Urinary incontinence (UI) is a public health problem and studies show a high prevalence in women. Stress urinary incontinence (SUI) is common in athletes, particularly in high-impact sports with high training volumes and repetitive activities that can lead to pelvic floor muscle fatigue. Crossfit is a popular sport that has grown in recent years and consists of various functional exercises, many repetitions and loaded and impactful movements, leading to situations of high muscular stress, particularly in the pelvic floor. Previous studies have shown that SUI is common among crossfit athletes, but the problem of SUI in sport is still underestimated and underreported. The aim of this study was to determine the prevalence of SUI in women practising CrossFit in Portugal and France, its impact on quality of life and the use of preventive measures.

Cross-sectional survey study. Data were collected through an online questionnaire (Google forms platform) via social networks and clubs for French and Portuguese CrossFit practitioners. It included socio-demographic questions, the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and the King's Health Questionnaire (KHQ). Inclusion criteria:  women over 18 years of age, nulliparous and of fertile age, i.e. not yet menopausal, who spoke French or Portuguese to ensure a good understanding of the questionnaire items. Exclusion criteria: Women with a BMI > 25, regular smoking and chronic diseases such as diabetes, heart disease, depression, hypertension, chronic cough, constipation or stroke. Women with a history of pelvic injuries or genitourinary surgery, or who had received hormone replacement therapy or pelvic floor rehabilitation were not included.  The study was approved by the Egas Moniz Ethics Committee (Process nº 1201 of 02/03/2023) and all women signed the free and informed consent form.

A sample of 29 women  completed the questionnaire, with a mean age of 27.2 ± 7.7 years, mean BMI of 22.6 ± 1.6 kg/m², 82.8% higher education, 3.5 ± 2.1 mean years of CrossFit experience, 252.0 ± 129.9 min mean CrossFit time per week, 65.5% had no specialisation in the different areas of CrossFit. 37.9% of women who practised CrossFit had UI, 54.5% of them had SUI, 81.8% had losses in small amounts, 54.6% of them felt between moderate to very uncomfortable. The KHQ scores show that the two domains that had higher scores were the use of preventive measures (31.1 ± 16.3) and the impact of UI on quality of life (30.3 ± 26.4).

The sample studied presented a prevalence of SUI similar to other studies and these athletes felt more discomfort in daily life. Length of CrossFit practice and incontinence severity index (ICIQ) showed a significant correlation (r = 0.65). CrossFit athletes reported changes in quality of life and the use of adaptive measures in their practice, such as wearing pads and liners or drinking less fluid before exercise. Although the results cannot be extrapolated to the general population due to the small sample size, they indicate that SUI is an existing problem and that physiotherapists may have an important role to play in its prevention and management.

Crossfit and exercise have many benefits for women's health, but women should learn how to prevent pelvic floor dysfunction and activate their pelvic floor muscles.

Dominguez-Antuña E, Diz JC, Ayán C, Suárez-Iglesias D, Rodríguez-Marroyo JA. Prevalence and severity of urinary incontinence among male and female competitors and recreational CrossFit® practitioners. Eur J Obstet Gynecol Reprod Biol. 2022; 276:144-147. doi: 10.1016/j.ejogrb.2022.07.014.
Gan ZS, Smith AL. Urinary Incontinence in Elite Female Athletes. Curr Urol Rep. 2023; 24(2):51-58. doi: 10.1007/s11934-022-01133-6.
Poli de Araújo M, Brito LGO, Rossi F, Garbiere ML, Vilela ME, Bittencourt VF; Cross Continence Brazil Collaboration Group. Prevalence of Female Urinary Incontinence in Crossfit Practitioners and Associated Factors: An Internet Population-Based Survey. Female Pelvic Med Reconstr Surg. 2020; 26(2):97-100. doi: 10.1097/SPV.0000000000000823.