Exercise and Pelvic Floor Dysfunction in Female Elite Athletes

The pelvic floor muscles (PFM) forms the bottom of the pelvis and the floor of the abdominal cavity. They comprise a three-layer muscle plate with two mayor muscle groups: the pelvic and the urogenital diaphragm. Well-established etiological factors for pelvic floor dysfunction include pregnancy and vaginal childbirth, older age, obesity, and gynecological surgery. There are two hypotheses about the pelvic floor and strenuous exercise: female athletes have strong PFM, female athletes may overload, stretch, and weaken the pelvic floor. Strength training of the PFM has shown to increase the thickness of the muscles, reduce muscle length, reduce the levator hiatus area, and lift the levator plate to a more cranial level inside the pelvis in women with pelvic organ prolapse. The prevalence of urinary incontinence and especially stress urinary incontinence among young, nulliparous elite athletes is high. Anal incontinence in the form of loss of flatus is also common.