The prevalence and experience of urinary incontinence among elite female Gaelic sports athletes

Abstract

Background: Research has indicated that that the prevalence of urinary incontinence (UI) is greater among female athletes compared to their non-athletic counterparts. In addition, there appears to be a paucity of research, and in particular qualitative research, into the experience of UI among elite female athletes. Design: A sequential explanatory mixed methods study design. Aims and Objectives: The primary aim of this research was to investigate the prevalence, severity, experience and impact of UI among elite female Gaelic sports athletes. Sample: A total of n=185 elite female Gaelic sports athletes responded to an online survey. One-to-one interviews were conducted with nine elite female Gaelic sports athletes. Methods: A sequential explanatory mixed methods design, underpinned by a philosophy of pragmatism, was employed and involved three studies. The first study was a mixed methods systematic review that reported the experiences of symptoms of pelvic floor disorders (PFDs) including UI among elite female athletes. Study 2 was a cross-sectional, online survey involving elite female Gaelic sports athletes and Study 3 was a qualitative study that utilised semi-structured, one-to-one interviews with elite female Gaelic sports athletes who were aged 18 years. Findings: The systematic review identified five themes from the research literature and found that there was limited qualitative evidence regarding elite female athletes' experience of UI. The prevalence of UI was high (61.6%) among the elite Gaelic sports athletes, and the severity of UI was moderate (mean (SD) ICIQ-UI-SF severity score = 6.1 (3.4)), however, the impact of UI on players' everyday life (EDL) was low. Stress urinary incontinence (SUI) was the most common type of UI reported. Players with a history of urinary tract infections (UTIs) (OR 3.015, 95% CI 1.071-8.490, p=0.037) and those reporting greater weekly minutes of sporting activity (OR 1.05, 95% CI 1.002-1.008, p=0.002) were statistically significantly more likely to experience UI. Four themes and nine subthemes were generated from the analysis of data from the players' interviews. The four themes were: 1. `Oh, that happened me' (The When and Why of UI); 2. `Then I can manage it that way' (What to do about UI); 3. `It is frustrating...and it bothers me' (Impact of UI) and 4. `No one ever talked' (Talking about UI). The most common triggers for UI were strenuous, high intensity, and high-impact activities such as jumping, landing and sprinting. Players used strategies to self-manage and contain their UI during their sporting activity including extra voiding, wearing protection and modifying or changing their clothing. Even though UI had emotional and physical impact on players, there appeared to be a reticence to disclose the extent of UI and players often minimised and normalised their UI and few sought treatment. Players spoke of not feeling confident in their knowledge of pelvic floor muscles (PFMs) nor how to perform pelvic floor muscle training (PFMT) effectively and expressed a desire for education. Most commonly, players spoke of experiencing emotions such as embarrassment, frustration, and worry because of their UI during sport. Conclusion: This research was the first to investigate the prevalence and experience of UI among elite female Gaelic sports athletes. A high prevalence of and risk factors for UI were identified among this cohort of elite female athletes. Despite the impact of UI on players, many were reticent to speak about the extent and experience of their UI during their sporting activity. Rather than discussing their UI with others, or seeking advice or treatment from a health professional, players instead used strategies to self-manage their UI. There appears to be a need for an education programme among the players, as well as those responsible for player welfare, that includes information regarding PFMs and PFMT, the condition of UI and the treatment options available and, how and where to access treatment.