What Stops 1 in 2 women playing sport or exercising?

For those assigned female at birth, sport and exercise is more than just a way to stay healthy—it’s a source of joy, connection and empowerment. Yet, for some, pelvic floor symptoms turn this source of joy into a source of anxiety. Pelvic floor symptoms, including urinary incontinence, pelvic pain, or a sensation of pressure, can become significant barriers to participation.

Research led by Dr Jodie Dakic at Monash University¹, involving 4,556 Australian women aged 18 to 65, revealed that one in two women experiencing PF symptoms either stopped participating in physical activity or modified how they engaged. This problem affected all age groups, including those aged 18–25, a demographic often overlooked.

The statistics are quite alarming - 46% stopped participating entirely, while over 50% adjusted their activities. Given the overwhelming evidence supporting the positive impact of sport and exercise on all aspects of our physical and mental health – this has significant societal ramifications. The research found that pelvic floor symptoms impact approximately one in three women across all sports, with prevalence rising to nearly 80% among those involved in high-impact activities such as gymnastics, trampoline, weightlifting and powerlifting.

Is there routine screening?

Routine pelvic floor symptom screening empowers women to recognise symptoms early, seek timely care and maintain their active lifestyles. A 2023 survey³ of 636 health and exercise professionals including physiotherapists, general practitioners, fitness instructors and exercise physiologists revealed that PF screening is not routinely carried out. Only 23% of professionals were screening women for pelvic floor symptoms and this was largely limited to women who were pregnant or returning to exercise after childbirth3. Additionally, the survey indicated a lack of confidence, knowledge and comfort in asking about and addressing pelvic floor issues from healthcare professionals.

Do women disclose their pelvic floor symptoms?

Despite the high numbers stopping sport or exercise due to symptoms, only 8% of symptomatic women report their symptoms to a healthcare provider². Most women choose to self-manage bladder leakage and other pelvic floor symptoms rather than seeking treatment. Unfortunately, we know that self-management rarely results in improved symptoms.

While screening protocols can help identify pelvic floor symptoms, many women may still hesitate to disclose their symptoms even when asked. Dakic et al.⁴ identified the main reasons for this were feelings of shame, embarrassment, a lack of understanding about pelvic health or simply not knowing how to start the conversation.

Screening in sport and exercise settings

Women generally supported the inclusion of pelvic floor symptom questions in existing screening protocols, but only if the questions were presented with respect and sensitivity. It is the responsibility of health and exercise professionals to foster a safe environment, encourage women to speak up by demonstrating expertise, trustworthiness and competence.

These findings highlight the importance of all health and exercise professionals educating women about the value of PF screening, building trust through clear information, obtaining consent, showing empathy and maintaining confidence within their specific scope of practice. That might be offering advice and education, suggesting exercise modifications, or making appropriate referrals and encouraging women to seek help.

Empowering Through Education

Education empowers women to recognise, report, and manage pelvic floor symptoms. Dakic⁴ found that early detection can reduce the long-term impact of urinary incontinence on participation. Research by Cardoso et al⁵ showed athletes who understand pelvic floor symptoms and their management are less likely to experience these issues during exercise. By fostering open conversations and providing clear guidance, healthcare providers can build confidence and support women in maintaining active lifestyles and women can empower themselves by seeking this education. A good place to start is understanding more about the pelvic floor muscles.

How can we all lead change – for individuals and the broader community

Use social media platforms to ensure the following messages become general knowledge - Pelvic floor symptoms are common but not normal and they significantly impact women's participation in sport and exercise.
Create safe environments that recognise, report, and encourage help seeking for bladder, bowel and prolapse issues.
Be willing to engage with each other in conversations about the pelvic floor and pelvic floor problems.
Demand routine screening for all sports and fitness settings, not just for women after having a baby.
Be honest about any pelvic floor symptoms and disclosing them to a healthcare provider.
Consider a pelvic health assessment with a physiotherapist specifically trained in pelvic floor health.
Engage in correct and effective pelvic floor muscle training to reduce symptoms.

Whether you are a competitive athlete or someone who simply enjoys a morning run, remember that pelvic floor symptoms are common but treatable. Change is always best led by the consumer – encouraging health and exercise professionals to perform routine screening, normalising these conversations and finding the courage to seek help for pelvic floor symptoms creates powerful change.

Remember, you are not alone. There is support available and pelvic floor issues such as bladder leakage do not have to hold you back from enjoying the sports and exercise you love.

References

^1.Dakic, J. G., Cook, J., Hay-Smith, J., Lin, K. Y., & Frawley, H. (2021). Pelvic floor disorders stop women exercising: A survey of 4,556 symptomatic women. Journal of Science and Medicine in Sport, 24(12), 1211–1217. https://doi.org/10.1016/j.jsams.2021.06.003

^2. Dakic, J. G., Cook, J., Hay-Smith, J., Lin, K. Y., Calo, M., & Frawley, H. (2021). Effect of pelvic floor symptoms on women's participation in exercise: A mixed-methods systematic review with meta-analysis. The Journal of Orthopaedic and Sports Physical Therapy, 51(7), 345–361. https://doi.org/10.2519/jospt.2021.10200

^3. Dakic, J. G., Hay-Smith, J., Cook, J., Lin, K. Y., & Frawley, H. C. (2023). Screening for pelvic floor symptoms in exercising women: A survey of 636 health and exercise professionals. Journal of Science and Medicine in Sport, 26(2), 80–86. https://doi.org/10.1016/j.jsams.2023.01.008

^4. Dakic, J. G., Hay-Smith, E. J. C., Lin, K. Y., Cook, J. L., & Frawley, H. C. (2023). Women's preferences for pelvic floor screening in sport and exercise: A mixed-methods study integrating survey and interview data in Australian women. British Journal of Sports Medicine, 57(24), 1539–1549. https://doi.org/10.1136/bjsports-2023-107017

^5. Cardoso, A. M. B., Lima, C. R. O. P., & Ferreira, C. W. S. (2018). Prevalence of urinary incontinence in high-impact sports athletes and their association with knowledge, attitude and practice about this dysfunction. European Journal of Sport Science, 18(10), 1405–1412. https://doi.org/10.1080/17461391.2018.1496146