Pelvic Floor Dysfunction in the Female Athlete

Germany’s Marlene Meier, Rayniah Jones of the U.S., and Germany’s Rosina Schneider in action during the women’s 60m hurdles REUTERS/Axel Schmidt

Pelvic floor dysfunction (PFD) includes but is not limited to urinary incontinence (UI), fecal incontinence, pelvic organ prolapse, sexual dysfunction, and chronic pelvic pain. Approximately 40-60% of all women suffer from PFD during their lifetime. However, it is under-reported, under-recognized, and under-treated in female athletes. High-impact, repetitive sports can put women at risk for developing PFD⁽¹⁾. Urinary incontinence is common in female athletes, and the prevalence in female nulliparous athletes can range between 5-80%, with the highest prevalence in women participating in high-impact sports. Researchers at the University of Trás-os-Montes and Alto Douro in Portugal reported that the prevalence of UI among female athletes was 25%, and stress urinary incontinence was 20%⁽²⁾. The prevalence in high-impact sports was 25%, with the highest prevalences observed in the following sports: volleyball (75%), trampolining (72%), indoor soccer (50%), cross-country skiing (45%), running (44%), basketball (34%), athletics (20%), and handball (20%)⁽²⁾. However, the risk for PFD increases in women after pregnancy and when aging due to other causative factors starting to play a larger role, such as hormonal changes and BMI, amongst other factors.

“Educating healthcare professionals is the first critical intervention in improving the management of athletes with PFD.”

Mechanisms

The pelvic floor works in coordination with the stabilizing muscles (the diaphragm, abdominal muscles, and back muscles such as the Multifidus muscle) to ensure effective force transmission and spinal support to withstand the forces, maintenance of posture, and dynamic stabilization (see figure 1).