Stress urinary incontinence (SUI) is the involuntary loss of urine due to an increase in intraabdominal pressure or weakening of the pelvic floor muscles. High performing female gymnasts, were thought to experience less SUI because of their athleticism and well-developed pelvic floor and abdominal musculature. Current literature suggests female athletes have higher rates of SUI compared to age and gender matched counterparts [1-3]. SUI in these females negatively affects their quality of life and can be associated with higher rates of depression, anxiety, and low self-esteem [2]. This project seeks to quantify the prevalence of SUI in female gymnasts and its impact on quality of life. We hypothesize there to be a high prevalence of SUI in young female gymnasts compared to nonathletic females.

A quantitative approach was used to explore the prevalence of urinary incontinence within the female gymnastics population in the United States through survey methods implemented from October 2018-March 2019. An electronic survey created on Qualtrics was distributed to past and present competitive gymnasts. The survey contained an optional free text section where the athletes could provide anonymous comments (table 1). A similar survey was sent to female medical students to serve as an age and gender-matched control group.  Sports practices, SUI frequency and emotional distress associated with SUI were addressed in the survey. The study group received a small incentive for their participation. The medical students were unable to be compensated due to university policy. Data was analyzed in SAS 9.4 (SAS Institute Inc., Cary, NC, USA). Chi-Square analysis was used with a P-value <0.05 indicating statistical significance.

96.50% (n=200) of female gymnasts experienced a urine leak during gymnastics training, 42.86% (n=98) of the control experienced a urine leak in their lifetime (P < 0.0001). The median age of SUI onset in the sample group was 13 (Interquartile Range: 10,17). 31.61% (n=193) of the sample group reported SUI nearly every time they practice gymnastics with 90.67% (n=193) reporting to have never leaked outside of gymnastics. 63.21% reported leaking most on spring floor, 50.78% reported balance beam, 51.30% reported tumble track (a 25-meter trampoline track designed for acrobatic practice), 37.82% reported vault and 17.62% reported uneven bars. 46.11% (n=193) reported experiencing the most SUI when they land on the ground after tumbling, and 47.67% (n=193) reported leaking most when front tumbling (rotating their center of gravity forwards over a horizontal axis). 24.87% of gymnasts and 10.00% of the control group were definitely embarrassed/isolated about urine leaks (P = 0.0003). 22.80% of gymnasts and no control group members reported their urine leaks as an extreme problem (P < 0.0001) (figure 1). 63.21% of gymnasts and 20.00% of the control reported that finding a solution for their incontinence was important to them (P = < 0.0001). Unfortunately, response rate from the sample group could not be determined because of how the survey was distributed. Response rate from the control group was roughly 42%.

A significantly greater proportion of female gymnasts experience more leaks during gymnastics training than the control population experienced in their lifetime. Most gymnasts reported that they leak only during gymnastics training and have never experienced a leak outside of gymnastics. This finding is in support of our hypothesis, that there is a high prevalence of SUI in female gymnastics compared to their age and gender matched counterparts. Female gymnasts reported to have the highest probability of leaking on spring floor, trampoline, vault and balance beam when landing after completing a high-impact tumbling pass. This is thought to be secondary to increased intraabdominal pressure, displacing abdominal and pelvic organs inferiorly putting strain on the pelvic floor architecture. 

Female gymnasts are overall more embarrassed and feel greater isolation related to their SUI than the control group. Our data suggests that female gymnasts are less likely to seek care from their physicians regarding their SUI due to embarrassment and associated stigma with SUI. There was a significant difference between gymnasts and control when comparing the emotional impact of SUI, providing testament to the level of concern these young athletes have regarding their condition (table 1). There was a significant difference between gymnasts and the control group about the importance of a solution, where finding a solution for their SUI was more important to the gymnasts compared to the control population. Most gymnasts reported SUI to be a problem (figure 1). This suggests that SUI can impact the quality of life of young female gymnasts.

There is an overwhelming prevalence of SUI in young female gymnasts. SUI appears to be more prevalent in the female gymnastics community compared to their age and gender matched counterparts. Most gymnasts reported SUI to be a problem in their lives and a solution is of importance to them. Our survey elicited conversations amongst teammates and has helped raise awareness of the prevalence of SUI in the gymnastics community (table 1).

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Casey EK, Temme K. Pelvic floor muscle function and urinary incontinence in the female athlete. Phys Sportsmed. 2017;45(4):399-407. doi:10.1080/00913847.2017.1372677
Bø K. Urinary incontinence, pelvic floor dysfunction, exercise and sport. Sports Med. 2004;34(7):451-464. http://www.ncbi.nlm.nih.gov/pubmed/15233598. Accessed February 5, 2018.