Special report: ‘There was urine flying through the air’



“Women are supposed to have a menstrual cycle – blood is supposed to come out of them once a month,” says Baz Moffat, a women’s health coach at The Well HQ who specializes in pelvic-floor education.

“You’re not supposed to wet yourself. You’re not supposed to leak urine, especially if you’ve not had a baby.”

Research has shown that pelvic-floor dysfunction and incontinence should not be solely viewed “as mums’ issues”, as Moffat puts it. Female athletes are, in fact, at a 177 per cent higher risk of presenting with urinary incontinence symptoms than sedentary women, with those involved in high-impact sports such as volleyball, athletics, basketball, rugby, football, cross-country, skiing and running all affected.

“The assumption is that you leak because you have a weak pelvic floor,” adds Moffat. “There’s this ‘keep doing your pelvic-floor exercises’ message but, actually, for many sportspeople, it’s about relaxing the pelvic floor and the down training, which sportspeople are pretty bad at.”

Urinary tract infections are another sign that the pelvic floor is too tight due to its inability to let go of urine, which stays in the urethra.

“The pelvic floor is a dynamic muscle which should move with your breathing,” adds Moffat. “Every muscle needs to have a range of movement that it works through and if all you’ve done is tighten and tighten your muscles, that’s not a healthy state for your connective tissue to be in.”

The issue is widespread in gymnastics. One academic paper revealed that the entire French gymnastics team experienced leakage during the 2016 Rio Olympics, while a 2021 study published in the International Urogynecology Journal found that out of 319 gymnasts and cheerleaders surveyed, two thirds suffered urinary incontinence.

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Moffat knows of parents Whose daughters Gymnast Have even started wetting the bed, Their overtrained and overtight pelvic floor through the consistent core work, while the stigma around incontinence has intensified sexual abuse by Been Scandals That Have rocked the sport.

Larry Nassar, the convicted paedophile doctor for the United States gymnastics team, twice shut down police probes into his sexual abuse after claiming his assaults on victims were medically legitimate “pelvic-floor therapy”. This type of treatment uses internal vaginal soft tissue manipulation, or massage, to relieve pelvic pain by accessing muscles that cannot be accessed any other way, and gave Nassar an easy cover story that allowed him to become a predatory abuser.

In other sports, the scale of stress incontinence and the prevalence of tight pelvic floors is only just starting to be understood – and in the case of Wales Rugby – tackled. After conducting a player questionnaire among the Wales women’s squad during the first Covid-19 lockdown, Jo Perkins, the team’s head physio, discovered incontinence was leading to huge performance implications.

“When I started working with the team in 2019, it was more chats of, ‘Oh, well, I pee myself’ or ‘I have horrendous abdominal pain when I reach my maximum speed’, or ‘It’s painful putting tampons in’. These all come under the umbrella term of pelvic-floor dysfunction,” says Perkins.

“If you’ve got pain or you’re leaking, all that pressure is going the wrong way, so you won’t be able to push as hard in the scrum or tackle and jump effectively. Our stats showed that, actually, the girls were leaking more through jumping, rather than tackling.”

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After launching its first set of professional full-time contracts this year, the Welsh Rugby Union began a pioneering partnership with “fem tech” brand Elvie to improve players’ pelvic-floor knowledge. Every player has a smart kegel trainer, a device that is vaginally inserted and helps with pelvic-floor training. It links with an app, and players can monitor their pelvic-floor strength as it contracts and releases.

“The app is really good at telling players whether they are squeezing effectively and how much they are squeezing,” explains Perkins. “It gives you real-time feedback. What we’re finding with a lot of the girls is that it’s the release that’s really difficult.”

With the rise of fem tech – the umbrella term for software, services and products focusing on women’s health – expected to exceed £40 billion within the next decade, there are an increasing number of products to help sportswomen deal with incontinence. But, according to Moffat, who conducts pelvic-floor health workshops, there is not an off-the-shelf one-fits-all solution.

“My approach to women and their bodies is they need to know what they need to be doing,” she says. “Just doing a set of pelvic-floor exercises at home will work for some people brilliantly. Nothing is perfect for everyone.

“My recommendation would always be to just go simple first of all and try doing pelvic-floor exercises on your own. Women have no clue how to do pelvic-floor exercises – they’ve never been taught properly – so that’s a challenge. If that’s the case, I would go and find a women’s health physio first who can teach you how to do them properly and also teach you what exercises you need to be doing.”

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Having seen specialists for her own pelvic-floor problems, Songhurst has found breathing techniques to relax her core which have helped, but she has reached a point where she is simply managing her leakage. “I kind of accept it’s going to be a thing for the rest of my career,” says Songhurst, who is targeting the Paris 2024 Olympics. “I’m open to trying things if someone suggests how to help.”

By simply talking about urinary stress incontinence, she and Gallagher Cox are making a major contribution to breaking the taboo.
“It’s so normalized after pregnancy,” adds Songhurst, “but why isn’t it normalized in sport?”


www.telegraph.co.uk

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George Holan

George Holan is chief editor at Plainsmen Post and has articles published in many notable publications in the last decade.

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