Hypothesis / aims of study
The primary aim of this exploratory study was to characterize the psychosocial landscape of urinary incontinence (UI) related stigma and its implications for disclosure and care-seeking within a high-impact varsity environment. Specifically, the study sought to differentiate between the internal psychological strain (internalized stigma) experienced by athletes and the external social pressures (enacted/anticipated stigma) present within the varsity team setting. It was hypothesized that the unique "superhuman" identity of varsity athletics creates a culture of secrecy that prioritizes performance status over medical disclosure.
Study design, materials and methods
A mixed-methods, exploratory cross-sectional online survey was conducted (N=81), targeting female athletes competing in Canadian university/college varsity athletics. Quantitative data were collected to provide a descriptive profile of the cohort using validated scales: the Pelvic Floor Health Knowledge Questionnaire (PIKQ), the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), and the Stigma Scale for Chronic Illness-8 (SSCI-8). Qualitative data were gathered through open-ended responses from 37 symptomatic athletes regarding confidence, pressure to hide symptoms, teammate reactions, and support needs. Data were analyzed using descriptive statistics for quantitative measures and a conventional content analysis for qualitative narratives to identify latent themes.
Results
The self-reported prevalence of UI in this cohort was 45.7% (n=37), with severity predominantly categorized as mild (37.8%) or moderate (59.5%). Triggers were primarily associated with high intra-abdominal pressure activities, including exercise (86.5%) and coughing/sneezing (43.2%). Despite this high prevalence, the institutional disclosure rate to coaches or athletic trainers was 0%, and only 5.4% had discussed symptoms with a healthcare professional. A majority of Athletes (75.7%) also considered UI "normal" in their high-impact sport.
Qualitative findings revealed a "mentally exhausting" level of hyper-vigilance required to maintain the presentation of a "normal," superhuman body. Athletes with UI reported emotional strain and lowered self-confidence as a result of their leakage. Athletes characterized their experience as one of "isolation," assuming they were the "only one" struggling, which contributed to lower athletic confidence and perceived performance. Furthermore, athletes reported an avoidant social dynamic within teams, where peers frequently pretend not to notice leakage, a silence that athletes expressed exacerbated their internalized psychological distress. A primary deterrent to seeking professional care was the fear of "performance-ending" medical advice, specifically that a provider would mandate quitting their sport.
Interpretation of results
These findings characterize a profound "Culture of Secrecy" within varsity athletics where the pressure to appear "superhuman" overrides the need for pelvic health. The 0% institutional disclosure rate suggests that athletes perceive UI not as a treatable condition, but as a "bodily weakness" that threatens their competitive viability. The "mentally exhausting" hyper-vigilance described by athletes indicates that the psychosocial burden of UI may be as disruptive to performance as the physical symptoms themselves. The avoidant peer dynamic further suggests that even when UI is noticed, the lack of a safe vocabulary or educational resources for discussion reinforces the taboo. This creates a critical window of vulnerability: while symptoms are often normalized as a "part of the game," they are simultaneously stigmatized as an unmentionable secret, allowing chronic dysfunction to progress unaddressed during peak performance years.