Urinary incontinence in elite female powerlifters aged 20–30: correlating musculoskeletal exam data with incontinence severity index and survey data
Authors: Nutt Kloie D. , Carnes Michael , Griffin Laura , Rivin Gregory 
Published: December 2024

Abstract

Context
Urinary incontinence (UI) in the powerlifting community has been a hot topic due to its noticeability during competition and the burden it places on female athletes who experience it. UI is even experienced in those we least expect: young, high-performing, females with no history of pregnancy. Current studies have utilized primarily survey methodology, thus there is a lack of clinical information on this topic. Furthermore, the top athletes are underrepresentedbecause previous surveys were open to anyone reporting themselves as a powerlifter, regardless of competition level.

Objectives
The objectives of this study were to determine whether UI in elite female powerlifters is correlated with any musculoskeletal diagnoses and to further evaluate potentially contributing factors for UI within this group.

Methods
Subjects underwent an osteopathic structural examination and then completed two surveys: the Incontinence Severity Index (ISI/Sandvik Test for Urinary Incontinence) and the Study Questionnaire.

Results
In total, there were 31 female participants, all of whom were in the top 2 % of powerlifters in the world between the ages of 20 and 30  years old (as of May 21, 2023) and reside in the United States. The survey results displayed a moderately positive relationship between age (rho=0.449, where rho refers to Spearman’s rho), history of pelvic floor examination (rho=0.413), and self-care practice with ISI (rho=0.340). Other survey information such as weight class, height, best total in competition, number of years training, average duration of training day, confidence in ability to contract pelvic floor muscles, history of abdominal or pelvic surgery, history of urinary tract infection (UTI), and sexual activity status all had rho values less than 0.300. With atlantoaxial (AA) rotation to the right, there was an increase in ISI score (p=0.009). Similarly, with AA rotation to the left, there was a decrease in ISI score (p=0.030). All patients with severe ISI had nonphysiologic sacral dysfunctions (p=0.051). Severe ISI-scored participants were more likely to yield a dysfunctional clavicle upon screening (p=0.027). There was a strong correlation between increasing severity of UI and findings of a restricted right clavicle and/or AA rotation to the right (p=0.010). In addition, there were only two individuals with both a restricted right clavicle and AA rotation to the right, and these two individuals both scored severe on the ISI (p=0.012). A pelvic diaphragm dysfunction was present in 74.2 % of the participants. Extension diagnoses of the lumbar spine were found in those with mild UI over those with severe UI (p=0.012). Most other diagnoses were largely unremarkable due to a wide distribution across all ISI scores.

Conclusions
Our study revealed a relationship between UI and somatic dysfunctions in this population. These findings may help providers, especially in the fields of primary care, sports medicine, and urogynecology, to expand treatment options for UI in this group in the future. Survey results yielded a positive relationship of moderate strength between age, history of pelvic floor exination, and engaging in leakage prevention practices with ISI. No survey category was found to have a relationship of high strength with ISI. These findings contribute to our knowledge on factors that do (or do not) contribute to incontinence severity.