Urinary incontinence (UI) is prevalent among elite sportswomen, particularly those engaged in high impact sports and with long hours of training [1]. Research has indicated that there is a need for sports-specific research on UI and female athletes, and a need to incorporate a qualitative component to investigate female athletes’ experiences of UI [1, 2, 3]. This current study is the quantitative component of a mixed-methods study investigating pelvic floor dysfunction in elite female Gaelic (Irish) sports athletes (elite Camogie players and Ladies Gaelic Football players). Gaelic team sports involve two 15-member teams, playing on a large grass pitch, aiming to score points over the bar and goals under the bar of ‘H shape’ goalposts. Ladies Gaelic Football involves kicking and/or handpassing a round football and Camogie involves playing using a hurley (stick) and a sliotar (small, hard, leather covered ball). County team players represent the elite athletes in this sport. This study’s main aim is to identify the prevalence and experience of UI among elite Gaelic sportswomen.

Design: Cross-sectional study
Methods:  All elite female Gaelic sports athletes who were 18 years or older and were playing at county level were invited to participate. An online self-administered anonymous questionnaire was developed in Qualtrics© and the validity and reliability of the survey instrument was established. The questionnaire comprised of three sections. Section One sought participants’ background demographic information, Section Two investigated the players’ knowledge regarding pelvic floor muscles (PFMs) and pelvic floor muscle training (PFMT) as well as the prevalence of UI using the International Consultation on Incontinence Questionnaire-UI Short Form Questionnaire (ICIQ-UI-SF). In addition, this section included questions regarding the players’ experiences of UI, the triggers regarding UI during their sporting and daily life, and the strategies used to manage UI. Finally, Section Three included questions concerning the players’ sports activity, injury, and medical history. The survey link was circulated to players by the Gaelic Players Association (GPA) and was made available to the county Camogie players at the end of the 2020 intercounty season (late November until mid-December) which had been delayed due to the Covid-19 pandemic and to both county Camogie and Ladies Gaelic Football players for the 2021 season (May to September). Descriptive statistics were used to identify prevalence, frequencies and means (SD). The normality of continuous data was evaluated, and Chi-square/Fischer’s exact test and the Mann-Whitney U test were used to evaluate differences between sports and to compare risk factors and background characteristics of players with and without UI. Logistic regression analysis reporting Odds Ratios, 95% Confidence Intervals (CIs) was conducted to further evaluate risk factors for UI.

A total of 185 players (102 Camogie Players and 83 Ladies Gaelic Football Players) completed the online survey. The mean (SD) age of the players was 25(5) years, and the majority were nulliparous (95.3%). 
Over half of the players (55%, 101/185) said that they know where the PFMs are and two fifths (40.5%, 75/185) of players said they had learned about PFMT. However, approximately one quarter (26%, 48/185) reported that they were confident in doing PFMT and only 13% (24/185) had performed PFMT within the last four weeks. Two thirds (65%, 49/75) of those who had learned about PFMT did so from a health professional. 
The ICIQ-UI-SF was completed by 159 players and the overall UI prevalence was 61.6% (98/159), 52.0% (n=51/98) of whom experienced stress urinary incontinence (SUI). The mean (SD) ICIQ-UI-SF total score for those with UI was 6.1 (3.4) suggesting moderate severity, and the mean (SD) everyday life (EDL) Interfere score 2.3 (2.3) indicated a relatively low impact on the players’ daily life.
There was a statistically significant association between UI and longer weekly sporting activity time (OR 1.05, 95% CI 1.002 to 1.008, p=0.002) and parous players were more likely to experience UI compared to nulliparous players (p=0.025). Jumping and sprinting activities were the most commonly reported triggers for UI (Figure 1) with pre-voiding and wearing protection (liners, pads) the most commonly adopted strategies to manage UI (Figure 2). 
Approximately one quarter (24%, 19/78) of players who reported UI said they had spoken about their UI with another person. Most commonly, players spoke to family (68%, 13/19) or friends (58%, 11/19). Only ten players received treatment for their UI, and this was most commonly in the form of PFMT. Eight of the ten players received treatment for their UI from a physiotherapist, six from a gynaecologist, three from a GP and one from a nephrologist.

A high prevalence of UI was reported among the elite female Gaelic sports athletes, and this may be unsurprising due to the physical nature of both sports. Longer average weekly time of sporting activity was associated with increased prevalence of UI (p=0.002). Despite the high prevalence of UI, the impact on players’ everyday life appeared to be relatively low as may be expected in a young and predominantly nulliparous group of players. Few players had performed PFMT in the last four weeks suggesting a need for education around PFMT in these sportswomen.
High impact activities such as jumping and sprinting were the most commonly reported triggers for UI. Few players discussed their UI with anyone, and the majority used strategies to try to manage their symptoms of UI and few sought treatment. Once again this suggests a need for education regarding pelvic floor health and UI among the players.

UI is prevalent among elite female Gaelic sports athletes.  Findings of this study also suggest a need for education regarding pelvic floor health and urinary incontinence and the treatment options available among these elite female Gaelic sports athletes.

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Continence 12S (2024) 101347
DOI: 10.1016/j.cont.2024.101347