Pelvic Floor Dysfunction (PFD)

If the natural behaviour and integrity of the pelvic floor muscle is compromised, symptoms of pelvic floor dysfunction can arise. This means that symptoms can present in relation to any, or all, of the roles of the pelvic floor, e.g., incontinence from bladder or bowel, heaviness or pressure in the vaginal region (due to pelvic organ descent or prolapse), inability to successfully empty the bladder or bowel, or pelvic pain. Symptoms of pelvic floor dysfunction have been shown to present a barrier to females continuing in sports and exercise (Dakic et al., 2021a).

Symptoms of Pelvic Floor Dysfunction

• Urinary incontinence
• Faecal incontinence
• Urinary urgency or frequency
• Faecal urgency or frequency
• Incomplete emptying of the bladder
• Incomplete emptying of the bowel
• Pelvic organ prolapse
• Dyspareunia
• Recurrent urinary tract infections
• Vaginal atrophy

Unfortunately, the pelvic floor muscle is often an overlooked body region, particularly in the context of sports medicine (Dakic et al., 2023b, Donnelly and Moore, 2023). Traditional return to sport frameworks lack female-specific considerations such as pelvic floor health. In 2022, the first female-specific return to sport postpartum framework was created  - The 6Rs (Donnelly et al., 2022). Despite these recent advancements, the call for recognition of pelvic floor muscle related symptoms within sports medicine is not new (Salvatore et al., 2009, Bø and Nygaard, 2020, Goldstick and Constantini, 2014, Brown and Miller, 2001). In more recent years, there has been greater recognition that symptoms of pelvic floor dysfunction [GA1.1], such as pain, incontinence, or pelvic organ prolapse, negatively influencing sports performance, ability to train and quality of life (Dakic et al., 2021a, Dakic et al., 2021b, Skaug et al., 2022).

Prevalence of Pelvic Floor Dysfunction

The prevalence of pelvic floor dysfunction varies depending on the population studied and the type of sport or activity they engage in. One in three postpartum women are considered to have pelvic floor dysfunction (NHS, 2019); however 43% of female rugby players experience urinary incontinence (McCarthy-Ryan M, 2024).  Pelvic floor symptom domains beyond stress urinary incontinence are less widely researched in the female athlete, but the study by Skaug and colleagues (Skaug et al., 2022) identified that 80% of female Olympic weightlifters had anal incontinence and 23% had pelvic organ prolapse. In the recent World Athletics Championships in Lima 2024, 54% of female athletes had at least one symptom of pelvic floor dysfunction (Giagio et al., 2025).

Sports Medicine and the Pelvic Floor

How do we know if athletes are experiencing Pelvic Floor Dysfunction?

Just like other areas of athlete screening and surveillance, it is important that organisations and coaches are screening female athletes for signs and symptoms of pelvic floor dysfunction (Moore et al., 2023, Moore, 2024, Orchard et al., 2025). A simple tool involving only 5 questions is the PFD-SENTINEL (Giagio et al., 2023). This tool is currently undergoing validation testing, and while not validated yet, it lends to sport settings and is quick and easy to implement, making it easier to embed into existing practices. Identification of the presence of any symptom should indicate signposting to a pelvic health physiotherapist. Implementation of advice and education about Pelvic Floor Muscles, such as resources above, is also advised.

Pelvic Floor Dysfunction - Screening Tool in Female Athletes: PFD-SENTINEL

Several validated tools exist, such as the ICIQ-SF (Avery et al., 2004) and the Australian Pelvic Floor Questionnaire (Baessler et al., 2009), however they are not exercise specific and take longer to complete.

It is worth noting that research by Jodie Dakic identified that female athletes (recreational) support the initiation of conversations about pelvic floor function by health and exercise professionals and want pelvic floor symptoms to be included in pre-exercise screening questions when they are clearly informed of the relevance and benefits of pelvic floor screening prior to it commencing. Making screening like this more trusted and successful includes building trust and rapport, providing information/resources, gaining consent and displaying comfort and genuine interest – all while staying with one’s scope of practice (Dakic et al., 2023b, Dakic et al., 2023a).