Women account for 36% of the world’s sport climbing population [1]. Sport climbing places high demands on the musculoskeletal system through vertical dynamic loads, prolonged isometric phases, and increased requirements for motor coordination and flexibility [2]. These mechanisms contribute to repeated challenges in relation to intra-abdominal pressure (IAP). Elevated IAP is a well-recognized mechanism underlying stress urinary incontinence (SUI). Both vertical constraints (gravity, acceleration) and horizontal constraints (muscle contractions and breathing) have been described as intrinsic factors influencing continence [3]. However, practice-related contexts and climbing-specific movements associated with UI remain poorly identified.
The aim of this study was to assess practice-related contexts and triggering movements among women suffering from climbing-induced UI.

A cross-sectional study was conducted among women presenting with climbing-induced UI. Associations between UI and practice-related contexts as well as triggering movements were reported. Statistical analyses were performed using odds ratios (OR), p-values, and Cramer’s V coefficient, with statistical significance set at p < 0.05.

Eighty-four female climbers were included (median age: 36 years; median weight: 58.5 kg; 46.4% nulliparous). Practice duration was not associated with urinary incontinence (UI) (< 1 year vs > 1 year: OR = 1.62; p = 0.176). In contrast, several practice-related factors were significantly associated with UI: climbing frequency > 3 sessions/week (OR = 2.14; p = 0.039), session duration > 2 hours (OR = 2.34; p < 0.001), bouldering level > 6c (OR = 2.19; p = 0.04), increased exercise intensity (OR = 52.2; p < 10⁻³⁰), and stress or anxiety related to the activity (OR = 11.1; p < 10⁻¹⁹).
Overall analysis suggested a higher frequency of leakage during bouldering compared with outdoor climbing. 
Triggering movements most strongly associated with SUI were post-exercise phase, with a fivefold increased risk (OR = 5.11; p = 0.010), maximal effort (OR = 4.55; p < 0.001), falls and ground landings (OR = 3.76; p = 0.002), and leg push-offs (OR = 2.75; p = 0.026). Breath-holding or static effort (35.7%), dynos (30.9%), and heel hooks (28.6%) were also frequently reported. Analysis by biomechanical categories showed no significant difference between vertical and horizontal constraints (OR = 1.00; p = 0.99).

The demographic characteristics suggest that UI does not exclusively affect profiles traditionally considered at obstetric risk. Similarly, the duration of climbing practice does not constitute a determining factor. This finding suggests that the underlying mechanisms are more likely related to acute and cumulative constraints associated with practice rather than to a progressive phenomenon linked to medical history or years of exposure. Finally, leakage appears to be related to specific climbing movements rather than to a single global biomechanical constraint, with involvement of both vertical and horizontal forces as well as other movement patterns suggesting different causal mechanisms.

UI in female climbers is strongly associated with practice frequency, volume, and intensity, but not with years of climbing experience. Certain trigger movements are associated with a two- to five-fold increase in the likelihood of experiencing UI. These findings highlight the importance of a movement-specific approach to better understand the mechanisms of climbing-induced UI and to guide prevention and management strategies.

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Niederauer S, Hunt G, Foreman KB, Merryweather A, Hitchcock R. Intrinsic factors contributing to elevated intra-abdominal pressure. Comput Methods Biomech Biomed Engin. juin 2023;26(8):941-51