Understanding the Increased Likelihood of Incontinence in Male Athletes, by Dr. Justin Vincent, PT, DPT

Imagine you’re a dedicated runner, consistently pushing your body to new limits. You’ve trained rigorously, competed fiercely, and maintained peak physical condition. But one day, during a routine jog, you feel an unexpected leak. It’s embarrassing and concerning, and you’re not alone. Urinary incontinence is an issue many male athletes face but rarely discuss. Let’s explore why this happens and what can be done about it.

The Unexpected Challenge: A Runner’s Story

Marshall,, a 35-year-old marathoner, had always prided himself on his athletic prowess. He followed strict training regimens, ate a balanced diet, and never missed a workout. However, over the past year, he noticed a troubling pattern. After long runs, he often experienced slight urinary leaks. Initially, he brushed it off as a one-time occurrence. But as the incidents became more frequent, his confidence began to wane. Marshall felt embarrassed and isolated, reluctant to share his issue with anyone, including his fellow runners.

The Anatomy of the Pelvic Floor

To understand why athletes like Marshall experience urinary incontinence, it’s crucial to understand the anatomy involved. The pelvic floor is a group of muscles that support the bladder, bowel, and, in men, the prostate. These muscles play a critical role in controlling the release of urine, feces, and gas.

The pelvic floor muscles are often described as a hammock or sling, extending from the pubic bone at the front to the tailbone at the back. They encircle the urethra, the tube that carries urine from the bladder out of the body. When the pelvic floor muscles are strong, they provide essential support and maintain continence. However, when they weaken or become damaged, control can be compromised.

High-Impact Sports and the Pelvic Floor

Marshall’s story is not unique. High-impact sports, such as running, weightlifting, and jumping, can place significant strain on the pelvic floor. Repetitive jarring motions or the heavy lifting involved in strength training can lead to the weakening of these crucial muscles. This strain can cause microtraumas over time, eventually resulting in a loss of support for the bladder and urethra.

In a study published in the Journal of Men’s Health, researchers found that up to 15% of male athletes experience urinary incontinence, although other studies show this to likely be up to 18%. This prevalence is higher than in the general male population, highlighting the specific risks associated with athletic activities .

The Role of Sex Hormones

Sex hormones also play a significant role in muscular strength and endurance, including the muscles of the pelvic floor. Testosterone, the primary male sex hormone, is known for its anabolic effects, promoting muscle growth and strength. However, as men age, testosterone levels naturally decline. This reduction can lead to a decrease in muscle mass and strength, affecting the entire body, including the pelvic floor.

Interestingly, the interplay between testosterone and other hormones like estrogen is complex. While estrogen is typically considered a female hormone, men also produce it in smaller amounts. Estrogen contributes to the maintenance of muscle and joint health. Therefore, hormonal imbalances can further exacerbate the risk of pelvic floor dysfunction and incontinence .

Why Male Athletes Are at Greater Risk

Several factors contribute to the increased likelihood of incontinence in male athletes:

  1. High-Impact Activities: Sports involving running, jumping, or heavy lifting repeatedly stress the pelvic floor, leading to potential weakening over time.
  2. Intense Training Regimens: The rigorous physical demands of high-level training can exceed the pelvic floor’s capacity for resilience, particularly if recovery periods are insufficient.
  3. Hormonal Changes: Declining testosterone levels and the resultant reduction in muscle mass and strength can affect pelvic floor integrity.
  4. Insufficient Core Training: Many athletes focus heavily on their primary sport without incorporating adequate pelvic floor or core strengthening exercises into their routine.

Preventive Measures and Solutions

  1. Pelvic Floor Exercises: Also known as Kegel exercises, these can strengthen the pelvic floor muscles. Men can benefit from practicing these exercises regularly, especially if they engage in high-impact sports.
  2. Core Strengthening: Incorporating exercises that strengthen the core, such as planks, can enhance overall stability and support the pelvic floor.
  3. Proper Technique: Ensuring proper form during activities, particularly weightlifting, can minimize unnecessary strain on the pelvic floor.
  4. Balanced Training Regimen: Including adequate rest and recovery time in training schedules is crucial to prevent overuse injuries, including those affecting the pelvic floor.
  5. Professional Guidance: Consulting with a physical therapist who specializes in pelvic health can provide personalized strategies to manage and prevent incontinence.

Marshall’s Path to Recovery

Realizing the impact his condition was having on his life, Marshall decided to seek professional help. He consulted a pelvic health specialist who explained the anatomy of the pelvic floor and the strain high-impact activities can place on these muscles. With guided pelvic floor exercises and adjustments to his training regimen, Marshall began to see improvements.

His specialist emphasized the importance of core strength and proper technique during weightlifting. Marshall also learned about the role of hormones in muscle health and started monitoring his testosterone levels with his doctor’s help. Over time, Marshall’s leaks diminished, and his confidence was restored.

Breaking the Silence: Encouraging Open Discussion

One of the biggest challenges surrounding urinary incontinence in male athletes is the stigma and silence. Many men, like Marshall, feel embarrassed to discuss their symptoms, fearing judgment or misunderstanding. However, open dialogue is crucial for breaking down these barriers and encouraging men to seek help.


Urinary incontinence is a common but often unspoken issue among male athletes. Understanding the anatomy of the pelvic floor, the impact of high-impact sports, and the role of sex hormones can help in addressing and managing this condition. Through preventive measures, proper training, and open discussion, athletes can maintain their physical health and continue to excel in their sports.

Marshall’s  journey highlights the importance of awareness and professional support in overcoming urinary incontinence. By sharing stories and spreading knowledge, we can help others who may be silently struggling with the same issue. Remember, seeking help is a sign of strength, not weakness.


  1. National Institutes of Health: Pelvic Floor Dysfunction in Male Athletes
  2. Journal of Men’s Health: Urinary Incontinence in Male Athletes
  3. Journal of Strength and Conditioning Research: Youth Strength Training
  4. American College of Sports Medicine: Exercise is Medicine
  5. AAP: Strength Training by Children and Adolescents
  6. Journal of Strength and Conditioning Research: Effects of Strength Training on Youth
  7. Mayo Clinic: Strength Training for Kids
  8. American Urological Association: Pelvic Floor Muscle Training
  9. Mayo Clinic: Hormones and Muscle Strength
  10. NIH: Role of Estrogen and Testosterone in Muscle Health

By understanding the underlying causes and addressing them head-on, we can help athletes like John regain control and continue pursuing their passions without fear or embarrassment.