What is known from the existing literature about the available interventions for pelvic floor dysfunction among female athletes? A scoping review

Persistent Pelvic Floor Dysfunction in Female Athletes: A Commentary on Postconservative Management

ABSTRACT

Pelvic floor dysfunction is still an undervalued, underreported, and undertreated condition among female athletes. Despite high prevalence rates and growing interest within the scientific community, significant gaps persist in the application of evidence-based practices in sports medicine. This commentary, inspired by real questions encountered in the authors' work, is presented in a Q&A format to simulate a realistic conversation. The authors aim to provide answers to sports medicine physicians and the wider interdisciplinary team by offering a comprehensive overview of key considerations for managing athletes with persistent pelvic floor dysfunction symptoms. Through evidence-based suggestions, strategies, and a critical approach, the commentary aims to improve the understanding of the current best practice strategies for managing these athletes, both during and after conservative treatment options.

An online workshop to raise awareness of pelvic floor in track and field female athletes: a quasi-experimental study

INTRODUCTION

Track and field is a high-impact sport that may facilitate pelvic floor dysfunction (PFD) of females. Although increasing the information may reduce deleterious habits, the traditional workshops to date did not motivate and engage the female athletes. This study aimed to evaluate the effects of an online educational workshop about pelvic floor awareness on knowledge and habits of track and field female athletes.

METHODS

A total of 49 track and field athletes participated in this quasi-experimental study: 38 attended an educational workshop and 11 did not. The workshop included innovative resources, such as 3D anatomic models, practical proprioceptive exercises guided by physiotherapists, and an anonymous questions and answers section. Before and 1 month later, all the athletes fulfilled an anonymous questionnaire to assess their knowledge about urinary incontinence (UI), ano-rectal incontinence (ARI), pelvic organ prolapse (POP) and female sexual dysfunction (FSD), as well as toileting and sports habits.

RESULTS

After attending the workshop, athletes obtained higher scores in knowledge about ARI (p = 0.019), POP (p < 0.001), and FSD (p = 0.018) compared to baseline and athletes who did not attend it. No improvements were observed in habits and knowledge about UI (p > 0.05). The athletes who reached 70% of correct responses about POP had greater number of healthy habits than the rest of the athletes.

CONCLUSIONS

An innovative educational workshop about pelvic floor increases knowledge of track and field female athletes but is insufficient to modify their habits. Sports and health professionals should design educational strategies to manage the most unknown topics about pelvic floor care, considering that the proposed methodology and innovative resources are effective to increase knowledge.

Athletes' Knowledge of Pelvic Floor Dysfunction and Their Knowledge of and Engagement with Pelvic Floor Muscle Training: A Scoping Review

INTRODUCTION

Pelvic floor dysfunction (PFD) is prevalent among athletes. Investigating whether athletes are practicing pelvic floor muscle training (PFMT) will assist in delineating the factors underlying the burden of PFD in this population. Additionally, investigating athletes' knowledge of PFD and knowledge of and attitudes toward PFMT may inform interventions to improve the practice of PFMT.

AIMS

This scoping review aimed to collate the available evidence regarding athletes' knowledge of PFD and their knowledge of and engagement with PFMT. Furthermore, this review aimed to determine the types of athletes (sports and competition levels) research had been conducted on and the definitions of PFD and PFMT most used.

METHODS

Six databases were searched up to January 2024. No study design or publication types were restricted; however, non-English articles were excluded due to resource constraints. Additional publications were identified through the reference lists of included articles. Data were synthesized and presented under subheadings relevant to the aims of this review.

RESULTS

Thirty-five publications were included for data extraction. Athletes had low practice of PFMT, poor knowledge of PFD and PFMT, but positive attitudes toward PFMT. One publication reported that higher levels of knowledge were associated with a lower prevalence of PFD. The athletic population was heterogeneous in sport type and competition level, and the definitions of PFD and PFMT were ill-defined.

CONCLUSIONS

Athletes have a low practice of PFMT and poor knowledge of PFD and PFMT. The education of athletes may have a role in supporting pelvic floor health.

Breathing, (S)Training and the Pelvic Floor—A Basic Concept

Background: The current scientific literature is inconsistent regarding the potential beneficial or deleterious effects of high-intensity physical activities on the pelvic floor (PF) in women. So far, it has not been established with certainty whether disparate breathing mechanisms may exert short- or long-term influence on the PF function in this context, although based on the established physiological interrelationship of breathing with PF activation, this seems plausible. Objective: To propose a basic concept of the influence of different breathing patterns on the PF during strenuous physical efforts. Methodical approaches: Review of the recent literature, basic knowledge of classical western medicine regarding the principles of muscle physiology and the biomechanics of breathing, additional schematic illustrations, and magnetic resonance imaging (MRI) data corroborate the proposed concept and exemplify the consequences of strenuous efforts on the PF in relation to respective breathing phases. Conclusion: The pelvic floor muscles (PFMs) physiologically act as expiratory muscles in synergy with the anterolateral abdominal muscles, contracting during expiration and relaxing during inspiration. Obviously, a strenuous physical effort requires an expiratory motor synergy with the PFM and abdominal muscles in a co-contracted status to train the PFM and protect the PF against high intra-abdominal pressure (IAP). Holding breath in an inspiratory pattern during exertion stresses the PF because the high IAP impinges on the relaxed, hence insufficiently protected, PFMs. It seems conceivable that such disadvantageous breathing, if performed regularly and repeatedly, may ultimately cause PF dysfunction. At any rate, future research needs to take into account the respective breathing cycles during measurements and interventions addressing PFM function.