Stress urinary incontinence in female rugby players
According to a recent study, 4 in 10 female players leak urine when playing rugby. The researchers explain the study and what needs to be done.
Dr Molly McCarthy-Ryan and Dr Isabel Moore from Cardiff Metropolitan University explain the recent study, which explored the experiences of rugby players within the UK and Ireland.
As well as discussing the results of the study and explaining what stress urinary incontinence is, they also explore what can be done to educate coaches and players.
What is SUI?
There are several types of urinary incontinence, which is a common problem thought to affect millions of people.
Specifically, stress urinary incontinence (SUI) is defined as an involuntary leakage of urine on effort or exertion.
This typically occurs through an increase in intra-abdominal pressure without the necessary increase in urethral closure pressure that is normally achieved via the urethral sphincter and pelvic floor muscles.
In day-to-day life this is can occur when you cough or laugh but it can also occur when playing high impact sports.
Importantly, leaking urine when playing sport or in day-to-day life should not be viewed as ‘normal’ and something women must put up with.
It is common but can be treated and women should speak to their GP or a pelvic health physiotherapist if they experience SUI symptoms.
We invited all female rugby players across the UK and Ireland to participate in this study regardless of their playing level and whether they experience urinary leakage or not. A total of 396 female rugby players were recruited. Â
How can it affect rugby players?
We found that the number of players leaking urine during general day-to-day activities increased once players started playing rugby.
We assessed risk factors for leaking urine when playing rugby. Interestingly, players who experienced constipation, had given birth, had a higher body mass index or played as a forward were identified as being at higher risk of having rugby-related SUI.
Additionally, we found that players who played at a higher standard, specifically at the international level, had a lower risk of leaking urine when playing rugby than those at the amateur level.
The most common activities that led to leaking urine during rugby were the tackle event (tackled and tackling), running and jumping/landing at all levels of play.
These activities occur frequently in matches and can be characterised by rapid transient increases in force, with tackling also having an element of unpredictability.
These recurring impacts may overload the pelvic floor muscles beyond their tolerance level, which is thought to be reason for leaking urine during rugby.
Most players do not modify their rugby activities even though they leak urine. A high percentage of players who do modify their rugby activities (71%) perceive it to negatively impact their performance.
The findings of our study show that despite the high rate of players reporting rugby-related SUI, they may not view leaking as significant, or this may be deemed normal as it does not typically result in time out of training or matches.
The players who do make modifications report altering non-contact activities, even though contact activities resulted in a greater prevalence of SUI, as well as using incontinence products.
What can coaches and governing bodies do?
Governing bodies and coach education can develop player welfare strategies focused on SUI risk factors and management options that players can implement themselves.
Communicating that SUI should not be seen as a normal part of playing rugby is important, as well as pelvic floor muscle training being part of a rugby player’s strength and conditioning programme.
Therefore, prevention and management of SUI should be a matter of priority within female rugby due to the increase in everyday urinary leakage and high occurrence while playing rugby.
Our research has informed the development of an educational resource to guide coaches working with players. The resource can be found here on the Welsh Rugby Union website.
Pelvic floor muscle conditioning is needed. It is advised, based on the WRU education document created by our colleague Jo Perkins, that a basic pelvic floor programme should initially be completed 2-3 times daily.
Our study has also informed the recent World Rugby guidelines for return to rugby postpartum. As postpartum players were at a higher risk of leaking urine when playing rugby, it is essential that rehabilitation back to rugby following childbirth provides guidance on this condition.
The guidelines are set to be released this year and will be available here. The guidelines specifically cover signs and symptoms of pelvic floor dysfunction, how to undertake pelvic floor muscle training and identify when signposting to onward referral may be needed.
The study highlights, a higher playing level (national compared with amateur) decreased the risk of having rugby-related SUI.
The tackle had the highest prevalence of rugby-related SUI. As although 4 in 10 players have rugby-related SUI, it seems that players may prioritise field performance. Rather than changing tackle technique, they look to modify other activities or use external modifications.
Moreover, it may imply that players may view SUI as insignificant compared to traditional time loss injuries.
It highlights the need for female specific surveillance, accounting for female health domains, as traditionally surveillance has been predominantly focused on males rather than accosting for the needs of female players.
Based on previous work (done by Dr Isabel Moore), it is clear that other categories need to be included within female injury surveillance, which captures female specific conditions.
We need to account for female specific considerations of menstrual and gynaecological health; preconception and assisted reproduction; pregnancy; postpartum; menopause; breast health; pelvic floor health; breast feeding, parenting, and caregiving; mental health and sport environments.
Prevention and management of SUI should be a matter of urgency for informing policy within female rugby due to the increase in everyday urinary leakage and high occurrence while playing rugby.
There is a need for education on SUI and management strategies targeted at lower playing levels of rugby, as well as including such strategies in postpartum return-to-rugby guidelines.
Read the published research paper here
Calling all teams in Wales
We urge all female teams within Wales to join our nation-wide injury surveillance.
We have created the first female-specific community and national level rugby injury surveillance system and are looking to characterise female time-loss and non-timeloss injuries.
Players and teams interested in being part of this project, which will inform player welfare strategies in Wales can sign up here.
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