As the Fleet Feet Momentum and No Boundaries training groups continue their training programs, and individuals prepare for the fall racing season, several questions regarding urinary control have surfaced at the store over the past few weeks.
The Fleet Feet staff called on an expert, Dr. Patrick Showalter, Urologist and accomplished runner, for advice. Dr. Showalter received his medical degree from Vanderbilt University and practices in Murfreesboro, TN.

Here is a brief dialogue on the subject of exercise and urinary incontinence:
 
1. What causes urinary incontinence?
Dr. Showalter:
The type of incontinence that your runners are talking about is called Stress Urinary Incontinence, and is most common among women. If urinary incontinence occurs in males, I would advise discussing this problem with a physician.
In Stress Urinary Incontinence, a "stress" is applied to the bladder and urine leaks out due to the pressure on the bladder. More specifically, the sphincter (urinary control muscle) force is exceeded by the force in the urethra.
Common “stressors” or risk factors include vaginal delivery, chronic constipation, chronic cough (smokers), diabetes, obesity, and an active event (jumping on a trampoline, for example). Unfortunately, female athletes have an increased incidence of urinary incontinence too.

2. What are common preventions and/or treatments for Urinary Incontinence?
Dr. Showalter:
Prevention is tough because we can’t choose our parents (risk factors can be genetic), and many women choose to have babies. However, a prevention that is in our control is to watch our weight.
Keeping your body at a healthy weight is key to this and so many other health issues. I have a number of patients who have stopped leaking after losing a substantial amount of weight (30-60 pounds).
Treatment: The range of treatment is from Kegel or pelvic floor exercises (most women are familiar with doing these after giving birth) to the other end of the spectrum: surgery. Kegel exercises are also an important preventative in female runners. There are a number of surgical options, but for the most part, urologists rely on a simple outpatient procedure called a “sling”. There are no strict indications for treatment. It’s elective because no one has ever died from urinary incontinence.....except maybe from embarrassment.

3. From the perspective of a Urologist, what advice would you give to runners?
Dr. Showalter:
Don't let leakage keep female runners from getting in shape and dropping pounds. Losing weight has many benefits including improved bladder control.
If dropping weight, alone, does not help the problem, it’s still better for the individual because thinner patients tolerate surgery better and recover more quickly. The thinner, active athletes who undergo a “sling” procedure have done really well in our practice long term. Their surgeries seem to be durable after re-starting their exercise program post operation.

As far as running advice in general:
1. Stay well-hydrated.
2. Do Kegel exercises routinely, even when not running
3. Wear pads if you have to when running
4. Take frequent bathroom breaks
5. Don't drink salty sports drinks unless you are running longer than one hour - the salt content raises the risk of kidney stone formation. Add a little lemon to your water.
6. Don’t give up.
7. Go your own pace.
8. Walking is an important adjunct to running. Walking one mile or running one mile burns roughly the same amount of calories.

Please contact his office for individual consultation:
Dr. Patrick Showalter
Middle Tennessee Urology
Gateway Medical Plaza II 1747 Medical Center Parkway, Suite 210 Murfreesboro, TN 37129 615-893-1600 | Fax 615-225-6887 www.midtnus.com

Patrick Showalter was a collegiate cross country and track runner in Indiana, and recently ran a 2:47:32 marathon in Eugene, OR.