Article Text

Performing high-level sport is strongly associated with urinary incontinence in elite athletes: a comparative study of 372 elite female athletes and 372 controls
  1. Alice Carvalhais1,2,3,
  2. Renato Natal Jorge3,4,
  3. Kari Bø5
  1. 1Department of Physiotherapy, CESPU, North Polytechnic Institute of Health, Paredes, Portugal
  2. 2Faculty of Sport, University of Porto, Porto, Portugal
  3. 3Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
  4. 4Faculty of Engineering, Department of Mechanical Engineering, University of Porto, Porto, Portugal
  5. 5Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
  1. Correspondence to Alice Carvalhais, Department of Physiotherapy, CESPU, North Polytechnic Institute of Health, Rua Central de Gandra, 1317, 4585-116 Gandra, Paredes, Portugal; acarvalhais{at}


Objective To evaluate the prevalence of urinary incontinence (UI) in female elite athletes compared with controls and to investigate potential risk factors for UI among elite athletes.

Methods This cross-sectional study included 372 elite athletes (athletes group, AG) and 372 age-matched controls (control group, CG). The median age was low (19 years) and the vast majority were nulliparous. Potential risk factors, including clinical, demographic and sports practice characteristics, were collected by using a questionnaire. The International Consultation on Urinary Incontinence Questionnaire-Urinary Incontinence-Short Form was applied to estimate the prevalence of UI. OR with 95% CIs were used to estimate the association with UI. The final model was adjusted for constipation, family history of UI and history of urinary infection.

Results The prevalence of UI was 29.6% and 13.4% in AG and CG, respectively (p<0.001). The following prevalences were obtained: AG: 19.6% and CG: 3.5% (p<0.001) for stress UI, AG: 3.8% and CG: 5.4% (p=0.292) for urgency UI and AG: 5.9% and CG: 0.8% (p<0.001) for mixed UI. After adjustment, performing high-level sport (adjusted (adj) OR=3.31; 95% CI 2.20 to 4.97), family history of UI (adj OR=1.54; 95% CI 1.04 to 2.29), history of urinary infection (adj OR=1.53; 95% CI 1.05 to 2.23) and constipation (adj OR=1.79; 95% CI 1.07 to 2.98) were associated with UI.

Conclusion The prevalence of UI among Portuguese female elite athletes is high and the odds of UI were three times higher than in controls. Also, constipation, family history of UI and history of urinary infections were significantly associated with UI.


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  • Contributors AC was involved in planning the study, reviewed and analysed the literature, wrote the paper, draft and approved the final version. RNJ critically revised the article and approved the final version. KB was involved in planning the study, critically revised the article and approved the final version.

  • Competing interests None declared.

  • Ethics approval Ethics Committee of the Faculty of Sports of the University of Porto (CEFADE 17.2014).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with 'BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.

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