Puberty, pelvic floors and netball

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Pelvic floors, bladders and bowels are older lady things, aren’t they?

A quick 101, pelvic floor muscles control the bladder and influence the bowels. To find out more you can do the deep dive here. 

A key fact here is that a younger girl’s pelvic floor muscles are still developing. Add in some social and psychological factors and we have to understand that the teenage pelvic floor has a unique risk profile of its very own. 

Development plus extra load

As young netballers advance in age, we hope they’ll continue to show up on court and perhaps dial up the intensity of their training and involvement. 

When this happens it’s great for our game … but less so for her pelvic floor. 

Again, a younger girl’s pelvic floor muscles are developing. They may not be sufficiently strong enough to handle what we’ll call an adult’s training load. And given netball – with its jumps, sprints and stop-starts – puts more strain on the pelvic floor than other sports, there could be fallout. 

Literally. An intensive netball session will fatigue the pelvic floor muscles (the same way any exercise will fatigue any muscles) but when those muscles start from a lower baseline they’ll likely fatigue further and faster. Cue a definite risk of leaking.

… plus extra pressure

Fair to say – teenagers face social pressures from multiple directions. Part of that could be that girls are self-conscious going for a wee (noise, sharing bathrooms) at school. Even simpler, there may be restrictions as to when she can and can’t. 

Puberty can be a time of under-confidence, awkwardness, mood swings, fear and anxiety so even if she really has to go, she mightn’t want to make a thing of it in the middle of class, or half-way through a training session. 

These so-called holding patterns – when you clutch a wee for too long – can become habit and this can tighten the pelvic floor muscles to where involuntary leaking is all-too-common. Jumping around a netball court will only increase the probability, hence research suggests up to 50% of young netballers have experienced some leaking. 

At the other end of the scale, teenage girls are also susceptible to what the experts call motor urgency. To you and me that’s an oversensitive bladder which kicks into life very suddenly; often before she’s ready. Much of this can be tied up in embarrassment and anxiety and, relatedly, bed-wetting is more common in teenage girls than you might think.

Teenage bowels

This last scenario (motor urgency) can also be linked to constipation. While constipation isn’t a pelvic floor issue per se, the straining effort while constipated causes the pelvic floor to stretch beyond its safe bounds. 

That, again, can cause damage and increase the likelihood of leaking. Constipation and bladder issues can be tightly linked. Girls and women suffering constipation may find that the pressure triggers the bladder at the wrong moment. In other words, clutching a poo may induce a sudden need to pee. 

For multiple reasons, constipation is not good. For sure, it’s more common further into life but younger teens certainly aren’t exempt and the big dumps of stress and anxiety common in puberty can make matters worse. 

Thankfully, the fix is pretty simple via the magic trio of fibre, water and physical activity. If those three don’t work there’s always over-the-counter laxatives or a trip to a paediatric urologist.

Education, awareness, action

At this point you might be asking how you can help. All this does sound a little personal, complicated, embarrassing … 

Maybe. But these are all facts and we won’t make sufficient headway if we can’t call it what it is. The taboos around peeing, pooing or leaking are silly and long past their use-by-date. 

We all do it. We need to take the sting out of it.

With that, here are some actions to think about to help teenage girls navigate pelvic health in puberty. 

• Talk about the problem and call body parts and issues by their proper names
• Understand that problems are common but don’t normalise them
• For coaches / parents: promote pelvic floor exercise at a young age
• For coaches / parents: understand that the young pelvic floor is still playing catch-up so adapt training loads to ensure younger bodies don’t take on adult training loads
• For coaches / parents: remember that some leaking (infrequent, small amounts) is normal, especially late on in a netball game when fatigue sets in
• Connect with a Women’s Health Professional (WHP) to gather info and boost your understanding 
• Invite professionals in to talk to groups of girls and / or parents
• Restricting girls’ bathroom breaks (at school or training) is a bad idea all around
• If problems persist, know your professionals: WHPs, paediatric specialists, dieticians, GPs and so on