REF-727 · Teixeira, Colla, Sbruzzi, Mallmann & Paiva, 2018 · International Urogynecology Journal, 2018 Dec;29 · Paper · PubMed
36% of female athletes leak urine, and athletes carry a 177% higher risk than sedentary women
The most under-asked question in coaching women
Key Findings
Ten databases plus manual reference search; observational studies of UI prevalence in female athletes published 2000-2016; quality assessed with the Downs and Black scale. Eight studies met eligibility; the pooled participant count is not given in the abstract.
Pooled prevalence of urinary incontinence in female athletes: 36%.
Compared with sedentary women, athletes had a 177% higher risk of presenting with urinary incontinence.
The proposed mechanism (background, not tested here) is mechanical: increased intra-abdominal pressure during high-impact exercise overloads the pelvic organs.
Urinary incontinence here means any involuntary loss of urine — not a clinical severity threshold.
The pooled figure is for female athletes across different sports; the abstract does not split it by parity. It is filed next to postpartum return-to-running (REF-569) because that is where the question often comes up.
Practical Application
Across 8 observational studies, 36% of female athletes in different sports reported urinary incontinence, and athletes had a 177% higher risk than sedentary women. Leaking on hard efforts is common, not an oddity — so ask.
Not from this paper; the base's own practice: ask it as a normal load question, not a medical interview — "does anything leak on hard efforts, jumps or coughing?" — alongside sleep and soreness, not singled out.
Inference, not tested: a sudden aversion to intervals, plyometrics or downhill running may be a symptom rather than low motivation.
It is treatable, and the treatment is trainable (REF-728: pelvic floor muscle training reduced leakage in a meta-analysis) — which is why asking matters.
⚠️ Refer out. Diagnosis and management belong to a pelvic-health physiotherapist or physician. A coach's job here is to ask, to normalise, to adjust load in the meantime, and to route — not to prescribe.
Limitations
Eight observational studies across different sports. A pooled 36% describes no single athlete. Not from this paper: REF-728 cites prevalence from 10.9% in cycling to 80% in trampoline gymnastics.
Inference, not tested: prevalence studies of a stigmatised symptom are prone to under-reporting.
Cross-sectional data cannot establish that training causes incontinence; the risk comparison with sedentary women is an association.
Parity, age and menopausal status are not separated out in the abstract's pooled estimate.
2018; sport-specific and postpartum-specific literature has grown since.
How this entry was checked and changed
Content correction 2026-09-27
Removed "including those who have never given birth" (the abstract does not split by parity) and "more common than most injuries" / "athletes self-modify in silence" (unsourced).
Lead rewritten as the pooled finding; interview wording labelled as the base's own practice, aversion-as-symptom and under-reporting labelled as inference.
Added search scope (2000-2016, Downs and Black); cycling/trampoline range attributed to REF-728 with its exact figures.