The Athlete and the Pelvic Floor

This post was written by H&W instructor Michelle Lyons, PT, MISCP . Michelle will be instructing the course that she wrote on "The Athlete and the Pelvic Floor" in Ohio this August.

Ample literature has shown that high impact and high intensity sporting activities are linked to pelvic floor dysfunction (Nygaard 1994, Nygaard 1997) and research has demonstrated that young female athletes participating in high-impact sports may be at particular risk for urinary incontinence.

Several epidemiological studies have shown that symptoms of SUI are frequent in populations of nulliparous female athletes. In a landmark study by Bo and Sundgot Bergen in 2001 on the prevalence of urinary incontinence in elite female athletes compared to age matched controls, the participants were asked ‘Do you currently leak urine during coughing, sneezing and laughter, physical activity (running and jumping, abrupt movements and lifting) or with urge to void (problems in reaching the toilet without leaking?’ The authors found equal prevalence of overall SUI and urge incontinence in both groups but the prevalence of leaking during physical activities was significantly higher in the elite athletes.

But what about pelvic pain in athletes, both male and female? Sports which involve kicking, side to side cutting, interval sprinting, rapid or sudden changes of direction, repetitive hip and pelvic girdle rotation have a high incidence of groin injuries. According to Lovell (1995) in Nam et al (2008) determining a differential diagnosis is essential as 27-90% of patients who present with groin pain present with more than one injury.

In a recent comprehensive review of the literature, Sommer et al (2010) concluded that there is a significant risk in relationship to cycling related uro-genital symptoms in both men and women. Some of the more common problems are pudendal nerve dysfunction, genital pain and numbness, erectile dysfunction in men and in women ‘bicyclist’s vulva’ or lymphedema of the labia majora.

In the sporting arena, the primary source of specialist consultation is the orthopaedic surgeon, who may perform a wide ranging assessment of the musculo-skeletal system with no real evaluation of the pelvic girdle of pelvic floor. The patient is unlikely to be asked about urinary, bowel or sexual dysfunction and often the patient does not volunteer this information unless prompted (Taylor et al 2012). Likewise, the urological specialist may carry out a thorough examination of the pelvic floor, sexual, bladder and bowel function but without the musculo-skeletal component.

So where can these patients seek and find comprehensive assessment and treatment of their complex and multi-layered dysfunctions, addressing both orthopaedic and pelvic health concerns?

It is the goal of this course to bridge the gap between orthopaedic assessment of pelvic dysfunction in athletes, with our pelvic rehab expertise. We will describe the relationship between the lumbo-pelvic, hip and pelvic floor complexes and examine how to integrate a multi-system evaluation approach, utilizing orthopaedic, respiratory and pelvic perspectives, with our objective being to return the athlete to her/his chosen sport or activity in the shortest time possible.

References:

1. Nygaard IE. ‘Does prolonged high-impact activity contribute to later urinary incontinence? A retrospective cohort study of female Olympians’. Obstet Gynecol. 1997 Nov; 90(5):718-22.

2. Nygaard IE1, Thompson FL, Svengalis SL, Albright JP. ‘Urinary incontinence in elite nulliparous athletes’. Obstet Gynecol 1994 Sep; 84(3):342.

3. Bo K, Borgen J 2001 ‘Prevalence of stress and urge urinary incontinence in elite athletes and controls’ Medicine and Science in Sports and Exercise 33:1797-1802

4. Nam, et al 2008 ‘Management and therapy for sports hernia’ (Review) {63 refs} J. Am. Coll. Surg. 206, 154-164

5. Sommer et al 2010 ‘Bicycle riding and erectile dysfunction: a review’ J Sex Med 7, 2346-2358