A Sporting Flaw – Pelvic Floor Problems in Sport

A female runner

I’m writing this as the Commonwealth games draw to a close. It’s been a packed 11 days of sport, and great to watch coverage of a whole range of sports we don’t usually get to see. It’s been particularly pleasing to see almost equal coverage of male and female athletes and sports.

Over the past few weeks I have also had numerous conversations with people about incontinence (bladder or bowel leakage) with exercise and sport. It’s not something we usually think about when we watch sport, is it? Incontinence is usually associated it with older (mainly) women – not elite athletes. It’s therefore a bit of a shock to see young, incredibly fit athletes wetting themselves. However, there have been numerous well-documented examples. An Olympic weight lifter, a French gymnast and several runners (male and female) have been caught on camera losing bladder or bowel control. And the usual reaction to this? Some initial shock … and then the conversation usually goes, “This is the length to which athletes will go to win.”

That’s pretty shocking in itself. That losing bladder or bowel control is acceptable if it means winning. The other shock is that these problems are actually far more common than the few examples we hear about.

Most of the studies on pelvic floor problems with exercise have focussed on loss of bladder control, or stress urinary incontinence (SUI). Many studies have looked at rates of SUI in young women competing at high school or college level, with a few looking at SUI in elite athletes. The figures are surprisingly high: 28-41% in athletics, 44-66% in basketball, 67% in gymnasts, and up to 80% of elite trampolinists! Of note is that all of these sports involve a lot of jumping and running. Compare that with only 10% of swimmers and 0% of golfers. Although there have been notable incidences of weight lifters prolapsing their bowels when lifting, I have never found any studies looking at pelvic organ prolapse or pelvic pain with sport. I suspect if it were to be investigated, the results would be just as shocking.

How is this relevant for the rest of us, who are not, and never will be, competing in elite-level sport?

Unfortunately the statistics for the average active woman are no better. A 2016 Australian study, looking at over 300 women who attended exercise classes or went to the gym, found almost 50% of them leaked urine with exercise. Most had mild to moderate symptoms. Just over half of those who leaked reported they modified the impact of their leakage with strategies like limiting fluids before exercise, or wearing a pad. However, other studies have shown women who suffer more severe leakage tend to stop exercising, and then do not meet the recommended activity levels for a healthy lifestyle. That has huge implications for their future health and well-being.

So are pelvic floor problems just the “price you have to pay” to remain active and healthy? The simple answer is NO. There are numerous things you can do to help. Firstly, tell someone about your problem – hopefully someone, like your doctor, who can then offer help. Numerous studies suggest pelvic floor problems are under-reported, with up to 92% of young women with SUI never telling anyone. I am always surprised by how many women think they just have to live with these problems, or that it’s normal after having a baby.

The next step (usually) is to start pelvic floor muscle exercises. These are specific exercises for the muscles that sit in the base of your pelvis and support your pelvic organs (bladder, bowel and uterus) and stop you leaking. There is a mountain of evidence that urinary leakage can be fixed or improved by doing pelvic floor muscle exercises. Pelvic floor muscle exercises can help young and old women, average women and elite athletes, when tailored well to individual needs.

However, to be effective, you have to be doing pelvic floor exercises correctly. Regular supervision from a Women’s Health Physiotherapist to progress your exercises and check your technique is recommended. The other reason a Women’s Health Physiotherapist should check your pelvic floor is that some women actually have over-active pelvic floor muscles (muscles that are too tight and tense) yet can still leak. These women need to learn to relax their pelvic floor muscles, as doing pelvic floor strength training will make things worse.

So the take home message here is: pelvic floor problems are really common amongst women who exercise at any level, but with the right help, things can get better. If you, or someone you know, suffers from leakage, prolapse or pelvic pain with exercise, or these problems are preventing you from exercising, then please seek help.

Yours in good pelvic health,


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