The female pelvic floor in triathlon

Who is the “pelvic floor” and what can it do? – An important topic not only for pregnant women and mothers!

Of course, most women have probably heard of the pelvic floor. And when they are told during stability training: “And now tighten your pelvic floor”, they are sure to do it dutifully. However, very few women probably know how to really tighten their pelvic floor. And even fewer women are aware that this muscle should be trained even if you haven’t just given birth.

Why is it important for triathletes to train their pelvic floor?

Pelvic floor issues such as urinary incontinence, pelvic floor dysfunction and pelvic ring pain are not exclusively related to pregnancy, childbirth or the menopause.

It is particularly important for female athletes to take a closer look at their pelvic floor muscles. The age of the athlete does not play a role here.

Contrary to the assumption that the pelvic floor of female athletes is also strong in accordance with their other training condition and is automatically trained, studies show a urinary incontinence rate of up to approx. 70% in competitive athletes (Chisholm et al. 2019; Da Roza et al. 2015; Eliasson et al. 2008). In addition to rebound sports and ball sports, pelvic floor dysfunction is more common in female endurance athletes (Schulte-Frei & Jäger, 2018; Araújo et al. 2008; Bø & Borgen, 2001).

Who is the “pelvic floor” and what can it do?

The pelvic floor muscles literally play a supporting role in the female body. These muscles close off the abdominal cavity incompletely at the bottom and thus hold our abdominal organs in place. The term “floor” is somewhat misleading, as the muscles are more like a funnel than a flat floor.

It is probably well known that the pelvic floor is responsible for continence. In addition to this task, however, it is also important that the muscles can relax at the right moment – for example during micturition, sexual intercourse or during the birth process. As if that wasn’t enough, it also has to “hold tight” during sudden events such as coughing, sneezing, laughing or during sport. It can be compared to a trampoline (Tanzberger et al. 2019; Carrière, 2010). A finely tuned interplay of tensing and relaxing the pelvic floor muscles is therefore necessary.

The hormonal influences on this muscle group should also not be ignored. Oestrogen in particular is important for the functionality of the pelvic floor. If there are fluctuations, which are physiological within the female cycle, or an imbalance, this can result in temporary but also long-lasting dysfunctions of the pelvic floor (Bø, 2004; Lebenstedt, Platte & Pirke, 1999).

What if the pelvic floor is not trained well enough?

If the pelvic floor muscles cannot perform these complex tasks or can only do so inadequately, this can manifest itself in various symptoms:

• Pain in the pelvic area
• Urinary or fecal incontinence
• Prolapse or protrusion of the pelvic organs such as the uterus or bladder, a so-called organ prolapse, which is a serious pathology (Yi et al. 2016)
• Untrained pelvic floor muscles may also be associated with back pain (Welk & Baverstock, 2020)

What are the principles of good pelvic floor training?

Through individually tailored training, the pelvic floor muscles can be dynamically trained in a targeted manner so that the above-mentioned problems can be prevented. If symptoms already exist, they can be reduced in this way.

Unfortunately, scientific findings are only slowly finding their way into pelvic floor training. And so there are still some outdated views in circulation. For example, the focus is often still on purely isometric or concentric training. However, the fact that the pelvic floor has to tense reflexively under stress is usually not trained. Exercising too much in tension can also have a negative impact on neuromuscular balance and therefore tend to promote incontinence, for example (Schulte-Frei & Schwenner, 2020).

In summary, it can be said that every triathlete, regardless of their level of performance, should train their pelvic floor muscles. It is important to note that this topic should not only be considered in the context of pregnancy and childbirth. A dynamically trained pelvic floor contributes significantly to a stable core. This in turn is a central pillar when it comes to improving performance or preventing injuries.

The consequences of dysfunction may only occur at an older age. However, training is then much more difficult.

So start now with customized pelvic floor training for female triathletes.

Luisa Kienle is a KickAss partner and expert in pelvic floor training

Luisa is a sports physiotherapist and specialized in the area of the female pelvic floor in athletes during her studies of applied therapy sciences.

Her mission is to break down the taboos surrounding the pelvic floor, provide education and thus contribute to an improved quality of life for female athletes.

Luisa has experience in physiotherapeutic care for various sports and in Paralympic sports. However, she has always remained loyal to triathlon.