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.