Urinary incontinence (leaking of urine), pelvic pain and pain with sexual intercourse are common but under reported in the general population. A research study, completed in Denmark in 2002 and published in the International Urogynecology Journal, discovered that urinary incontinence is more common than we initially thought in elite female athletes and dancers. Unfortunately, we were unable to find any research pertaining to dancers and pain with sexual intercourse, although it is suspected that some of this population may be suffering from it.
Urinary incontinence has often been associated with being “old.” This is not actually a true association. In fact, as physical therapists, we hear this as a complaint in the young athletic population. It is not commonly known about because it is under reported.
One dancer we treated shared her experience: “With repetitive jumping at dance I can feel urine leaking out. I have had days where I have soaked through my leotard. I blame it on sweating a lot that day. But it is embarrassing. I am thinking about quitting dance because it is becoming more difficult to control!”
At the evaluation it was discovered that her pelvic floor muscles were so tight that she was unable to coordinate them to hold back urine. This dancer was treated with pelvic floor physical therapy. After releasing the muscles and restoring normal muscle coordination and strength, the dancer’s urinary incontinence resolved and she was able to return to dance symptom free.
Pain with sexual intercourse and pelvic pain is also presenting in this young population. Dancers are especially prone to these problems due to the high impact exercise they are exposed to and their muscle holding patterns. Most people suffer in silence and don’t know that there is help available to significantly decrease or resolve the symptoms.
A study completed in Denmark in 2002, looking at elite female athletes, revealed that 43% of the ballet dancers surveyed had experienced urinary leakage with jumping being the largest contributing activity. They not only experience leakage during dance but also in daily life. The researchers stated that they were surprised to find such a high percentage of well-trained athletes with this condition; they expected that the athletic conditioning would prevent such a problem. They believe that the high level of physical activity may be a contributing factor. A research study completed in Spain and published in the Journal of Dance Medicine and Science in 2007 described a few theories about the cause of incontinence in dancers. The authors indicated that the incontinence may be related to the “increased abdominal pressure on the pelvic floor during jumps or impact, fatigue of the pelvic floor muscles, or hypotrophy and weakness of these muscles.”
We have looked for research articles to determine a reason why so many dancers suffer from this, but unfortunately there’s very little data related specifically to dancers with incontinence and cause.
Patients with urinary incontinence, pelvic pain and pain with sexual intercourse often present with abnormal movement patterns, poor strength, muscles that are too tight, or altered posture. As physical therapists, we have found that restoring normal posture and bladder health habits as well as joint and muscle balance helps to resolve these symptoms.
It is clear that dancers have altered stabilization and postural habits, compared to the general public; this may predispose them to pelvic pain and urinary incontinence/dysfunction. They tend to stand with their legs turned out and their pelvis tucked under in order to flatten their lumbar spine and achieve the proper “dance aesthetic.” This does not allow the gluteal (buttocks) muscles to work efficiently in stabilizing the sacroiliac joints (pelvis). It also limits their ability to use their deep abdominal muscles, the transverse abdominis, to better manage stability of the pelvis.
Dancers demonstrate a tendency to stand with a flattened upper back and altered breathing pattern secondary to their training. They tend to pull their lower abdomen in and ribcage down and maintain this rigidity while moving and breathing. Normal breathing should allow the lower abdomen to move outward with inhalation and in with exhalation. Unfortunately, this altered breathing habit and abdominal wall gripping places more stress on the pelvic floor and increases dancers’ risk for urinary leakage. These same habits can increase pelvic floor muscle tone, which may contribute to pain with sexual intercourse in dancers as well.
If you are suffering from urinary incontinence, pain with sexual intercourse or pelvic pain, please know that you are not alone and there are resources and treatment available. In addition to the resources below, please search the Share Mayflowers website for additional information.
For more information regarding bladder dysfunction and treatment options, visit:
For more information regarding pelvic pain, visit:
To find a pelvic floor physical therapist in your area, visit:
Erika Johnson, PT, DPT, Marathon Physical Therapy and Sports Medicine