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When I bring up the topic of pelvic floor dysfunction in athletes, stress incontinence is usually the first aspect of pelvic health that springs to mind – and rightly so, as professional sport is one of the risk factors for stress urinary incontinence. (Poswiata et al 2014). The majority of studies show that the average prevalence of UI across all sports is 50%, with SUI being the most common LUT symptom. Athletes are constantly subject to repeated sudden & considerable rises in IAP: eg heel striking, jumping, landing, dismounting and racquet loading.

What’s often less discussed however, is the topic of GI dysfunction in athletes. Anal Incontinence in athletes is not well documented, although a study from Vitton et al in 2011 found a higher prevalence than in age matched controls (Conversely a study by Bo & Braekken in 2007 found no incidence) More recently, Nygaard reported earlier this year (2016) that young women participating in high-intensity activity are more likely to report anal incontinence than less active women.

However, a presentation by Colleen Fitzgerald, MD at AUGS in 2014 highlighted the multifaceted nature of pelvic floor dysfunction in female athletes, specifically in this case, triathletes. The study found that one in three female triathletes suffers from a pelvic floor disorder such as urinary incontinence, bowel incontinence and pelvic organ prolapse. One in four had one component of the female athlete triad, a condition characterized by decreased energy, menstrual irregularities and abnormal bone density from excessive exercise and inadequate nutrition. Researchers surveyed 311 women for this study with a median age range of 35 – 44. These women were involved with triathlete groups and most (82 percent) were training for a triathlon at the time of the survey. On average, survey participants ran 3.7 days a week, biked 2.9 days a week and swam 2.4 days a week.

Of those who reported pelvic floor disorder symptoms, 16% had urgency urinary incontinence, 37.4% had stress urinary incontinence, 28% had bowel incontinence and 5% had pelvic organ prolapse. Training mileage and intensity were not associated with pelvic floor disorder symptoms. 22% of those surveyed screened positive for disordered eating, 24% had menstrual irregularities and 29% demonstrated abnormal bone strength.

With direct access becoming a reality for many of us, we must acknowledge the need for specific questioning when it comes to pelvic health issues, as well as the ability to recognise signs and symptoms of the Female Athlete Triad in our patients.

Or come to the Inaugural Women in Women’s Health Event in December in NYC – I’ll be speaking alongside such giants in women’s healthcare as Jessica Drummond, Jenny Burrell, Dr Aviva Romm and many more luminaries! Day 1 is all about the Female Athlete through the life cycle and Day 2 will focus on the Business of Women’s Health. Come and learn, network, socialise and make new contacts with colleagues working towards an integrative approach to the health of female athletes