Urinary incontinence (UI) is common among physically active women, particularly in sports such as running; however, preventive behaviors related to pelvic floor health remain underexplored. This study aimed to assess the prevalence of UI in female road runners, describe knowledge, attitude, and practice (KAP) regarding pelvic floor health, and investigate the acceptability of pelvic floor muscle training (PFMT) programs.

A cross-sectional study was conducted with 307 Brazilian female runners recruited through an online questionnaire disseminated via digital media and running groups. Data were collected using the International Consultation on Incontinence Questionnaire – Short Form (ICIQ-SF) and a validated Knowledge, Attitude, and Practice (KAP) questionnaire adapted for non-pregnant women. Additional questions assessed running performance and the acceptability of PFMT programs. UI was defined as ICIQ-SF >0. Descriptive analyses were performed, and comparisons between continent and incontinent women were conducted using non-parametric and chi-square tests (p<0.05).

The prevalence of UI was 42.0% (n=129). Among incontinent women, urinary leakage occurred mainly during coughing/sneezing (61.2%) and physical activity (55.8%). UI was associated with lower running frequency (2.87±1.06 vs. 3.19±0.98 sessions/week; p=0.006) and shorter weekly distance covered (18.16±11.81 vs. 21.61±14.28 km/week; p=0.025). UI also impacted sports participation, with 27.1% reporting training interruption, 31.8% reporting reduced motivation, and 36.4% reporting decreased confidence in public settings. Adaptive behaviors included fluid restriction (62.0%) and the use of protective clothing or pads (52.7%).
Although most participants demonstrated adequate knowledge and a positive attitude regarding pelvic floor health, preventive practices were limited and showed a significant association with UI (p<0.001), suggesting a more reactive rather than preventive pattern of behavior. The acceptability of PFMT programs was high (84.0%), with a preference for flexible and digital formats, particularly video-based interventions.

UI has a high prevalence among female runners and is associated with measurable functional impairment in performance and sports participation. Despite an adequate level of knowledge, the low adoption of preventive practices highlights a gap between knowledge and behavior. The higher frequency of adequate practices among incontinent women suggests that interventions are often initiated only after symptom onset. The high acceptability of PFMT, particularly in digital formats, indicates an opportunity for implementing scalable preventive strategies targeted at this population.

Urinary incontinence is common among female runners and negatively impacts training patterns and the overall sports experience. Preventive strategies related to pelvic floor health are underutilized despite a good level of knowledge. The high acceptability of PFMT programs reinforces their potential for integration into female sports training as a preventive and performance-maintenance approach.

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Continence 19S (2026) 102508
DOI: 10.1016/j.cont.2026.102508