Urinary incontinence (UI) is prevalent among sportswomen, particularly those engaged at an elite level, in high impact sports and with long hours of training and the need for sports-specific research has been identified [1, 2]. In addition, a need for the incorporation of a qualitative component in future research investigating elite sportswomen’s experiences of UI was also identified [3]. This current study is part of a larger mixed methods study investigating pelvic floor dysfunction in female Gaelic (Irish) sports athletes. Ladies Gaelic Football is a Gaelic team sports where two 15-member teams, playing on a grass pitch, aim to score points and goals by kicking and/or handpassing a round football. There are 32 county teams in Ireland that play Ladies Gaelic Football at an elite level. This study’s main aim is to identify the prevalence and experience of UI among elite Ladies Gaelic Football players.

Design: A cross-sectional study
Methods:  All elite Ladies Gaelic Football players who were 18 years or older and were playing at county level were invited to participate. An online self-administered anonymous questionnaire was developed and the survey link was circulated to players by the Gaelic Players Association (GPA) during the 2021 Gaelic football season. The questionnaire was administered via Qualtrics and comprised of three sections. Section One sought participants’ demographic information. Section Two included questions on participants’ knowledge concerning pelvic floor muscles (PFMs) and pelvic floor muscle training (PFMT). This section also ascertained prevalence of UI among the players using the International Consultation on Incontinence Questionnaire-UI Short Form Questionnaire (ICIQ-UI-SF), their experiences of UI and the management strategies, and triggers concerning UI during training, matches and daily life. Section Three included questions concerning the players’ medical history, injury history and sports history. Validity and reliability of the survey instrument was established. Descriptive statistics were used to identify prevalence, means and frequencies, and the Mann-Whitney U test was used to assess the influence, if any, of the average weekly time engaged in training and matches on the prevalence of UI.

A total of 83 County Ladies Gaelic Football players eligible to participate in this study completed the online survey. The mean age of the players was 25.16 +/- 3.99 years [range 19 to 34 years], and the majority (94.52%) were nulliparous.
Eighty players completed the ICIQ-UI-SF and UI prevalence was 63.75% (n=51/80). The mean ICIQ-UI-SF total score for those with UI was 6.04 +/-3.50 suggesting moderate severity, and the everyday life (EDL) Interfere score 2.33 +/- 2.69 indicated a relatively low impact on the players’ daily life. Players experiencing UI reported longer average weekly minutes of sporting activity compared to players who reported that they did not experience UI (U= 200.200, z= -2.439, p=0.015).
Almost two-thirds (63.9%, n=53/83) knew where the PFMs are, less than half (45.8%, n=38/83) had learned about PFMT, half of whom (50%, n=19/38) stated that they had learnt about them from a physiotherapist. Almost two-thirds (63.16%, n=24/38) felt confident that were performing PFMT correctly. Only 8.4% (7/83) reported that they had performed PFMT within the last four weeks.
Four-fifths of players (80.39%, n=41/51) used strategies to manage or mitigate their UI symptoms with the most frequently reported being going to the toilet before or during particular activities (65.85% (n=27/41) (Figure 1).
Less than one-fifth (17.65%, n=9/51) of those with UI talked to another person about their UI and, most commonly, the players spoke to family or friends (88.89%, n=8/9; 55.56%, n=5/9, respectively).  Only two of these nine players talked with a health professional (physiotherapist).
A minority (7.84%, n=4/51) of those with UI received treatment. The health care professionals consulted were physiotherapists and gynaecologists, and the treatment offered involved PFMT.
Forty-nine players with UI responded to the question on triggers for UI during their sporting activity. Of these, almost two-thirds (61.22%, n=30/49) experienced UI at particular times during their sporting activity with the most frequently reported trigger involving jumping activities (66.67%, n=20/30).

A high prevalence of UI was reported among the County Ladies Gaelic Football players, and this may not be surprising due to the physical nature of the sport which involves running, jumping, catching, passing and kicking a ball over a large 145m x 90m pitch. Longer average weekly minutes of sporting activity was associated with increased prevalence of UI (p=0.015). Despite the high prevalence, the impact of UI on the players’ everyday life appeared to be relatively low which is as expected in a predominantly nulliparous group of players. Whilst many players knew where the PFMs are, not all were confident in performing PFMT and very few had been doing PFMT in the last four weeks. All of these data suggest a need for education around PFMT in these sportswomen.
The players reported triggers for UI during their sporting activity. The majority used strategies to try to manage and mitigate the symptoms of their UI whilst few discussed their UI or sought help for what is a treatable condition. Once again, this suggests a need for education regarding pelvic floor dysfunction among the players and highlights the need to address women’s health in sport.

UI is prevalent among County Ladies Gaelic Football players.  This study suggests a need for education regarding pelvic floor health and dysfunction and the treatment options available among County Ladies Gaelic Football players.

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