The aim of the present study was to evaluate the prevalence of urinary incontinence (UI) and analyse the impact of pelvic floor muscle training (PFMT) on urine loss in female football athletes.

This was a quasi-experimental study. The focus was a team of female football athletes, minimum age 18 years old, competing at a national second league level. Participants with history of previous pregnancy or gynaecological surgery were excluded. Being sexually active was a specific inclusion criterion for pelvic floor muscle (PFM) variables assessment and, having a urinary or vaginal infection and pain in the probe insertion were exclusion criteria. Data regarding general background variables: age, medical history, years of sports participation and volume of training (hours/week) were collected through hand delivery questionnaires. The International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) was applied to assess UI. To quantify urine loss a 20 min pad test was performed during football training activities and PFM variables (strength, endurance, and resting pressure) were assessed by manometry. The evaluations were performed at baseline and post completing the training protocol. The researcher who assesses PFM variables was blinded to continence status. An educational session was offered to all team members. Instructions and recommendations were given to perform correct PFM contraction. 
The PFMT was implemented in group sessions, during 10 weeks twice a week and was divided into three phases: 1) awareness and proprioceptive exercises of the PFM (2 weeks); 2) PFM strength and power training (4 weeks); 3) functional training with pre-timed PFM contraction prior to exerting intra-abdominal pressure (4 weeks).
The study was carried out according to the principles of the Helsinki Declaration and was approved by the football club head leaders. Written informed consent was obtained from all participants.
For statistical analysis, the Wilcoxon test or paired samples T-test was used. Significance level was set at p < 0.05.

Thirty-seven players were identified and 26 (70.3%) agreed to participate. Eighteen (69.2%) and 5 (19.2%) performed the pad test and the PFM variables evaluation, respectively. Table 1 shows the background variables and prevalence of UI among athletes.
Regarding the frequency of leakage, 8 (%) players reported that urine loss occurred about once a week or less often and 3 (%) two or three times a week. In all cases, urine loss was reported to be of a small amount. The median (IQR) overall impact of UI on everyday life was 1.0 (2.0). Six (54.5%) athletes referred urine loss during sports practice.

The present study included young nulliparous women with no comorbidities. High prevalence of UI, mainly SUI, was found in approximately half of the athletes. The results are in line with previous studies performed in athletes [1]. More than half of the athletes with UI reported urine leakage during sports practice suggesting that PFM endurance is required. Short-term fatigue of the PFM in women with stress urinary incontinence following 90 min of strenuous physical exercise has been reported [2].
After 10 weeks of PFMT program, PFM strength increased. No significant differences were found on PFM endurance and resting pressure. The amount of urinary leakage has significantly decreased. The effectiveness of PFMT on UI in a group of athletes has been previously reported [3].

Strengths of the present study are the use of validated instruments to assessed UI. The lower number of participants submitted to PFM variables evaluation may have influenced the results.

Urinary incontinence is high among female football players and should be assessed in competitive athletes. PFMT could be incorporated into their fitness and training programmes. More research is needed to determine optimal PFMT protocols for athletes. Sport team members should be aware of this frequent but under-reported complaint.

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Ree, M L, Nygaard, I E and Bø, K. Muscular fatigue in the pelvic floor muscles after strenuous physical activity. Acta Obstet Gynecol Scand. 2007;86:870–876.
Ferreira, S, Ferreira, M, Carvalhais, A, Santos, P C, Rocha P and Brochado G. Reeducation of pelvic floor muscles in volleyball athletes. Rev Assoc Med Bras. 2014;60(5):428-433.