Lately I’m seeing more female athletes popping up in the clinic with pelvic floor dysfunction. From postpartum runners to nulliparous gymnasts and Crossfit athletes, more and more women are experiencing pelvic organ prolapse and stress urinary incontinence during their athletic endeavors.
A 2016 study by Ameida et al. examined urinary incontinence in female athletes who participate in high impact sports. 67 athletes were shown to be at high risk for UI, uncontrolled flatus, and sexual dysfunction compared to a control population of 96 non-athletes. The authors concluded that women involved in long-term high-impact and strengthening sports should be educated in the possible ramifications that these activities can have on pelvic floor function and offered preventive PFD strategies. 1
Education and awareness is key with this population, as they tend to ignore bodily discomfort and focus on their goals. Their body is an instrument and if the symptom is not pain they are apt to ignore it.
I have an educational video discussing the role of high impact sports on pelvic floor dysfunction for patients below, which can be used as a resource for educating patients.
Diaphragmic breathing has been a staple of pelvic floor treatment for decades. The relationship between the diaphragm and the pelvic floor is one likened to a piston, mechanically speaking, with the pelvic floor (PF) activating both in lift and squeeze during exhalation and increased intra-abdominal pressure.
Have you ever considered how forcefully you cue patients to breathe, and the role this may have on pelvic floor muscle activation? A quasi-experimental repeated measures study conducted by Kitani et al. sought to determine if force of expiration effected automatic activation of the pelvic floor muscles.1
Participants in this study were 26 nulliparous females age 18-35 years, all with normal activation of the pelvic floor muscles. A breathing device was utilized during the study to provide 3 different variations in resistance, measured with spirometry. Cranial displacement of the PF muscles was measured utilizing visualized ultrasound, while squeeze pressure of the PF muscles was measured using a perineometer.
The investigators found that of the three variations in force production during exhalation, a cranial-ventral pelvic floor displacement was found most often during minimum forced expiration during PF training aimed at enhancing displacement in an “optimum and protective direction”.
Clinically, this study reinforces the importance of cuing our patients to exhale gently during PF activation training. My verbal cues include “exhale gently as if you were blowing out birthday candles”, or “exhale gently as if you were trying to blow a feather across a table”.