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Factors Associated With Urinary Incontinence in Nulliparous Female Elite Athletes: An Exploratory, Cross-Sectional
Zoe S Gan1, Karthik Sundaram2, Ariana L Smith1
1Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
The Journal of Urology
|January 27, 2025
Summary
Urinary incontinence in elite female athletes is linked to pelvic floor muscle hypertrophy and disordered eating. Dynamic MRI revealed anatomical differences in symptomatic athletes, suggesting a multifactorial cause for their urinary symptoms.
Area of Science:
- Urology
- Sports Medicine
- Pelvic Floor Imaging
Background:
- Urinary incontinence (UI) is prevalent among nulliparous female elite athletes, yet its underlying causes remain unclear.
- Existing research lacks comprehensive understanding of the pelvic floor anatomy and function in this specific demographic.
Purpose of the Study:
- To investigate urinary symptoms and associated pelvic floor anatomy and function in nulliparous female elite athletes.
- To determine if athletes with UI exhibit pelvic floor characteristics similar to older incontinent women or those related to intense athletic training.
Main Methods:
- A cross-sectional study involving NCAA Division 1 nulliparous female athletes, comparing symptomatic and asymptomatic groups.
- Assessment included validated questionnaires for urinary and genitourinary pain symptoms, pelvic examination, and dynamic MRI to evaluate pelvic floor structures at rest and during strain.
- Pelvic floor anatomical structures were segmented and analyzed from MRI data.
Main Results:
- Symptomatic athletes reported significantly worse urinary symptoms and genitourinary pain compared to asymptomatic athletes.
- Greater anterior thickness of the striated urethral sphincter, puborectalis, and levator ani muscles was observed in symptomatic athletes.
- Symptomatic athletes also showed higher scores for disordered eating, as measured by the Brief Eating Disorder in Athletes Questionnaire.
Conclusions:
- Dynamic pelvic MRI revealed distinct pelvic floor anatomical differences in nulliparous female elite athletes experiencing UI.
- These anatomical variations, alongside factors like muscle hypertrophy and disordered eating, may contribute to the multifactorial etiology of UI in this population.
