Introduction
Materials and methods
Study design and protocol registration
Search strategy and selection criteria
Study selection and assessment of methodological quality
Data extraction and data analysis
Results
Selection and quality of the studies
Descriptive analyses of the studies excluding information relating to the reporting of experiences
Experiences of pelvic floor dysfunction
Study | Triggers for symptoms of PFD | Strategies adopted by athletes to manage/mitigate symptoms of PFD | Impact on QOL/daily life | Impact on performance | Impact on emotions |
---|---|---|---|---|---|
Almeida et al. 2016 [26] | Type sport in competition or training- UI- highest prevalence among the athletes who practiced artistic gymnastics and trampoline (88.9%) SUI-artistic gymnasts and trampolinists = 87% | 48% (32/67) of athletes used strategies to avoid UI "Emptying the bladder before training" was the most reported strategy-31.4% (10/32) | NR | NR | NR |
Cardoso et al. 2018 [27] | Training-UI in training in 61% (50/82) Competition- UI in competition 45% (37/82) | Strategies reported included: Hydric restriction-15% (12/82) Use of pad-12% (10/82) Sought medical assistance-4% (3/82) Sought physiotherapeutic care-0% Mentioned UI to trainer-0% | Slight impact-as measured by ICIQ-UI-SF, mean of 1.98 points for impact on QOL, reflecting a slight impact | Did not affect sports performance Most athletes considered UI did not affect their sports performance (no. % or n/n given) | NR |
Carls 2007, USA [23] | Type of movement/activity in sport- sports 14%, exercises-11.6%, jumping-6.9% and weightlifting-2.3% Coughing-11.6%; sneezing-6.9% Walking to bathroom with a strong urge-11.6% Hearing running water with urge-4.7% (n/n unspecified) | Avoided activities-8% reported avoiding hobbies, social activities, sports,and exercises because of their SUI Majority of athletes with UI did not speak to anyone about SUI-92% | Negative effect-16% with UI reported a negative effect on their social life, sports or exercise | NR | NR |
Carvalhais et al. 2017 [28] | Training-UI in training in 74.5% (82/110) Middle/end of training sessions-Of those reporting UI in training 84.1% (69/82) reported it happened at middle/end of training | 14.6% (12/82) athletes with UI used strategies to ‘reduce visible leakage’ Use of pad-75% (9/12) of those that used strategies reported wearing pads | NR | Affected sports performance– 39.1% (32/82) considered that UI affected sports practice | NR |
Carvalho et al. 2020 [29] | Training sessions-Of the cheerleaders who reported UI then 47.6% (10/21) reported UI during training | NR | NR | NR | NR |
Caylet et al. 2006 [30] | Training-34.1% (15/44) reported UI in training Second part of training sessions-86.67% (13/15) reported that it happened only in the second part of training Competition-38.6% (17/44) reported UI Second part of competitions-58.8% (10/17) UI only in the second part of competition | Majority of athletes did not speak to anyone about UI-84% (37/44) Spoke to trainer-0% Spoke to family doctor-2.2% (1/44) Spoke to sports doctor-2.2% (1/44) Spoke to family member-11.3% (5/44) | NR | NR | NR |
Da Roza et al. 2015 [31] | Training-UI in training-72.7% (16/22), all incontinent women stated that UL started only after they began trampoline training Higher ranking in sport- a positive association observed between higher ranking in the national championship and ICIQ score (r = 0.573, p = 0.05) | NR | Self-reported overall impact of UI on QOL was reported as “Not interfere” or “Interfering “mildly” by 68.8% (11/16) of the incontinent athletes Affected daily life-Only 1 athlete reported that loss of urine had a great effect in her daily life | NR | Embarrassment-athletes with higher training volumes felt more embarrassment and discomfort with urine leakage (no % or n/n given) |
Dobrowolski et al. 2020 [32] | Competition and Training (% and n = unclear) Type of movement/activity in sport-SUI occurred most often among these athletes when performing “double unders” 67% (36/54) and “triple unders” 86% (48/56) | Strategies used by retired RS with UI during RS (survey 2) Voiding before events-72% (46/64) Voiding between events-71% (45/63) Using containment, e.g. pads or tampons-38% (24/63) Limiting fluid intake-20% (12/61) Sought treatment for UI-0% Only one female athlete identified that SUI was one of eight reasons for retiring from RS | Slight impact of UI on QOL-median ICIQ-UI-SF score in incontinent athletes was 4 (IQR 3–6), indicating a slight impact of UI on their overall QOL | Affected sports performance-some athletes stopped participating in “double unders” and “triple unders” events because of SUI Attrition from participation in ‘double unders’ and ‘triple unders’ due to SUI was 6% in competition; 16% in practice | NR |
Dockter et al. 2007 [33] | Coughing, sneezing and/or laughing- 16.5% (n = 18/109) reported ‘sometimes’ or ‘frequently’ During physical exertion (lifting, running, jumping, abrupt movements) 16.5% (n = 18/109) reported ‘sometimes’, ‘often’ or ‘always’ UI urge to void (problem on way to toilet)-10.1% (11/109) | Prevention strategies used by-38.53% (42/109) Strategies Increase frequency of urination/go before event/run to bathroom-42.85% (18/42) Holding urine or avoiding laughing-16.67% (7/42) Doing nothing to prevent leakage-30.95% (13/42) Other (not defined)-9.52% (4/42) | NR | NR | NR |
Eliasson et al. 2002 [35] | End of the exercise session-Leakage during jumping (answered by 21 participants mainly: “at end of exercise session” 47.6% (n = 10/21), New, strenuous and difficult exercises-reported as triggers 38.1% (n = 8/21) Type of activity in sport- UI reported occurring ‘in double somersaults” 23.8% (n = 5/21) Women in leakage group had been training longer (p < 0.04) and more frequently(p < 0.03) | Strategies used by those with UI Protective pads-82.1% (23/28 with 12/23 of these always) Frequent toilet visits-(n/n unspecified) Limiting fluid intake-(n/n unspecified) | NR | NR | Embarrassment- 51.4% (18/35) athletes reported that they were embarrassed and considered the leakage a social or hygienic problem (61.1%, 11/18-very embarrassed”) |
Eliasson et al. 2008 [34] | Type of activity in sport- 28% (39/138) of athletes connected leakage with specific exercise- high jumps or somersaults especially double ones Training- athletes reported UI occurred more often during training (p = 0.022) Coughing, laughing- (numbers not specified); on way to the toilet- (numbers not specified); during other physical activities- (n/n unspecified) | Protective pads- 78 % (45/58) competitive athletes (CG) used sanitary pads, and this was significantly more than recreational group (RG) 43 % (34/80) (p < 0.001) Discussed their leakage- 72% (n = 99/138) of athletes (Competition Group & Recreation Group) had discussed their leakage with someone, most of them with friends, team coach or parents | Affected daily life-when experiencing UI during trampolining-36% (20/85) competitive athletes were affected in their daily life 61% (31/85) were affected psychologically | Affected sports performance- 12%, (n = 16/133) of athletes (Competition Group & Recreation Group) had stopped trampolining due to the leakage | NR |
Faulks & Catto 2021, [36] | Type of activity in sport- Being tackled- 67% (26/39) Sprinting- 61% (24/39) Jumping 54%- (21/39) Making a tackle- 49% (19/39) Changing direction while running-39% (15/39) Jogging-33% (13/39) Grappling or wrestling-31% (12/39) Scrummaging- 28% (11/39) Lifting- 23% (9/39) Throwing-21% (8/39) Catching- 18% (7/39) | NR | NR | Affected sports performance- 28% (11/39) reported effect of SUI on performance during game or training setting 5% (2/39) reported SUI as barrier to playing rugby union in the future | NR |
Ferreira et al. 2014 [37] | Training - experimental group/EG-87.5% (14/16), Control Group/CG-81.3% (13/16) Competition- EG-12.5% (2/16), CG-18.8% (3/16) | Protective pads- wearing pads EG, 68.8% & CG, 68.8%, (11/16) Voiding before sports- going to the bathroom prior to sport (EG, 87.5%,14/16; CG, 100% 16/16) Reducing liquids- reducing fluids prior to sport (EG, 56.3%, 9/16/; CG, 50.0%, 8/16) | NR | NR | NR |
Gram & Bo-2020 [38] | 34 athletes reported UI and 21 athletes SUI Of the 21 with SUI then: Physical Activity (PA)- UI on PA- 57.1% (12/21) Coughing & sneezing- UI in 9.5% (2/21) | NR | Mild interference on QOL-Mean score ICIQ-UI-SF UI interfering with daily life was 1.2 (SD 1.1) | Affected sports performance- UI affected sports performance- 70.6% (24/34) gymnasts with UI reporting that the condition had some affect | Fear- Of the 34 gymnasts with UI, 29.4% (10/34) reported to be afraid of visible leakage and 14.7% (5/34) that leakage would happen again |
Hagovska et al. 2018 [39] | Physical activity (PA)- slight UI on PA- in 6.14% sportswomen (n/n unspecified) | NR | Significant negative effect on QOL- Significant negative correlation was observed between SUI and the overall I-Qol questionnaire score (r = 0.522, p < 0.001) | Affected sports performance- Significantly worse parameters were recorded in the group of sportswomen (r = 0.648, p < 0.001) in the I-QoL in sub-scales ‘avoidance & limiting behaviour score’ | Embarrassment- Significantly worse parameters recorded in the sportswomen in the I-QoL in sub-scales- psychosocial impact score & social embarrassment score (p < 0.001) |
Jácome et al. 2011 [40] | 1.Questionnaire 41.5% (44/106) Urgent need to go to the bathroom- 43.1%, (19/44) Coughing-38.6%, (17/44) Practicing sport- 36.4%, (16/44) Sneezing- 31.8%, (14/44) Laughing- 31.8%, (14/44) 2. Focus group Activities requiring physical effort Jumping | 1.Questionnaire Discussed their leakage-38.6% 20.4% (9/44) discussed it with a friend, 11.4% (5/44) with a relative, 4.5% (2/44) with a health professional 2.3% with the team coach (1/44) 2. Focus group strategies used to limit UI Restriction of liquids, preventative urination Performance of physical activities in restricted way, sought help-no athlete in the focus group had sought help from a health professional for UI | 2. Focus group (n = 7) Despite their concerns about UI, the athletes stated that the condition had no current impact on their daily lives | 2. Focus group Affected sports performance- Resulted in ‘performance of physical activities in a restricted way’ | 2. Focus group When urine loss occurred, subjects reported being: Concerned Annoyed Frustrated Fearful ‘that a new activity might trigger another leakage’ (n/n unspecified) |
Larsen & Yavorek 2006 [41] | NR | Use of pad- only one woman reported using pads due to UI 3.6% (1/28) | None of the women felt that urine loss constituted a problem | NR | NR |
Ludviksdottir et al. 2018 [42] | Coughing & sneezing (n/n unspecified) | NR | 11/18 athletes with UI Disturbed daily life- scale 0-10 36.4 % (4/11) no disturbance 63.6% (7/11) score ≤ 5. | NR | NR |
Nygaard et al. 1994 [44] | Practice-UI 16% (23/144) Competition-16% (23/144) Type of movement/activity in sport- Jumping/legs apart (30%), Jumping with legs together (28%), Running (30%), Impact on floor during dismount/after flips 14%). Daily Activities (excluded leaking ‘rarely’) Coughing- 15%, sneezing- 6%, heavy
lifting- 3%, walking to the bathroom- 29%, sleeping- 6%, on hearing running water- 11% | Use of pad- Only one woman stated that she wore a pad because of the urine loss Discussed their leakage-(n/n unspecified) Almost half of the athletes discussed the incontinence with a teammate, < 5% had discussed the UI with a trainer, coach, physician, nurse or family member | NR | NR | Embarrassment- 38% of the athletes felt embarrassed Anxiety 22% describing anxiety, fear-6% expressed fear about the condition (n/n unspecified) |
Nygaard 1997 [43] | During Olympic sport High impact- 35.8% (19/53) Low impact- 4.5% (12/44) | Strategies during Olympic activity not recorded Current strategies-Use of pad (currently)-3 of the high-impact athletes and 1 of the low-impact athletes wearing a pad daily (n/n unspecified Discussed their leakage-4 athletes sought medical treatment for UI (n/n unspecified) | NR | Affected sports performance (currently)- athletes stopped an activity because of UI (n/n unspecified) | NR |
Pires et al. 2020 [53] | Coughing sneezing and running (as per KHQ Part II Q5)- 69.2% (9/16) of all athletes (both CG and EG) CG-Control group EG- Experimental group | NR | High QOL in participants- Pre-intervention the mean global score in the KHQ was low in both groups (CG: 8.80 ± 4.62; EG: 6.35 ± 5.19 in EG) indicating high QoL | Affecting physical activities (PAs) (pre-intervention) -69.2%, (9/13), responded ‘a little’, 7.7% (1/13) ‘moderately’ re bladder problem affecting PAs | NR |
Poswiata et al. 2014 [24] | NR | NR | Scale from 0–100, the degree to which the respondents found the UI symptoms bothersome- Not bothered -29.46% Slightly bothered 42.86% Moderately bothered -18.75% Significantly bothered 8.04% Heavily bothered- 0.89% (n/n unspecified) | NR | NR |
Rodríguez-López, 2021 [8] | Type of movement/activity in sport Trigger for leakage while training: Lifting weights- 9% (14/156) Running 19.2% (30/156) After running 4.5% (7/156) Jumping 43.6% (68/156) After jumping 2.6% (4/156) Trunk rotation 1.3% (2/156) Forward flexion 0.6% (1/156) Days spent training: In female athletes, weak correlation between UI and days of training/week (r = 0.104; p = 0.028) | NR | Severity of condition: ISI scores reported indicated that among female athletes with UI (n = 168): 3% (5/168) described condition as severe 28.6% (48/168) as moderate 68.5% (115/168) as slight | NR | NR |
Sandwith & Robert 2021 [45] | Competition and training Rugby game competition- 90% (46/51) Type of movement/activity in sport Tackled/hit- 88% (45/51) Running- 41% (20/51) Weight training- 18% (9/51) Time spent training Athletes who leaked urine reported more hours of training/week (p = 0.008). For every additional hour of training, the risk of UI increased by 15.3% (2.9%–29.3%, 95% CI) | Use of pad- None of the athletes disclosed use of any incontinence products or pads during exercise Discussed their leakage/Sought treatment- Only one athlete had discussed her UI with a health professional None of players had received any treatment for UI Several players 18% (9/51) were interested in receiving treatment for their urinary incontinence | Degree of bother associated with UI % Of players who reported that UI was ‘not a problem/only a small problem’: Rugby game competition- 100% (46/46) Tackled/hit- 98% (44/45) Running- 41% (20/20) Weight training- 100% (9/9) | NR | NR |
Skaug et al. 2020 [46] | Triggers for UI Type of movement/activity in sport (n = 82) Heavy lifting (1-5RM)- 78% (64/82) Deadlift- 63% (52/82) Squat- 56% (46/82) Weightlifting with belt- 34% (28/82) Clean lift- 13% (11/82) Weightlifting (>6 reps)- 12% (10/82) Power/explosive training- 12% (10/82) Bench Press- 2% (2/82), Snatch lift- 1% (1/82) Training& Competition- - Most women with SUI reported UI during training- 91.5% (75/82) and more than half during competition 56.1% (46/82) Body mass index was the only factor found to have a significant positive association with SUI Triggers for AI Training and competition- Gas AI- 89.1% (123/138) experienced leakage during training or competition Liquid AI- 23.8% (14/59) Solid AI- 15.4% (2/13) Level of competition international level of competition was positively associated with AI Time spent training: AI-weightlifting training of <4 days per week had a significant negative association | Strategies to manage UI (n/82) Use of pad- 54.9% (45/82) reported the use of pads to protect against visible leakage and 7.3% (6/82) used intravaginal tampon Voiding before sports activity- 86.6 (71/82) voiding before training or competition Restriction of fluids- 13.4% (11/82) decreased fluid intake Performance of PA in restricted way- 19.5% (16/82) reported they would occasionally avoid training or specific exercises because of UL Discussed their leakage/sought treatment- 25.6% (21/82) had never spoken about the condition with anyone Pelvic floor muscle training (PFMT)- 42.8% (77/180) women did not know why and 44.4% how (80/180) to train the PFM 78.3% (141/180) women responded they would do PFM training to prevent or treat PFD if they knew how | Degree of bother associated with UI ICIQ-UI-SF -Mean impact of UI on daily activities was 1.8 (SD: 2.0, range: 0–9), with 11 (12.2%) scoring ≥ 5 Degree of bother associated with AI Of women reporting AI, the mean bother of accidental loss of gas, liquid and solid stool was 2.3 (SD: 2.5, range: 0–9), 2.0 (SD: 2.5, range: 0–9) and 2.2 (SD: 2.8, range: 0–9), respectively The percentage of women scoring ≥ 5 on bother was Gas AI- 15.9% (22/138) Liquid stool- 15.3% (9/59) Solid stool- 15.4% (2/13) | Affected sports performance – 87.8% (72/82)) of those with SUI reported a negative effect of UI on sports performance | Impact of SUI Loss of concentration- 51% (42/82) Fear of visible leaking- 59% (48/82) Fear of Urine odour- 34% (28/82) Embarrassment- 33% (27/82) Negative effect on performance- 27% (22/82) Feeling frustrated, annoyed or worried- 24% (20/82) Fear of leakage happening- 23% (18/82) Making more mistakes -13% (11/82) |
Skaug et al. 2022 [47] | Triggers for UI Type sport -Proportion of SUI was significantly lower in cheerleaders compared to artistic gymnasts (and team gymnasts (p < 0.001) Type of movement/activity in sport (n = 210) Running- 4% (8/201) Jumping- 50% (101/201) Take-off to a gymnastic or acrobatic element- 67% (135/201) Land from a gymnastic or acrobatic element- 60% (121/201) In air during a gymnastic or acrobatic element- 13% (26/201) Trampoline or trampolette- 51% (103/201) Training& Competition- Most athletes with SUI reported leakage during training – 98% (198/201) 44.8% during competition (90/201) Triggers for AI Years with specialization in gymnastics/cheerleading was the only variable found to be positively associated with AI Training and competition- Gas- 87.6% (227/259) experienced leakage during training and/or competition: 38.2% (99/259) rarely, 35.1% (91/259) occasionally, 12% (31/259) often and 2.3% (6/259) all the time Liquid AI- 22.3% (29/130) experienced leakage during training and/or competition; 18.5% (24/130) rarely and 3.8% (5/130) occasionally Solid AI- 17.9% (7/39) reported leakage during training/competition, all experienced it rarely | Strategies to manage UI (n/201) Use of pad- 28.4% (57/201) reported use of pads to protect against visible leakage and 4.5% (9/201) used intravaginal tampon Voiding before sports activity- 66.7% (134/201) prevoiding training/competition Restriction of fluids- 8.5% (17/201) decreased fluid intake Performance of PA in restricted way- 22.4% (45/201) reported they would occasionally avoid training or specific exercises because of UL Discussed their leakage/sought treatment- 26.4% (53/201) had never spoken about UI 13 (6.5%) had spoken with their coach and 12 (6.0%) with health care personnel, 115(57.2%) had spoken about UI with their teammates, 76 (37.8%) with friends and 40 (19.9%) with a parent Pelvic floor muscle training (PFMT)- 0.9% (3/319) reported they did or had tried PFMT 41.4% (132/319) of the athletes had never heard about the PFM. 73.7% (230/319) women responded they would do PFMT to prevent or treat PFD if they knew how 12.2% (39/319) of the athletes reported that they had heard about the PFM from their coach, 10% (32/319) (from teammates, 19.1% (61/319) from health personnel and 16.9% (54/319) from other sources (friends, siblings or parents) The mean self-rated knowledge of the PFM was 1.5 (SD: 1.7) of 10. Thirty-two (10.0%) knew how and 58 (18.2%) why to train the PFM | Impact on daily life associated with UI ICIQ-UI-SF score mean impact of UI on daily activities was 2.5 (SD: 2.4, range: 0–10), with 46 (21.4%) scoring ≥ 5 AI Of females reporting AI, mean bother of accidental loss of gas, liquid and solid stool was 3.0 (SD: 2.6, range: 0–10), 2.3 (SD: 2.3, 0–10) and 2.4 (SD: 2.4, range The number of athletes scoring ≥ 5 on bother 0–10) was respectively: Gas AI – 26.6% (69/259) Liquid stool- 15.4% (20/130) Solid stool- 15.4% (6/39) | Affected sports performance – 82.6% (166/201) of those with SUI reported a negative effect of UI on sports performance | Impact of SUI Fear of visible leaking- 66% (133/201) Embarrassment- 65% (131/201) Fear of Urine odour- 51% (103/201) Fear of leakage happening- 39% (78/201) Loss of concentration- 31% (62/201) Feeling frustrated, annoyed or worried- 29% (58/201) Negative effect on performance- 18% (9/201) Making more mistakes -11% (22/201) Impact of SUI Fear of bowel leakage happening- 49% (13/) reported that they sometimes or more often were worried about bowel leakage |
Thyssen et al. 2002 [25] | Training and competition- UI in training- 95.2% (119/125) UI during competition- 51.2% (64/125) | Use of pad- 60.2% (91/151) occasionally wore a pad/shield Restriction of fluids- 6.6% (10/151) reduced liquid intake to reduce UL Discussed their leakage/sought treatment- Only 3.3% (5/151) discussed UI with their doctor Pelvic floor muscle training (PFMT)- 4.6% (6/151) had completed a pelvic floor training program because of UI | 33.8% (51/151) considered the UL as a problem 21.1% (32/151) as a hygienic problem | NR | NR |
Velázquez-Saornil et al. 2021 [48] | Training and competition- Leakage caused by exercise or physical exertion accounts for 64.3% Type of sport/athletics- (No significant relationship UI/sporting discipline) Greatest number of athletes with UI practice long-distance running, represented by 32.1% of all women experiencing UI Jumping events lowest percentage 10.7% UI | Use of pad- 58.6% (17/28) of women use protection 39.3% (11/28) wet their underwear | 0% of athletes considered that UI affected their daily life | 46.4% (13/28) were affected in their sporting environment | Anxiety/depression- 14.3% (4/28) |
Wikander et al. 2019 [49] | UI- Training and competition lifts (n/n unspecified) Voluntary comments by 27 women Type of activity in sport-Deadlifts- 40.7% (n = 11), squats- 18.51% (5/27) front squats- 7.4% (2/27) Wearing a belt lifting- 18.51% (5/27) End of sets-14.8% (4/27) UI moderate to heavy weights Heavier weights-51.9% (14/27) UI with very heavy/maximal weights Activity outside sport-Jumping- 14.8% (4/27) Sneezing- 7.4% (2/27) | Strategies to control or minimise UI Pelvic floor exercises- 7.4% (2/27) Not wearing a belt- 7.4% (2/27) Prophylactic voiding- 11.1% (3/27) Improving their diet 3.7% (1/27) | NR | NR | NR |
Wikander et al. 2020, [50] | Training and competition- UI during competition 32.1%, (145/452) Training 37.4% (169/452) 38.3% (n = 173/452) experienced UI during training and/or competition as well as daily life 17.7% (80/452) experienced UI during training and/or competition but NOT in daily life Type of movement/activity in sport- High impact high repetition activities involving jumping and running activities most likely to cause UI - Jumping rope 39.16% (177/452), Double-unders 36.95% (167/452), Trampoline 25.00% (113/452), Running/Jogging 20.57% (93/452) Activities least likely to provoke UI were low impact, body weight activities such as lunges UI during high repetition sets- 28.7% (N = 60/208) End of session 50% (30/60) indicated that UI was most likely to occur at the end of high repetition sets Intensity- 28.2% (N = 59/208) of incontinent women reporting UI during heavy sets | Pelvic floor muscle training (PFMT)- 73.6% (n = 153/208) of participants who had experienced UI at some point had never undergone a pelvic floor assessment. 26% (n = 54/208) of women who reported UI at some point in their life were not confident in their ability to correctly perform pelvic floor exercises | NR | NR | NR |
Wikander et al. 2021A [51] | Training and competition- 23.1% (111/480) had experienced ‘athletic incontinence’ 17.9% of women (86/480) had been continent before commencing powerlifting now UI in training or competition but not during everyday activities (Type 1 athletic incontinence) 5.2% (25/480) had UI before commencing powerlifting but are now continent during everyday activities while continuing to experience UI during training or competition (Type 2 athletic incontinence) Type of movement/activity in sport- 30.6% (147/480) experienced UI in competition during maximum lift attempts 40.4% (194/480) experienced UI in training during maximum lift attempts 12.5% (60/480) during sumo deadlifts 35.2% (169/480) during high repetition sets End of session- 64.5% (109/169) stated UI worse at end of sets Intensity- 79.3% (N = 134/169) indicated that UI was only an issue if the sets were heavy | Strategies to control or minimise UI were listed under the following headings (no. N = or % given): Bracing related- Modifying technique, ± belt use, ± PFEs Preparation/setup related- Blowing/exhaling prior to lift, pelvic floor lift, dynamic warmup/post-workout stretching routine Pelvic floor related- PFMT, pre-contraction of PF Technique/form/breathing related- exhaling during lift, ribcage positioning, bracing PFMs Other training related- Avoid wearing belt, frequent voiding, fluid restriction, take spare underwear to gym and competitions General- wear protection, physiotherapy treatment/PFMT/stretching/relaxation and massage, TENS, core exercises, avoid straining/certain activities/laughing, reducing caffeine Sought treatment- 20.9% (49/234) with UI had undergone a pelvic floor assessment Pelvic floor muscle training (PFMT)- 71.71% (344/480) of participants stated that they were either confident/very confident re PFEs | NR | NR | NR |
Wikander et al. 2021B [52] | Training and competition- 16.2% (31/191) of weightlifters reported ‘type one athletic incontinence’ 17.8%, (34/191) UI in competition i 25.7%, (49/191) UI in training 25.7%, (49/191) Type of movement/activity in sport- 57.1% (40/70) experienced urinary leakage during high repetition sets Max. effort lift in competition 16.8% (32/191) Max. effort lift in training 24.6%, (47/191) Wearing a belt provoked UI n 3.7% (7/191) Intensity- 67.5% (27/40) of these women indicated that leakage was only an issue if the sets were heavy End of session- 50% (20/40) who experienced UI during high repetition sets stated that the leakage was more likely to occur at the end of the set | Strategies to control/minimise UI (no. N =, % given) Antibiotics for recurring urinary tract infections, yoga and Pilates, emptying bladder before training and frequent urination during training sessions/competitions Engaging pelvic floor before lifting Focusing on breathing, bracing core before lifts, trying to not over brace, wearing a pad, using a tampon or avoiding the use of tampons, practicing pelvic floor exercises outside training, release work/massage, focus on pelvic mobility, core training, not overtightening belt, wearing dark-coloured clothing, maintain a low body mass, crossing legs before sneezing Sought treatment- 24.3% (17/70) of those with UI had undergone a pelvic floor assessment Pelvic floor muscle training (PFMT)- 77.1% (54/70) of those with UI stated that they were confident/very confident in their ability to perform pelvic floor exercises | NR | NR | NR |
Theme 1: Triggers for symptoms of PFD
Theme 2: Strategies adopted by athletes to manage/mitigate symptoms of PFD
Theme 3: Impact of PFD on QOL/daily life
Theme 4: Impact on performance
Theme 5: Impact on emotions
Discussion
Limitations
Conclusion
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The impact of PFD on elite female athletes’ emotions
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Why do many elite female athletes not discuss their PFD with others?
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Triggers for PFD reported by elite female athletes
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Strategies adopted by elite female athletes to manage/mitigate their PFD
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Why do many elite female athletes not seek help from a health professional?
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Do elite female athletes who limit their sporting activity due to PFD seek treatment?