Elite female athletes’ experiences of symptoms of pelvic floor dysfunction: A systematic review

Abstract

Introduction and aims Pelvic floor dysfunction (PFD) is a collection of signs, symptoms and conditions affecting the pelvic floor and urinary incontinence (UI) is the most common type of PFD. Recent systematic reviews have indicated a higher prevalence of UI among female athletes compared to their non-athletic counterparts. To date, no review has been undertaken to investigate female athletes’ experiences of PFD. This review aims to offer insight and understanding, through aggregation, summary, synthesis and interpretation of findings from studies that report elite female athletes’ experiences of symptoms of PFD. Methods The review protocol was registered in PROSPERO in August 2020. A systematic search was conducted in Embase, MEDLINE (OVID), Cochrane Library, CINAHL, PsycINFO and Web of Science for studies published in the English language reporting elite female athletes’ experiences of symptoms of PFD. This review included primary research studies that involved elite female athletes of any age or ethnicity. Results Of the 1922 citations retrieved in the search, 32 studies met the methodological criteria for data extraction and analysis. Five main themes emerged: (1) triggers for symptoms of PFD; (2) strategies adopted by athletes to manage/mitigate symptoms of PFD; (3) impact on QOL/daily life; (4) impact on performance; (5) impact on emotions. Conclusions The findings of this review suggest a need to further explore the experiences of PFD among elite female athletes and it is suggested that future research should adopt qualitative methods or incorporate a qualitative component.

Experience of Playing Sport or Exercising for Women with Pelvic Floor Symptoms: A Qualitative Study

“…Community dwelling women report that living with UI evokes feelings of shame and humiliation; they are concerned that others will notice their symptoms in social settings and judge them unfavourably [ 46 ]. The current study builds on knowledge obtained from prior survey data that female athletes report embarrassment, fear, anxiety and frustration as a consequence of PF disorders [ 20 ]. Many of the same negative emotions were also reported by participants within our study and the basis for experiencing these emotions described.…”

“…Self-disclosure of PF symptoms by female athletes is uncommon; less than 10% have ever told a health professional [ 16 – 19 ]. A recent systematic review of quantitative data found that elite female athletes employed coping strategies such as wearing pads, restricting fluids and frequent voiding to manage symptoms of UI [ 20 ].…”

Sports Medicine and the Pelvic Floor

“…It is acknowledged that the reported prevalence figures for PFD show a large range throughout the literature due to varying case definitions, recruited populations, and study methodologies (53). The prevalence of urinary incontinence in athletes is often quantified using general, but validated questionnaires, such as the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (54,55) and the Incontinence Severity Index (56). However, more recently sport-specific questions about leaking urine have been used (57,58).…”

“…For athletes, the sport itself is a modifiable risk factor. Female athletes report competition, training, and physical activity as the most significant triggers for their symptoms of PFD, followed by specific movements during their sport (54), such as impact-related activities ( e.g. , running, jumping) and strenuous activities ( e.g.…”

“…Many athletes try to manage symptoms of PFD by altering their bladder emptying behavior and fluid intake, which can lead to the development of further presentations of PFD (54). For example, an athlete presenting with simple stress urinary incontinence may try to manage this by restricting fluid intake and frequently emptying their bladder before and during training, resulting in the development of urinary frequency, urgency, and incontinence.…”