Conclusions

Overall, UI and related pelvic floor symptoms appear common across athletic populations, including nulliparous women. However, when examined collectively at a population level and within the constraints of the available evidence, commonly used sport-label classifications did not meaningfully explain between-cohort variability in UI prevalence. Although some directional differences were observed (e.g. higher point estimates in rugby or among professional athletes), these patterns were not robust moderators once heterogeneity was accounted for.

In contrast, exposure-related variables were more consistently associated with UI prevalence in the available data, although these associations reflect study-level reporting rather than direct pelvic floor-specific load quantification. Competitive level showed a directional trend toward higher prevalence among professional athletes, likely reflecting greater cumulative exposure rather than sport type per se, although this association requires confirmation in adequately powered, level-stratified studies. Most notably, cumulative training exposure, operationalised as weekly training volume, emerged as the most consistently reported exposure correlate of UI odds and remained robust across sport categories, impact classifications and sensitivity analyses. This finding should be interpreted as descriptive and hypothesis generating, and in the context of limited reporting of training intensity and pelvic floor-specific mechanical load. Nevertheless, the consistently high prevalence of symptoms across sports and competitive levels supports a precautionary athlete-centred approach to pelvic health screening, independent of unresolved mechanistic uncertainties.

Taken together, these findings suggest that UI risk in women athletes is better understood through an exposure-based framework than through nominal sport labels. From a clinical and performance perspective, this supports shifting pelvic health screening and prevention strategies away from sport type-based assumptions and toward monitoring cumulative training exposure and symptom response across all sports and competitive levels. Future research should prioritise prospective designs that integrate training exposure with pelvic floor-specific function and symptom trajectories to inform load management strategies and help define safe pelvic floor exposure thresholds in women athletes.