Stress urinary incontinence (SUI) has been described as a barrier to sports practice because its presence can cause abandonment. Running is the Chilean population's third most common physical activity. According to Dakic, 45% of female athletes report a negative impact on their participation due to symptoms of pelvic floor dysfunction.
This study aimed to explore the beliefs, barriers, facilitators, and coping mechanisms of female runners regarding SUI and the promotion of physical activity.

A qualitative study with an exploratory-descriptive scope was undertaken to ascertain the perspectives of female runners in Chile on SUI associated with the activity of running. Authorization for the study was accorded by the Ethical Scientific Committee of the Facultad de Medicina Clínica Alemana-Universidad del Desarrollo (Ref – 2023-53, dated the 4th of July, 2023). Participants acquiesced to informed consent electronically and provided verbal assent before engaging in the interview process.

Eligibility criteria encompassed female runners aged over 18, domiciled in Chile, competent in the Spanish language, and agreeable to partake in the study. A purposive sampling technique was employed, utilising social networks, direct engagement, and SeRun® network's outreach to enlist participants. A convenience sampling approach was adopted to assemble the sample, guided by the precedent set by Hernández Sampieri, without a predetermined number, focusing instead on establishing a unit of analysis and considering an approximate number of cases as a reference. The objective was to collect a minimum of 10 cases. However, the target was surpassed after 13 interviews when data saturation was achieved with a heterogeneous sample.

Interviews were structured according to a predetermined script, preliminarily tested with a runner, and refined iteratively throughout the study. Sessions spanned 20 to 40 minutes, were executed remotely via the Zoom platform with video function, and were steered by the principal researcher, who was adept in qualitative interviews. Each session was documented and transcribed meticulously, utilizing Microsoft Word's audio transcription functionality, followed by a stringent quality review for veracity and reliability. The median interview duration stood at 25 minutes.

Data analysis was conducted through a thematic examination following the protocol delineated by Braun and Clarke, which incorporated a six-step process: commencing with data familiarisation, transitioning to the initial generation of codes, proceeding with an inductive search for themes reflective of core concepts and similarities within the data, and a deductive process based on the specific aims of the research. Themes were meticulously reviewed, delineated, and named, encapsulating their essence. A comprehensive report of the data was generated, integrating sociodemographic information as an integral component of the sample description. Recordings, totaling 331.3 minutes from the 13 interviews, were scrutinized in their entirety. Additionally, a descriptive summary of the findings was communicated to two of the interviewees, soliciting their insights as a measure of data triangulation.

This study elucidated six thematic areas concerning SUI in female runners. Firstly, it was discovered that SUI is perceived to occur more frequently within the running community than commonly assumed, particularly among advanced runners and older women. This prevalence is often under-reported or diminished due to societal norms. Participants indicated that the condition is more commonly discussed and evident in women, attributing this to factors such as lesser muscle mass and the stresses of pregnancy and childbirth on the body.

Secondly, the research identified a lack of muscular training, specifically of the pelvic floor, pregnancy, and childbirth, as significant predisposing factors for SUI. Additionally, running and similar high-impact exercises that involve jarring motions and uneven terrain were recognised as contributing to the onset of SUI.

The study revealed various coping strategies employed by runners to manage SUI, with a notable reliance on menstrual products for symptom control. These included sanitary pads, liners, and specialised menstrual underwear. Despite the practicality of such measures, they often served merely as temporary solutions. Participants also reported reducing fluid intake before running, acknowledging this as an unhealthy but effective short-term strategy to prevent urinary leakage.

A significant knowledge gap regarding the role of physiotherapy in managing SUI was observed, alongside a palpable apprehension about seeking treatment due to unfamiliarity with the therapeutic processes. Nonetheless, physiotherapy, with a focus on pelvic floor strengthening, was recommended by some participants as a sustainable approach to managing SUI while continuing to run.

The study divulged that SUI, while prevalent amongst female runners, remains a taboo subject with significant impacts on activity engagement. Women recognize SUI as more prevalent in their gender, especially in older demographics, a notion supported by existing literature. The findings align with global and national data on SUI's high prevalence in women and are further substantiated by Dakic et al., who noted a considerably higher likelihood of SUI in active women compared to sedentary ones.

Primary risk factors were identified as pregnancy, postpartum periods, and general muscular weakness. Notably, advanced runners, some of whom had never given birth, most frequently associated pregnancy and childbirth with SUI, reflecting a disparity between perceptions and documented evidence that multiple factors can predispose one to SUI. Basic profile runners emphasized muscular preparation, coinciding with Caetano et al.'s suggestions that excessive physical exertion may trigger SUI.

Despite awareness of temporary solutions, such as decreased hydration and menstrual product use, many runners overlooked kinesiology as a long-term treatment option. Advanced runners, while acknowledging SUI's normality, cited pelvic floor physiotherapy, resonating with the professional opinion that physiotherapy is a conservative management strategy for pelvic floor dysfunctions.

The normalization of SUI by advanced runners, despite recognizing its severity, suggests a potential reluctance to address the issue, possibly due to a lack of knowledge. Incontinence, although common and prevalent, is not normal and warrants professional attention. Runners are cognisant of SUI's multifaceted impact but often lack comprehensive information, underscoring the vital role of health professionals and coaches in providing education and preventative care.

These being preliminary results, limitations of the study include data saturation within a diverse group rather than a larger and more distinct sample across runner profiles. The different ages and training levels of participants may influence perceptions of SUI. Further research should be conducted further to explore the perceptions of healthcare professionals and trainers, informing interventions designed to prevent and treat SUI during running.

The findings of the study indicate that while female runners are aware of SUI and recognise its prevalence within the running community, it remains a taboo subject. This condition significantly impacts their activity, leading many to adopt temporary measures rather than seeking proper treatment. Highlighting the importance of timely and appropriate management of SUI is crucial in reducing barriers to physical activity. By addressing this, the number of women in Chile engaging in physical exercise could substantially increase.

In conclusion, to enhance female participation in running and other physical activities, there is an imperative need for destigmatising SUI and promoting informed health-seeking behaviours amongst female runners. This calls for educational efforts and accessible healthcare services that advocate for proactive management and therapy to treat the underlying causes of SUI, rather than merely containing its symptoms.

Dakic, JG., Hay-Smith, J., Lin, KY., Cook, J., Frawley, HC. "Experience of Playing Sport or Exercising for Women with Pelvic Floor Symptoms: A Qualitative Study." Sports Med Open, 2023.
Caetano, AS., Tavares, MDCGCF., Lopes, MHBDM. "Urinary incontinence and physical activity practice." Revista Brasileira de Medicina do Esporte, 2007.