The female pelvic floor in triathlon

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

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

22. Oktober 2021

Why is it important for female triathletes to train the pelvic floor?

The issues surrounding the pelvic floor, such as “urinary incontinence, pelvic floor dysfunctions and pelvic ring pain” are not exclusively related to pregnancy, childbirth or menopause. 

It is especially 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.

This is because, contrary to the assumption that the pelvic floor is also strong in female athletes according to their other training status and is automatically trained along with it, studies show a urinary incontinence rate of up to about 70% in female 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 prevalent in endurance female 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. For example, this musculature incompletely closes off the abdominal cavity at the bottom and thus keeps our abdominal organs in place. The term “floor” is somewhat misleading, as the musculature is more like a funnel than a flat floor.

It is probably 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 – such as during micturition, sexual intercourse or during the birth process. As if that were not enough, it also has to “keep tight” during sudden events such as coughing, sneezing, laughing or even during sports. It can certainly be compared to a trampoline (Tanzberger et al. 2019; Carrière, 2010). Thus, a finely tuned interplay of contraction and relaxation of the pelvic floor muscles is necessary. 

The hormonal influences on this muscle group must also not be disregarded. Estrogen 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 lead to temporary but also long-lasting dysfunctions of the pelvic floor (Bø, 2004; Lebenstedt, Platte & Pirke, 1999).

KickAss Sports, Beckenboden im Sport

What if the pelvic floor is not trained well enough?

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

  • Pain in the pelvic area
  • Urinary or fecal incontinence 
  • Sagging or protrusion of pelvic organs such as the uterus or urinary bladder, called organ prolapse, which is a serious pathology (Yi et al. 2016)
  • It is also possible that untrained pelvic floor muscles are related to 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 some outdated views are still circulating. For example, the focus is often still on purely isometric or concentric training. However, the fact that the pelvic floor must tense reflexively under load is usually not trained. Also, too much can be trained into tension, which can have a bad influence on neuromuscular balance and thus tends to promote incontinence, for example (Schulte-Frei & Schwenner, 2020).

So, in summary, every triathlete, regardless of performance level, should train her pelvic floor muscles. It is important to note that this topic should urgently not only be considered in the context of pregnancy and childbirth. A dynamically trained pelvic floor contributes significantly to a stable torso. This in turn is a central pillar when it comes to performance enhancement or injury prevention.

The consequences of a dysfunction can possibly only appear at a later age. Then, however, training is much more difficult. 

So start now with an individually tailored pelvic floor training for female triathletes.

Luisa Kienle is KickAss partner and expert in pelvic floor training 

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

Her mission is to de-taboo issues around the pelvic floor, educate and contribute to an improved quality of life for female athletes. 

Luisa has experience in the physiotherapeutic care of various sports and in Paralympic sports. However, she has remained true to triathlon at all times.

Literature

Araújo, Maíta Poli de; Oliveira, Emerson de; Zucchi, Eliana V. Monteiro; Trevisani, Virginia Fernandes Moça; Girão, Manoel João Batista Castello; Sartori, Marair Gracio Ferreira (2008): The relationship between urinary incontinence and eating disorders in female long-distance runners. In: Revista da Associacao Medica Brasileira (1992) 54 (2), S. 146–149. DOI: 10.1590/s0104-42302008000200018.

Bø, Kari; Borgen, J. S. (2001): Prevalence of stress and urge urinary incontinence in elite athletes and controls. In: Medicine and science in sports and exercise 33 (11), S. 1797–1802. DOI: 10.1097/00005768-200111000-00001.

Bø, K. (2004). Urinary incontinence, pelvic floor dysfunction, exercise and sport. Sports Medicine (Auckland, N.Z.), 34(7), 451–464. doi: 10.2165/00007256-200434070-00004

Carrière, B. (2010). Beckenboden: Physiotherapie und Training (2., vollst. überarb. u. erw. Aufl.). Physiofachbuch (Thieme). Stuttgart: Thieme. 

Chisholm, Leah; Delpe, Sophia; Priest, Tiffany; Reynolds, W. Stuart (2019): Physical Activity and Stress Incontinence in Women. In: Current bladder dysfunction reports 14 (3), S. 174–179. DOI: 10.1007/s11884-019-00519-6.

Da Roza, Thuane; Brandão, Sofia; Mascarenhas, Teresa; Jorge, Renato Natal; Duarte, José Alberto (2015): Volume of training and the ranking level are associated with the leakage of urine in young female trampolinists. In: Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine 25 (3), S. 270–275. DOI: 10.1097/JSM.0000000000000129.

Eliasson, Kerstin; Edner, Ann; Mattsson, Eva (2008): Urinary incontinence in very young and mostly nulliparous women with a history of regular organised high-impact trampoline training: occurrence and risk factors. In: International urogynecology journal and pelvic floor dysfunction 19 (5), S. 687–696. DOI: 10.1007/ s00192–007–0508–4.

Lebenstedt, M., Platte, P. & Pirke, K. M. (1999). Reduced resting metabolic rate in athletes with menstrual disorders. Medicine and Science in Sports and Exercise, 31(9), 1250–1256. doi: 10.1097/00005768-199909000-00004

Schulte-Frei, B. & Jäger, L. (2018). Inkontinenz bei Leistungssportlerinnen. Physioscience, 14(03), 105–111. doi: 10.1055/a-0658-0190

Schulte-Frei, B. & Schwenner, E. (2020). Mit maximaler Kraft, Ausdauer- und Entspannung: Physio- und sporttherapeutische Konzepte bei Inkontinenz. Journal für Urologie und Urogynäkologie/ Österreich 1 · 2020 · 27:3–7. doi: 10.1007/s41972-020-00098-3. 

Tanzberger, R., Kuhn, A., Möbs, G., Baumgartner, U., Daufratshofer, M., Kress, A. & Kuntner, L. (2019). Der Beckenboden – Funktion, Anpassung und Therapie: Das Tanzberger-Konzept® (4. Auflage). München: Elsevier Urban & Fischer. 

Welk, B. & Baverstock, R. (2020). Is there a link between back pain and urinary symptoms? Neurourology and Urodynamics, 39(2), 523–532. doi: 10.1002/nau.24269

Yi, Johnny; Tenfelde, Sandi; Tell, Dina; Brincat, Cynthia; Fitzgerald, Colleen (2016): Triathlete Risk of Pelvic Floor Disorders, Pelvic Girdle Pain, and Female Athlete Triad. In: Female pelvic medicine & reconstructive surgery 22 (5), S. 373–376. DOI: 10.1097/SPV.0000000000000296.

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