PELVIC FLOOR HEALTH
IN ATHLETICSA GUIDE TO UNDERSTANDING AND CARINGFOR ATHLETES’ PELVIC FLOOR HEALTHOVERVIEW

LET’S START!
As an athlete, your body is your greatest asset.
Fully understanding its functions is essential for maximizing performance and maintaining yourhealth. The pelvic floor, a crucial yet often overlooked area, significantly influences your athletic
performance and overall well-being.
Through expert advice and real-life examples from track and field athletes, this guide is designedto provide you with comprehensive insights into the pelvic floor. Our approach is structured
around four key steps to help you gain essential information:

STEP ONEUNDERSTAND YOUR PELVIC FLOORSTEP TWO

RECOGNISE SIGNS AND SYMPTOMSOF PELVIC FLOOR DYSFUNCTIONSTEP THREE

BE AWARE AND
PREPARE YOUR PELVIC FLOORSTEP FOURGET SUPPORTPELVIC FLOOR HEALTH IN ATHLETICS

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STEP ONESTEP ONE:UNDERSTAND
YOUR PELVIC FLOOR
Manuel, a high jumper athlete, has aquestion for his sports medicine physician:"I've heard about the pelvic floor, but I'mnot sure why it matters for my health,training, and performance.
Could you explain it to me?"Manuel 's question is a good starting point.
The pelvic floor is a group of muscles and connective tissues located at the base of your pelvis.
It plays a key role in bowel and bladder control, organ support and sexual function. Even though
you may not feel it, the pelvic floor is always active, continuously adapting during movement toensure all its functions meet your body’s demands.

Pelvic Floor Muscles

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STEP ONESTEP ONE:UNDERSTAND
YOUR PELVIC FLOORIn athletics the pelvic floor muscles are
subject to numerous constraints. They mustabsorb and redistribute the forces exerted onthe body. Think about the pressure during
your movement, the load, the eventual impact
on landing, and your overall muscle fatigue—
the pelvic floor is constantly working andadapting.

Your pelvic floor must be STRONG, yet
simultaneously ELASTIC and RESPONSIVE,to ensure optimal sports performance andoverall well-being.

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STEP TWOSTEP TWO:RECOGNISESIGNS & SYMPTOMS OFPELVIC FLOOR DYSFUNCTION
Here is Paula, a track athlete, with hercoach: "Coach, I need to talk to you aboutsomething. During our intense training
sessions, I've started to experience urinaryleakage. It usually happens when I sprint.
It's really embarrassing. What's going on?"Paula 's story is a common case ofpelvic floor dysfunction where themuscles aren't functioning properly.
Unfortunately, she is not the only one.

48.6%
Almost half the adolescent female athletes
suffers some forms of urinary incontinence

18.8%
18.8% of elite male athleteswho practice track and field have urinary incontinence

Pelvic floor dysfunction can affect athletes of all ages and genders. It's not limited to highimpact sports, and aggravating factors like chronic constipation, aging, and pregnancy cancontribute to these conditions. Signs and symptoms of pelvic floor dysfunction may refer tourinary incontinence, anal incontinence, pelvic organ prolapse, overactive bladder syndrome andpelvic pain.

For more info:
Rebullido TR, et al. The Prevalence of Urinary Incontinence among Adolescent Female Athletes: A Systematic Review. J Funct Morphol Kinesiol. 2021;6(1):12. Published 2021 Jan 28.
doi:10.3390/jfmk6010012
Rodríguez-López ES, et al. Urinary Incontinence Among Elite Track and Field Athletes According to Their Event Specialization: A Cross-Sectional Study. Sports Med Open.
2022;8(1):78. Published 2022 Jun 15. doi:10.1186/s40798-022-00468-1

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STEP TWOSYMPTOMSCHECKLIST
Are you experiencing pelvic floor symptoms?
Answer these few questions:

Do you ...
Usually experience urine leakage?
Usually lose stool or gas beyond your control?
Usually experience urinary urgency (strong sensation of needing to go
to the toilet) usually accompained by frequent urination and nocturia(wake at least once in the night to urinate)?
Usually experience pain or discomfort in the lower abdomen or genital
region? It can occur during or after sports activities, including sexualintercourse
Usually have a bulge or something falling out that you can see or feel inyour vaginal area? (for females only)

By recognizing the symptoms early, you can seek help and address theseissues before they impact your performance or daily life.

For more info:
Giagio S, Salvioli S, Innocenti T, et al. PFD-SENTINEL: Development of a screening tool for pelvic floor dysfunction in female athletes
through an international Delphi consensus. Br J Sports Med. 2023;57(14):899-905. doi:10.1136/bjsports-2022-105985

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STEP THREE

STEP THREE:BE AWARE AND PREPAREYOUR PELVIC FLOOR
To maintain pelvic floor health, adopt healthy lifestyle habits and train your pelvic floor muscles
like other muscle groups.

1
Develop good habits
Avoid "just in case" toilet trips and do not strain
during urination or bowel movements. Instead, let
your body follow its natural flow. Avoid holding inurine or stool for extended periods.

2

Stay hydrated
Proper hydration is key; do not restrict water intake.
If you have any doubts, consult a healthcare
professional for personalized advice.

3

Prioritise pelvic floor care andprepare your pelvic floor
Within your medical team, consider schedulingrouting

assessments.

Includepelvic

floor

exercises in your training program, focusing onstrength, endurance, coordination, and relaxation.
Do not forget to take care of the overall pelvis
related-areas.

PELVIC FLOOR HEALTH IN ATHLETICS

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STEP THREE

Take care of the overall pelvis
related-areas
Your pelvic floor does not work in isolation.
The back, adductors, abdominal area, and glutes are all interconnected with the pelvis andrequire attention for optimal pelvic floor health. Additionally, your breathing is an
important part of this system!

How?
You can incorporate a combination of relaxation,
stretching exercises, and strength training
tailored to your specific needs. Perform bodyweight
exercises or use equipment such as elastic
resistance bands. Here are some basic examples:

Adductors stretching
Lie on your back and hold an elastic band withyour hands. Lift one leg upward and gently pull theband to stretch the inner thigh (adductors). It canbe done alone or with assistance. Perform 3 sets,holding for 20-30 seconds. Repeat on the otherside.

Glutes strenght training
Lie on your back with knees bent and a resistanceband above your knees. Lift one leg straight up,
engage your core and glutes, raise your hips, thenlower. Perform 3 sets of 10-12 repetitions. Repeaton the other side.

Remember
There is no one-size-fits-all protocol. In some cases, these areas need strengthening; in others,retraining or specific programs.

PELVIC FLOOR HEALTH IN ATHLETICS

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STEP THREE

Basic guide for training
the pelvic floor muscles
Here is Paula again.
“How can I train my pelvic floor?

Find a comfortable position lying on yourback, focusing on your pelvic area.
HowContract your pelvic floor muscles as ifstopping the flow of urine. Then, relax yourpelvic floor after each repetition.
Frequency
Daily practice.
For maintenance: at least 1-2 times perweek.
Repetitions
Perform 8-12 repetitions of maximum
voluntary contractions.

Proper technique is important. Avoid contracting abdominal, thigh, or buttock muscles. If you'reunsure or struggle to feel the contractions and relaxations, seek guidance from a pelvic floor
specialist.
Remember
Not all pelvic floor issues are related to weak muscles. In some cases, they need strengthening; inothers, they require retraining or a specific approach. There is no one-size-fits-all protocol.
Ask your coach or consult with World Athletics medical staff to develop the best program to meetyour needs.

Exercise Protocol from: Donnelly GM, Coltman CE, Dane K, Elliott-Sale KJ, Hayman M, McCarthy-Ryan MF, Perkins J, Rollins S, Moore
IS. Prioritise safety, optimise success! Return to rugby postpartum. Eur J Sport Sci. 2024 Jul 8. doi: 10.1002/ejsc.12144. Epub ahead ofprint. PMID: 38978338.

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STEP FOUR

STEP FOUR:GET SUPPORTAs an athlete, you do not have to face pelvic floor issues alone. Don't hesitate to reach out to your
medical staff, coach, or a pelvic floor specialist for guidance and support, whether you're
experiencing symptoms or just seeking information.
Your medical team is your ally.

SYMPTOMS CHECKLISTNOYES
Seek support to your
medical and/or staff team

Plan together the right andthe best treatment strategy
for youInterested in more
information?

Develop good habits
Stay hydrated
Schedule routine assessments
Integrate individualised pelvic
floor exercisesContinue monitoring
pelvic floor health withinyour teamWorld Athletics supports your health and well-being by providing initiatives to ensure you havethe guidance you need. If you have concerns about your pelvic floor health, do not hesitate toreach out.

PELVIC FLOOR HEALTH IN ATHLETICS

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TAKE ACTION FOR YOURPELVIC FLOOR HEALTH!

ASK

Ask your coach/staff: get tips on how to
implement pelvic floor programs and improveyour pelvic floor health.

SHARESharethismaterial:

discuss

itandstart

conversations with your medical staff, coach, andteammates.

CONNECT
Connect with experts: reach out to the World
Athletics medical staff for specialised guidance.

PELVIC FLOOR HEALTH IN ATHLETICS

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ADDITIONAL INFORMATION

www.worldathletics.org

MORE RESOURCES
Continence Foundation of Australia
Pelvic, Obstetric and Gynaecological
Physiotherapy
England Rugby. 2023. Rugbysafe Toolkit- Womens and Girls Healthcare Rugby
Football Union: Keep Your Boots on

AUTHORS
Silvia Giagio, PhD, Physiotherapist specialising in women‘s health, Researcher at University ofBologna (Italy), World Athletics research consultant.
Contact: silviagiagioft@gmail.com
Paolo Emilio Adami, MD, PhD, Sports and Exercise Medicine Specialist, Head of MedicalOperations, Health and Science Department.
Contact: paoloemilio.adami@worldathletics.org
Frederic Garrandes, PhD in Sport and Exercise Physiology, Scientific Manager, Health andScience Department.
Contact: frederic.garrandes@worldathletics.org

PELVIC FLOOR HEALTH IN ATHLETICS

2024

PELVIC FLOOR HEALTH
IN ATHLETICSA GUIDE TO UNDERSTANDING AND CARING FOR
ATHLETES’ PELVIC FLOOR HEALTH

www.worldathletics.org