The Surprising Health Issue Plaguing Female Triathletes

Published June 16, 2019 04:00PM

As recently as 50 years ago, doctors held the belief that sports—specifically those involving running or jumping—could cause a woman’s uterus to fall out. Though that notion has long since been dispelled, researchers have found women who compete in triathlon are at increased risk for pelvic floor disorders.

“We found that one in three female triathletes have symptoms of pelvic floor disorders, specifically pelvic organ prolapse and incontinence,” says Dr. Johnny Yi of Aracea Women’s Care in Denver, Colo. Yi led a 2014 investigation into the gynecologic health of female triathletes. Findings were presented at the American Urogynecologic Society 2014 Scientific Meeting and in the Journal of Injury, Function & Rehabilitation.

Pelvic floor disorders are described as problems that involve the pelvic floor anatomy. Disorders can include pelvic organ prolapse (where internal organs “drop” from a normal place in the lower belly due to weak pelvic muscles), incontinence, urinary retention, constipation and/or pelvic pain. These symptoms are quite common in women—more so in those who are athletic.

“High impact sports lead to increased intra-abdominal pressure, and this can lead to the symptoms of pelvic floor disorders,” says Yi, “Running, jumping, gymnastics, heavy weight lifting would all be considered high impact on the pelvic floor, which may predispose these women to pelvic floor symptoms.”

Any time an athlete engages in such high-impact activity, the pelvic floor muscles are activated as part of the core muscle group, along with the abdominal and back muscles. Yi and colleagues hypothesized vigorous training puts the pelvic floor muscles at risk for fatigue, making them weaker and vulnerable to incontinence or a prolapse.

Symptoms of pelvic floor disorders include (but are not limited to) involuntary leakage of urine when sneezing, coughing, running or jumping; pelvic pain or pain with intercourse; a strong, compelling need to urinate; and/or a bulge that is felt or seen outside of the vagina.

Because the disorders are unpleasant to experience, much less discuss, most women do not seek help for their symptoms. Many women also chalk their symptoms up to aging or the residual effects of childbirth. Though these are common contributors to pelvic floor disorders, Yi says his study discovered symptoms were present in female triathletes of all ages and those who have not had children. Avoidance of issues early on can lead to greater problems down the line—a woman has a lifetime risk of 11-20% of having a surgery for urinary incontinence or uterovaginal prolapse.

“I believe that pelvic floor symptoms are often under reported,” says Yi. “While these symptoms are common, they are treatable and patients should speak to their doctors about these treatments. Starting with their primary care physician or OBGYN is a great start, but there are pelvic floor specialists, called Urogynecologists or Female Urologists, who have specialized training to treat these disorders.”

Treatments for pelvic floor disorders range from conservative measures such as physical therapy to more invasive actions such as surgery. A complete stop to training is not usually recommended, says Yi:

“Our goal with our study was to increase awareness of how common these symptoms are. We do not intend to discourage triathletes from training or discourage exercise in any way. However, if patients do find they are bothered by these symptoms, sometimes it can be a sign of a more serious problem. They should discuss their symptoms with their physician.”