Skip to main content

Advertisement

SpringerLink
Log in

Urinary Incontinence in Elite Female Athletes

  • Lower Urinary Tract Symptoms and Voiding Dysfunction (J Sandhu, Section Editor)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To summarize the current understanding on the epidemiology, pathophysiology, and management strategies of urinary incontinence (UI) in female athletes, highlighting findings specific to nulliparous elite athletes.

Recent Findings

UI occurs in about 20–50% of female athletes of all ages and parity status, around 40% for younger nulliparous athletes, and is more prevalent in high-impact sports. Possible contributing factors to UI in female elite athletes include pelvic floor laxity and bladder neck descent, pelvic floor muscle fatigue, low energy availability, and hypermobility syndrome. In female elite athletes, urinary symptoms negatively affect quality of life, although the effects of symptoms on exercise participation are not well understood. Current management strategies are primarily conservative and centered on behavioral modifications and pelvic floor muscle physiotherapy.

Summary

UI in female elite athletes appears to be multifactorial. Clarifying how individual factors influence UI in this population will inform athlete counseling, prevention, and treatment strategies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. de Mattos Lourenco TR, Matsuoka PK, Baracat EC, Haddad JM. Urinary incontinence in female athletes: a systematic review. Int Urogynecol J. 2018;29(12):1757–63.

    Article  Google Scholar 

  2. Teixeira RV, Colla C, Sbruzzi G, Mallmann A, Paiva LL. Prevalence of urinary incontinence in female athletes: a systematic review with meta-analysis. Int Urogynecol J. 2018;29(12):1717–25.

    Article  Google Scholar 

  3. Pires T, Pires P, Moreira H, Viana R. Prevalence of urinary incontinence in high-impact sport athletes: a systematic review and meta-analysis. J Hum Kinet. 2020;73:279–88.

    Article  Google Scholar 

  4. •• Almousa S, Bandin Van Loon A. The prevalence of urinary incontinence in nulliparous female sportswomen: a systematic review. J Sports Sci. 2019;37(14):1663–72. Describes UI prevalence in nulliparous female athletes, including categorization of SUI and UUI.

  5. Joseph C, Srivastava K, Ochuba O, Ruo SW, Alkayyali T, Sandhu JK, et al. Stress urinary incontinence among young nulliparous female athletes. Cureus. 2021;13(9): e17986.

    Google Scholar 

  6. Rebullido TR, Gómez-Tomás C, Faigenbaum AD, Chulvi-Medrano I. The prevalence of urinary incontinence among adolescent female athletes: a systematic review. J Funct Morphol Kinesiol. 2021;6(1).

  7. Ferreira S, Ferreira M, Carvalhais A, Ribeiro Santos PC, Rocha P, Brochado G. Reeducation of pelvic floor muscles in volleyball athletes. Rev Assoc Med Bras. 2014;60:428–33.

    Article  Google Scholar 

  8. Jacome C, Oliveira D, Marques A, Sa-Couto P. Prevalence and impact of urinary incontinence among female athletes. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2011;114(1):60–3.

    Article  Google Scholar 

  9. Nygaard IE, Shaw JM, Bardsley T, Egger MJ. Lifetime physical activity and female stress urinary incontinence. Am J Obstetr Gynecol. 2015;213(1):40.e1-.e10.

  10. Bø K, Sundgot-Borgen J. Are former female elite athletes more likely to experience urinary incontinence later in life than non-athletes? Scand J Med Sci Sports. 2010;20(1):100–4.

    Article  Google Scholar 

  11. Hannestad YS, Rortveit G, Daltveit AK, Hunskaar S. Are smoking and other lifestyle factors associated with female urinary incontinence? The Norwegian EPINCONT Study Bjog. 2003;110(3):247–54.

    Google Scholar 

  12. Townsend MK, Danforth KN, Rosner B, Curhan GC, Resnick NM, Grodstein F. Physical activity and incident urinary incontinence in middle-aged women. J Urol. 2008;179(3):1012–6; discussion 6–7.

  13. Bo K. Urinary incontinence, pelvic floor dysfunction, exercise and sport. Sports medicine (Auckland, NZ). 2004;34(7):451–64.

    Article  Google Scholar 

  14. Kruger JA, Murphy BA, Heap SW. Alterations in levator ani morphology in elite nulliparous athletes: a pilot study. Aust N Z J Obstet Gynaecol. 2005;45(1):42–7.

    Article  Google Scholar 

  15. Kruger JA, Dietz HP, Murphy BA. Pelvic floor function in elite nulliparous athletes. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2007;30(1):81–5.

    Article  CAS  Google Scholar 

  16. Arbieto ERM, Dos Santos KM, da Luz SCT, Da Roza T. Comparison of urinary incontinence, based on pelvic floor and abdominal muscle strength, between nulliparous female athletes and non-athletes: a secondary analysis. Neurourol Urodyn. 2021;40(5):1140–6.

    Article  Google Scholar 

  17. Machado LDS, Marques Cerentini T, Laganà AS, Viana da Rosa P, Fichera M, Telles da Rosa LH. Pelvic floor evaluation in CrossFit® athletes and urinary incontinence: a cross-sectional observational study. Women Health. 2021;61(5):490–9.

  18. Bo K, Stien R, Kulseng-Hanssen S, Kristofferson M. Clinical and urodynamic assessment of nulliparous young women with and without stress incontinence symptoms: a case-control study. Obstet Gynecol. 1994;84(6):1028–32.

    CAS  Google Scholar 

  19. Da Roza T, Brandao S, Mascarenhas T, Jorge RN, Duarte JA. Volume of training and the ranking level are associated with the leakage of urine in young female trampolinists. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine. 2015;25(3):270–5.

    Article  Google Scholar 

  20. de Melo SR, Rodrigues MES, Puga GM, Dionisio VC, Baldon VSP, Resende APM. The relationship between running kinematics and the pelvic floor muscle function of female runners. Int Urogynecol J. 2020;31(1):155–63.

    Article  Google Scholar 

  21. Dos Santos KM, Da Roza T, Mochizuki L, Arbieto ERM, Tonon da Luz SC. Assessment of abdominal and pelvic floor muscle function among continent and incontinent athletes. Int Urogynecol J. 2019;30(5):693–9.

  22. Bauer SB, Vasquez E, Cendron M, Wakamatsu MM, Chow JS. Pelvic floor laxity: a not so rare but unrecognized form of daytime urinary incontinence in peripubertal and adolescent girls. J Pediat Urol. 2018;14(6):544.e1–.e7.

  23. Wikander L, Kirshbaum MN, Gahreman DE. Urinary incontinence and women CrossFit competitors. Int J Womens Health. 2020;12:1189–95.

    Article  Google Scholar 

  24. Eliasson K, Larsson T, Mattsson E. Prevalence of stress incontinence in nulliparous elite trampolinists. Scand J Med Sci Sports. 2002;12(2):106–10.

    Article  CAS  Google Scholar 

  25. Ree ML, Nygaard I, Bo K. Muscular fatigue in the pelvic floor muscles after strenuous physical activity. Acta Obstet Gynecol Scand. 2007;86(7):870–6.

    Article  Google Scholar 

  26. Russek LN. Hypermobility syndrome. Physical Therapy. 1999. 1999/06//:591.

  27. Beighton P, Solomon L, Soskolne CL. Articular mobility in an African population. Ann Rheum Dis. 1973;32(5):413–8.

    Article  CAS  Google Scholar 

  28. Mountjoy M, Sundgot-Borgen J, Burke L, Carter S, Constantini N, Lebrun C, et al. The IOC consensus statement: beyond the female athlete triad–relative energy deficiency in sport (RED-S). Br J Sports Med. 2014;48(7):491–7.

    Article  Google Scholar 

  29. • Whitney KE, Holtzman B, Cook D, Bauer S, Maffazioli GDN, Parziale AL, et al. Low energy availability and impact sport participation as risk factors for urinary incontinence in female athletes. Journal of pediatric urology. 2021;17(3):290.e1-.e7. Identifies both low energy availability and high-impact sports as independent risk factors for UI in a large cohort of nulliparous female athletes.

  30. Ng QX, Lim YL, Loke W, Chee KT, Lim DY. Females with eating disorders and urinary incontinence: a psychoanalytic perspective. Int J Environ Res Public Health. 2022;19(8).

  31. Alperin M, Burnett L, Lukacz E, Brubaker L. The mysteries of menopause and urogynecologic health: clinical and scientific gaps. Menopause. 2019;26(1):103–11.

    Article  Google Scholar 

  32. Gouttebarge V, Castaldelli-Maia JM, Gorczynski P, Hainline B, Hitchcock ME, Kerkhoffs GM, et al. Occurrence of mental health symptoms and disorders in current and former elite athletes: a systematic review and meta-analysis. Br J Sports Med. 2019;53(11):700–6.

    Article  Google Scholar 

  33. Vrijens D, Drossaerts J, van Koeveringe G, Van Kerrebroeck P, van Os J, Leue C. Affective symptoms and the overactive bladder — a systematic review. J Psychosom Res. 2015;78(2):95–108.

    Article  Google Scholar 

  34. Beck RP, Arnusch D, King C. Results in treating 210 patients with detrusor overactivity incontinence of urine. Am J Obstet Gynecol. 1976;125(5):593–6.

    Article  CAS  Google Scholar 

  35. Hindmarsh JR, Gosling PT, Deane AM. Bladder instability. Is the primary defect in the urethra? Br J Urol. 1983;55(6):648–51.

  36. Chapple CR, Helm CW, Blease S, Milroy EJ, Rickards D, Osborne JL. Asymptomatic bladder neck incompetence in nulliparous females. Br J Urol. 1989;64(4):357–9.

    Article  CAS  Google Scholar 

  37. Thyssen HH, Clevin L, Olesen S, Lose G. Urinary incontinence in elite female athletes and dancers. Int Urogynecol J Pelvic Floor Dysfunct. 2002;13(1):15–7.

    Article  CAS  Google Scholar 

  38. Rodríguez-López ES, Calvo-Moreno SO, Basas-García Á, Gutierrez-Ortega F, Guodemar-Pérez J, Acevedo-Gómez MB. Prevalence of urinary incontinence among elite athletes of both sexes. J Sci Med Sport. 2021;24(4):338–44.

    Article  Google Scholar 

  39. •• Dakic JG, Hay-Smith J, Cook J, Lin KY, Calo M, Frawley H. Effect of pelvic floor symptoms on women’s participation in exercise: a mixed-methods systematic review with meta-analysis. J Orthop Sports Phys Ther. 2021;51(7):345–61. Meta-analysis of the effects of pelvic floor symptoms on exercise; identifies evidence gap for elite athletes.

    Article  Google Scholar 

  40. Dakic JG, Cook J, Hay-Smith J, Lin KY, Frawley H. Pelvic floor disorders stop women exercising: a survey of 4556 symptomatic women. J Sci Med Sport. 2021.

  41. Carvalhais A, Natal Jorge R, Bø K. Performing high-level sport is strongly associated with urinary incontinence in elite athletes: a comparative study of 372 elite female athletes and 372 controls. Br J Sports Med. 2018;52(24):1586–90.

    Article  Google Scholar 

  42. Wikander L, Kirshbaum MN, Waheed N, Gahreman DE. Urinary incontinence in competitive women weightlifters. J Strength Cond Res. 2021.

  43. Rzymski P, Burzyński B, Knapik M, Kociszewski J, Wilczak M. How to balance the treatment of stress urinary incontinence among female athletes? Arch Med Sci. 2021;17(2):314–22.

    Article  CAS  Google Scholar 

  44. Glavind K. Use of a vaginal sponge during aerobic exercises in patients with stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 1997;8(6):351–3.

    Article  CAS  Google Scholar 

  45. Sorrigueta-Hernández A, Padilla-Fernandez BY, Marquez-Sanchez MT, Flores-Fraile MC, Flores-Fraile J, Moreno-Pascual C, et al. Benefits of physiotherapy on urinary incontinence in high-performance female athletes. meta-analysis. J Clin Med. 2020;9(10).

  46. Falah-Hassani K, Reeves J, Shiri R, Hickling D, McLean L. The pathophysiology of stress urinary incontinence: a systematic review and meta-analysis. Int Urogynecol J. 2021;32(3):501–52.

    Article  Google Scholar 

  47. Goldstick O, Constantini N. Urinary incontinence in physically active women and female athletes. Br J Sports Med. 2014;48(4):296.

    Article  Google Scholar 

  48. Elliott-Sale KJ, Tenforde AS, Parziale AL, Holtzman B, Ackerman KE. Endocrine effects of relative energy deficiency in sport. Int J Sport Nutr Exerc Metab. 2018;28(4):335–49.

    Article  CAS  Google Scholar 

  49. Ozbek E, Otunctemur A, Sahin S, Ozcan L, Dursun M, Polat E, et al. Low serum insulin like growth factor - 1 in patients with stress urinary incontinence. Int Braz J Urol. 2016;42(4):787–92.

    Article  Google Scholar 

  50. Dias N, Peng Y, Khavari R, Nakib NA, Sweet RM, Timm GW, et al. Pelvic floor dynamics during high-impact athletic activities: a computational modeling study. Clin Biomech (Bristol, Avon). 2017;41:20–7.

    Article  Google Scholar 

  51. Williams AMM, Sato-Klemm M, Deegan EG, Eginyan G, Lam T. Characterizing pelvic floor muscle activity during walking and jogging in continent adults: a cross-sectional study. Front Hum Neurosci. 2022;16: 912839.

    Article  Google Scholar 

  52. Brandão S, Parente M, Mascarenhas T, da Silva ARG, Ramos I, Jorge RN. Biomechanical study on the bladder neck and urethral positions: simulation of impairment of the pelvic ligaments. J Biomech. 2015;48(2):217–23.

    Article  Google Scholar 

  53. Peschers UM, Fanger G, Schaer GN, Vodusek DB, DeLancey JO, Schuessler B. Bladder neck mobility in continent nulliparous women. BJOG. 2001;108(3):320–4.

    CAS  Google Scholar 

  54. Schoenfeld BJ. The mechanisms of muscle hypertrophy and their application to resistance training. The Journal of Strength & Conditioning Research. 2010;24(10):2857–72.

    Article  Google Scholar 

  55. Balmforth JR, Mantle J, Bidmead J, Cardozo L. A prospective observational trial of pelvic floor muscle training for female stress urinary incontinence. BJU Int. 2006;98(4):811–7.

    Article  Google Scholar 

  56. Dankel SJ, Jessee MB, Mattocks KT, Mouser JG, Counts BR, Buckner SL, et al. Training to fatigue: the answer for standardization when assessing muscle hypertrophy? Sports medicine (Auckland, NZ). 2017;47(6):1021–7.

    Article  Google Scholar 

  57. Deffieux X, Hubeaux K, Lapeyre E, Jousse M, Sheikh Ismael S, Thoumie P, et al. Perineal neuromuscular fatigue. Ann Readapt Med Phys. 2006;49(6):413–7.

    Article  Google Scholar 

  58. Huang W-C, Yang J-M. Bladder neck funneling on ultrasound cystourethrography in primary stress urinary incontinence: a sign associated with urethral hypermobility and intrinsic sphincter deficiency. Urology. 2003;61(5):936–41.

    Article  Google Scholar 

  59. Green TH Jr. Development of a plan for the diagnosis and treatment of urinary stress incontinence. Am J Obstet Gynecol. 1962;83:632–48.

    Article  Google Scholar 

  60. Abrams P. Describing bladder storage function: overactive bladder syndrome and detrusor overactivity. Urology. 2003;62(5, Supplement 2):28–37.

  61. Petros PP, Konsky BV. Anchoring the midurethra restores bladder-neck anatomy and continence. The Lancet. 1999;354(9183):997–8.

    Article  CAS  Google Scholar 

  62. McGuire EJ, Lytton B, Kohorn EI, Pepe V. The value of urodynamic testing in stress urinary incontinence. J Urol. 1980;124(2):256–8.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

Special thanks to Robin Noel for assistance with figure graphics.

Author information

Authors and Affiliations

  1. Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, 3rd Floor West Pavilion, Perelman Center for Advanced Medicine, Philadelphia, PA, 19104, USA

    Zoe S. Gan & Ariana L. Smith

Authors
  1. Zoe S. Gan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ariana L. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zoe S. Gan.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Lower Urinary Tract Symptoms and Voiding Dysfunction

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gan, Z.S., Smith, A.L. Urinary Incontinence in Elite Female Athletes. Curr Urol Rep 24, 51–58 (2023). https://doi.org/10.1007/s11934-022-01133-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11934-022-01133-6

Keywords

Search

Navigation