Pelvic Floor Dysfunction in Sport

Pelvic floor dysfunction, most often leaking urine during sport, is common in female athletes, treatable, and usually found only if you ask.

Most athletes will not mention leaking unless asked directly. Many assume it is the price of their sport, and some quietly modify their training or stop. That makes it a sport and exercise medicine (SEM) problem as much as a gynaecological one.

• •It is not confined to women who have given birth: young nulliparous athletes are affected too
• •It does not always mean a weak pelvic floor: increased tone can occur instead, and more contractions make that worse
• •Men are affected too, though far less is known, and nearly all the evidence comes from female athletes

The pelvic floor is a muscular sling, principally the levator ani (pubococcygeus, puborectalis and iliococcygeus), with coccygeus behind it. It supports the pelvic organs and contributes to urethral closure. It works with the diaphragm above, the abdominal wall in front and the deep spinal muscles behind, as a pressure system rather than an isolated muscle.

Continence during effort depends on urethral closure pressure exceeding bladder pressure. Landing forces and rapid rises in intra-abdominal pressure reach the bladder, and if the pelvic floor cannot generate and time enough counter-pressure, leaking follows. Timing matters as much as strength: the floor should activate before and during the pressure rise, not after it.

• •Symptoms are commonly reported in jumping and running sports, with trampolining often cited as the extreme, but prevalence estimates vary widely
• •Fatigue matters, so a floor that copes early in a session may fail late in it
• •Factors associated with symptoms in elite female athletes include pelvic floor laxity, bladder neck descent, muscle fatigue, hypermobility and low energy availability; these are associations, not proven causes