NEUROUROLOGY & FEMALE UROLOGY

Prevalence and Occurrence of Stress Urinary Incontinence in Elite Women Athletes
Caylet N, Fabbro-Peray P, Mares P, Dauzat M, Prat-Pradal D, Corcos J
Laboratory of Functional Exploration of the Nervous System, Nimes University Hospital Centre, Nimes, France
Can J Urol. 2006; 13: 3174-9

• Objective: 1) To assess the prevalence of stress urinary incontinence (SUI) and urge urinary incontinence (UTI) in elite women athletes versus the general female population, and 2) to analyze the conditions of occurrence of urine loss in search of etiological clues in elite athletes.
• Decision: An anonymous self-questionnaire was collected transversally from women aged 18 to 35 years. The exposed group was composed of elite female athletes; the non-exposed group was made up of women in the same age range accepting to answer the questionnaire.
• Results: A total of 157 answers from elite athletes and 426 from control subjects were available for analysis. Urinary incontinence prevalence was 28% for athletes and 9.8% for control subjects (p = .001). There was no significant difference in the relative prevalence of SUI between the athletes and control subjects. Athletes reported urine loss more frequently during the second part of the training session (p < 0.0003), and the second part of competition (p < 0.05). Urinary incontinence prevalence was 9.87% in physically-active control subjects versus 9.84% in sedentary control subjects (NS). Even a small quantity of urine loss was felt to be embarrassing. Most incontinent women did not dare to speak of their condition to anybody.
• Conclusions: There is a very high prevalence of urinary incontinence in women athletes. Detailed studies of the patho-physiology of this problem are necessary to formulate preventive recommendations.
  
  
• Editorial Comment
  As stated by the authors, this was an epidemiologic study of the presence of urinary incontinence in female athletes and a controls. The two groups were not age matched but fairly close. The authors found a statistically significant difference between athletes and physically active women with regards to the prevalence of urinary incontinence. Parity was not found to be a risk factor in the elite athlete study group. Of note, though both groups complained of incontinence, < 5% of either group wore any incontinence protection such as pads or shields. It seemed, as noted in the figures of the paper, that swimmers had one of the highest rates of urinary incontinence thus giving support to those who value highly chlorinated swimming pools. In addition, there are few among the readership who would challenge the athletes participating in the fight category to their claim of 0% of urinary incontinence. It would have been of interest for the authors to have included the incontinence rates in the subgroup of elite athletes participating in gymnastics and weightlifting: the internet has provided ample pictures of ill-timed episodes of urinary loss during weightlifting competitions. It was interesting to see that when looking at the group of women who participated in physical exercise but were not classified as nationally competitive athletes, that physical activity did not seem to be a risk factor for incontinence. It will be of keen interest to examine the rate of response to pelvic floor exercise and therapy in the group of elite level national athletes; will this highly disciplined and physically trained group have a higher success rate than the general population of patients which are seen in our usual practice.

Dr. Steven P. Petrou
Associate Professor of Urology
Chief of Surgery, St. Luke’s Hospital
Associate Dean, Mayo School of Graduate Medical Education
Jacksonville, Florida, USA