As exercise bikes are linked to incontinence DR PHILIPPA KAYE asks if spin class could be root cause

The patient, in her 50s, wasn’t so much embarrassed as perplexed. 

Recently, she was unable to resist the urge for pee. Worse, she’d also begun to ‘leak’ a bit, almost without realising.

She’d not suffered this kind of problem significantly after the births of her two children, who were now in their early teens. 

And she’d religiously done her pelvic-floor exercises, which help women regain and retain control of their bladder after being pregnant.

‘It makes no sense – I can’t work out why it’s happening now,’ she lamented, adding that a number of her friends had been far worse affected.

It didn’t take long to narrow down the cause. The worst part of her problem came when she was not exercising, which was almost always spinning.

The classes are intense and often feature loud music, an instructor pushing the group and a dedicated following.

Spinning: This intense indoor cycling class, often featuring loud music and an instructor pushing the group forward, has been in existence for many years. It is a popular choice and has a loyal following.

But now there’s also Peloton, a stationary bike with a 22in flatscreen attached to the handlebars on which you can take virtual spinning classes at home at any time.

Despite the eye-watering prices – from £1,300 to £1,800 – they sold like hot cakes during the lockdown, although demand has apparently died down now that more of us are heading back to the gym.

The patient was now able to do both. This meant that she could get on the saddle at high-energy sessions four times per week. 

‘I’d do it more if I had time,’ she admitted. ‘I love it.’ 

She’d also bought a real bike so she could cycle with the kids on the school run and to the shops.

Had she noticed any numbness or discomfort ‘down there’ I asked? ‘Yes, but I thought it was normal to be a bit saddle-sore,’ she said. 

So you can imagine her disappointment when I told her that no, it wasn’t normal, and her new-found obsession may be contributing to her incontinence.

It didn’t take long to narrow down the cause. The worst part of her problem was when she was not exercising, which was almost always spinning. Pictured: Peloton exercise bike

It’s long been suspected that cycling can cause men all sorts of problems with their urinary and genital organs – the genitourinary system. 

One recent study found an increased rate of prostate cancer in men who cycled more than eight hours a week, although it’s not totally clear why.

One theory is that the saddle exerts pressure on the perineum – the area between the testicles and the anus – which can, in turn, irritate the prostate, which sits just below the bladder. 

It’s been suggested this could be linked to erectile dysfunction and urinary incontinence, however research has found that these problems – which are common in middle-aged men – are seen just as often in those who do other sports.

What’s less well known is that too much time in the saddle can trigger a range of problems in women.

While there aren’t official figures, Facebook groups for Peloton and spinning are packed with hundreds of posts from female enthusiasts with similar stories to my patient.

Many suffer from alarming swelling following vigorous classes, as well as pins or needles-like sensations. Unexpected leaks, even in women without children who’d never had problems before, was another common theme.

An analysis of over 300 female triathletes revealed that nearly three quarters suffered from incontinence. Female cyclists may also experience decreased labial and vaginal sensitivity and higher rates of infections.

What’s the reason for this? Men are able to move their genitals out of the way when they cycle, but women can’t. 

And while having low handlebars may make you feel faster, leaning forwards to hold them increases the internal pressure exerted by the saddle which then engages the pelvic floor – the hammock of muscle that sits at the base of the pelvis and supports the bladder, uterus and rectum. 

One theory is that the saddle exerts pressure on the perineum – the area between the testicles and the anus – which can, in turn, irritate the prostate, which sits just below the bladder. It’s been suggested this could be linked to erectile dysfunction and urinary incontinence, however research has found that these problems – which are common in middle-aged men – are seen just as often in those who do other sports 

This can lead to leaks if the pelvic floor is not strong enough.

Another trigger is strenuous exercise like running or jumping. But also coughing, sniffing and even laughing. Stress incontinence is what we call it.

Incontinence can be caused by an overactive pelvic floor or overworked bladder. This pressure causes the bladder to contract and the nerves to supply the bladder to become irritated, leading to a sudden need to go. 

A sudden change in position can prompt the sensation of urgency – for example, during a spinning class when you move from sitting in the saddle to standing up on the pedals. 

You can also have a mix of both types of incontinence, and both may be worse after the menopause – the loss of oestrogen can lead to the tissues of the pelvic floor and genitourinary system weakening.

This isn’t to say don’t cycle, as I told my patient. 

It is possible to get endless health benefits by incorporating exercise into your day. For example, you can do moderately intense exercises five days a semaine for 30 minutes. 

Incontinence can impact daily life. GPs may be able or willing to refer you to a continence clinic. Specialist physiotherapists will recommend exercise programs to help with bladder control. [File picture] 

However, if incontinence or genital discomfort becomes a problem, you will need to make some changes.

Getting your saddle and handlebars adjusted professionally at a bike shop is key, to ensure they’re comfortable.

Look into padded cycling shorts, too – these have to be worn without underwear as your knickers can literally end up in a twist, exacerbating the situation.

You can also find a variety of saddles to better suit the female anatomy.

Applying an anti-chafing cream to the inner thighs, labia and groin can help with sores. 

Experts recommend that you stand up once every ten to fifteen minutes while riding, in order to ease the pressure on your bowels. 

This might occur naturally if you’re commuting on urban roads, but you might have to remind yourself when on a static bike.

Urinary incontinence, which affects 40 per cent of women at some point in their lives, shouldn’t ever be dismissed. 

It’s one of my missions as a GP to make sure it’s not accepted as a normal consequence of pregnancy, childbirth or the menopause.

Unfortunately, the NHS can sometimes be slow to respond. Even when patients seek assistance, they can find themselves on lengthy waiting lists. 

According to a recent report by The Pelvic Floor Society – a body made up of bladder and bowel specialists – some incontinence sufferers wait a decade for even a diagnosis.

Incontinence can impact daily life. GPs may be able or willing to refer you to a continence clinic. Specialist physiotherapists will recommend exercise programs to help with bladder control.

It’s also important to remember that any new pelvic pain should be investigated, to rule out anything sinister.

So if cycling is causing you problems, a few simple adjustments to the bike and your riding style can be all that’s needed to get you back, comfortably, in the saddle.

What is the difference between tartar or plaque? 

Although both plaque and tartar buildup on teeth can cause gum disease, these are distinct substances. 

After eating, plaque is a sticky and soft film that covers the gums and tooth enamel. 

The bacteria is made up of millions and can interact with other bacteria to create acid if it’s not cleaned away properly during brushing or flossing. 

Although both plaque and tartar buildup on teeth can cause gum disease, these are distinct substances. [File picture]

It can cause cavities and tooth enamel erosion. 

If plaque is not removed, Tartar can form as hardened calcium. 

It can be seen in yellowish-brown staining of teeth. 

This can lead to the receding of your gums and may require a dentist’s intervention.