properly, this can be referred to as “pelvic floor dyssynergia”.  The inability to relax and contract the pelvic floor muscles correctly can lead to symptoms of constipation, straining with bowel movements, and feelings of incomplete evacuation.

Some of the physical therapy treatments for constipation include external and internal rectal myofascial release techniques, trigger point release techniques, biofeedback therapy to help down train tight muscles and/or up train weak muscles, instruction to correct bowel techniques to prevent straining, instruction in home exercise program to stretch and strengthen pelvic floor, hip and gluteal muscles.

Manual therapy is needed to reduce the tension, adhesions, and knots in muscles that cause them to become dysfunctional.  This treatment is always with a patient’s permission, may be uncomfortable, but overall a very successful approach to rehabilitate faulty pelvic muscles patterns that resulted in constipation.

Biofeedback therapy helps retrains your pelvic floor muscle’s ability to contract and relax within their full range of motion. It is a treatment which requires insertion of a rectal sensor (sensor is the size and length of a pinky) to measure pelvic floor muscle tension through electromyography (EMG). The EMG activity is visually displayed on the biofeedback unit so you can see what your muscles are doing and learn to better control these muscles with verbal and tactile cueing from the physical therapist.  Identifying the internal sensations associated with the relaxation and how to maintain the ability for your pelvic floor muscles to be at a relaxed state throughout the day is taught as well.

Specific stretching and strengthening exercises are taught for the pelvic floor; the abdomen and pelvic girdle (the gluteal, hamstring and adductor musculature).  Manual therapy such as soft tissue mobilization and trigger point release are administered to tight and restricted tissue both to the lower abdominal region and pelvic floor musculature to help increase blood flow, decrease restrictions and promote healing.  Education regarding normal bowel function and identification of problematic toileting habits is also an important step to recovery.

By complying with a pelvic floor physical therapist’s recommendations, you can be well on your way to pain free and stress free bowel function – no more constipation!