Urinary incontinence is often seen as something that belongs firmly in the realms of pelvic health. When I worked solely in MSK, I rarely asked about it unless I was screening for cauda equina. If I am honest, I hoped for a straightforward “no”. If someone did say yes, I clarified that it was not new or acute, reassured myself it was not a red flag, and moved on. I am sure I was not alone in that approach.
The reality is that urinary incontinence is very common.
In the UK, around 14 million people live with some form of urinary incontinence. Roughly one in three women and up to one in ten men will experience it during their lifetime. In female athletes the numbers are higher still, particularly in impact sport. It is not rare or niche; it is present in many of the people we already treat.
Broadly, we see two main patterns. Stress urinary incontinence occurs with effort such as coughing, jumping, lifting or sprinting. Urge urinary incontinence is leakage that follows a strong, sudden need to void that is difficult to delay. Many people experience a mix of both.
Stress urinary incontinence is multifactorial. Pelvic floor muscle weakness is one contributor, but not the only one. Parity, hormonal changes, connective tissue laxity, hypermobility and altered neuromuscular timing all play a role. Oestrogen deficiency in the peri- and postmenopausal years can reduce urethral closure pressure and tissue integrity. In younger athletic populations, high training loads without adequate recovery may influence tissue resilience.
So why does this matter in MSK?
