Could Your Workout Put Your Pelvic Floor at Risk?

Jessica McKinney, PT Health Guide
  • Exercise is pretty universally accepted as a good thing.  You may love it, you may hate it, or you may fall somewhere in between, but no one argues that exercise is something we should do. 


    But could it be possible that certain types or amounts of physical activity are actually putting our bodies at risk for urinary incontinence or other pelvic floor disorders?  Two recent studies presented by separate groups of researchers last month at the joint scientific meeting of The International Urogynecological Association and The American Urogynecologic Society would seem to suggest this is the case.  (And before any of the exercise-haters take that as carte blanche to hang up the sneakers and yoga mats, let me sum up). 

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    Extra precautions with regard to strenuous activity may be warranted in teen girls.

    In this study, investigators surveyed middle-aged women about their overall lifetime physical activity to determine how this may be related to lifetime incidence of stress urinary incontinence (SUI).  They identified SUI as more likely in those with previously described risk factors of vaginal delivery, obesity, and less than excellent health.  However, they also found that there was a modest increased lifetime risk of SUI in women who reported higher levels of strenuous activities in their teen years.  This appeared to be a more powerful influencer than whether or not they engaged in such strenuous activities later in life. 


    Strenuous activities were categorized as those associated with repetitive impact (think running or jumping) and/or relatively higher intra-abdominal pressure (IAP)  To quickly understand what is meant by increased IAP, think of the way you tighten your abdomen and catch or hold your breath to lift something heavy or with a hard cough.  Aspects of many popular youth sports would fit into this ‘strenuous’ category – gymnastics, soccer, volleyball, track and field, and cheerleading, to name a few.  Since previous studies have already identified high prevalence of SUI in young female athletes, particularly in those participating in high-impact sports, this most recent study makes us consider that those cumulative stresses are affecting women throughout their lifespan, even if they are not symptomatic in their youth.


    Female triathletes have greater prevalence of pelvic floor disorders than the general population.

    While prevalence of pelvic floor disorders in the general public is widely believed to be under-reported, it is often cited as affecting approximately 1 in 3 women.  However, in this study of female amateur triathletes, the prevalence was 43 percent for symptoms of urinary incontinence.  It is important to note that while known major contributors to lifetime urinary incontinence (UI) are vaginal delivery and obesity. This is a population in which fewer than half of participants had ever given birth and the mean BMI was 22.41, a number accepted as indicative of a healthy weight.  With childbirth and weight-related risk factors decreased, the rate of UI in this population becomes even more striking and these authors again point out the potential role of high-impact sports on the female pelvic floor.


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    In addition, nearly 1 in 4 of the female triathletes reported one or more of the following: disordered eating, menstrual irregularities, and abnormal bone strength.  These three symptoms are known as the Female Athlete Triad and have been previously linked to participation in endurance sports. 


     At the end of the day, what’s a well-meaning exerciser to do?  Keep moving.  But if you’re experiencing pelvic floor symptoms during exercise – particularly high-impact exercise – consider substituting with a lower impact activity and talking to a health care provider that specializes in pelvic health (Find a Doctor here and find a PT here).  The same recommendation applies if you have pelvic girdle pain during exercise.  And if you are a teen athlete, or know one well, it may help to talk to one of these same specialists.  They can help you control your risks and modify your program accordingly, which may be as simple as doing adequate cross-training and trunk and hip strengthening.




    1. Nygaard I, Shaw J, Bardsley T, Egger M.  Too much too soon?  Lifetime physical activity and stress urinary incontinence.  Female Pelvic Med & Reconstructive Surgery.  20(4) Suppl. Jul/Aug 2014 OP 123, S119.
    2. Yi J, Tenfelde S, Tell D, Brincat C, Fitzgerald C.  Triathlete risk of pelvic floor disorders, pelvic girdle pain, and the Female Athlete Triad.  Female Pelvic Med & Reconstructive Surgery.  20(4) Suppl. Jul/Aug 2014 OP 028, S59-60.
Published On: September 18, 2014