Female triathletes, pelvic floor disorders, pelvic girdle pain and the female athlete triad

Triathlon Forum
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Hello all,
As we promised several months ago, we are able to now share our exciting findings from the Female Triathlete study that we performed and many of you participated in. Our goal with this study is not to suggest that triathlon training, or other endurance sport training, is not healthy or detrimental to your health. Instead, our goal is to inform women triathletes that these symptoms are common and that there are effective treatments for pelvic floor disorders. Further, we always encourage women to stay active, but in doing so, it is important to maintain adequate nutrition and energy availability to optimize your health during exercise. We hope you will find this study interesting and if you find yourself having any of these bothersome symptoms, please seek medical attention. Urogynecologists have expertise in pelvic floor disorders- urinary and fecal incontinence and pelvic organ prolapse. If you are concerned about your nutritional health, please discuss this with your primary care provider.

Sincerely,
Johnny YI and Colleen Fitzgerald
Loyola University Medical Center
Division of Urogynecology
Maywood, IL

Triathlete Risk of Pelvic Floor Disorders, Pelvic Girdle Pain and the Female Athlete Triad

Objective: To estimate the prevalence of pelvic floor disorders(PFD), pelvic girdle pain(PGP) and female athlete triad(Triad) in the female triathlete population and determine an association between PFD and PGP or Triad.

Design: Web-based survey

Setting: Nationwide survey for female triathletes >18 years old.

Participants: 311 subjects participated from 7 different regions of the US

Main Outcome Measures: Using validated questionnaires, we estimate the prevalence of PFD and PGP in the female triathlete population. We also used the female athlete triad screening questionnaire to evaluate the prevalence of those at risk for the Triad. Percentage and continuous variables were analyzed using a Chi-square and Student’s T-test while correlations were analyzed with the Spearman Correlation using SPSS version 20.0 (Chicago, Illinois).

Results: Three hundred eleven women with a median age range of 35-44 years responded. Participants were mostly White/Caucasian (89.7%), nonsmokers (99.4%) , premenopausal (80%) and had a mean BMI of 22. Mean weekly training was as follows: running 3.7 days, biking 2.9 days and swimming 2.4 days.

16% endorsed urgency urinary incontinence (UUI), 37.4% Stress Urinary Incontinence (SUI), 5% Pelvic Organ Prolapse (POP) and 37% anal incontinence (AI) and 28% with fecal incontinence (FI). Training mileage and intensity were not associated with PFD. Parity was associated with higher prevalence of SUI (55 vs 24% p=0.001) and POP (8 vs 3%, p=0.05).

18% of respondents had PGP thought it was not disabling per the PGPQ with a mean score of 35.6 (SD=8.0). Those with SUI, UUI and AI had higher levels of PGP. (SUI p=0.05, UUI p=0.03, AI p=0.03)

75% of respondents completed the triad questionnaire and 22% screened positive for low energy availability, 24% for menstrual irregularities, and 29% for abnormal bone strength. 24% screened positive for one arm of the triad. There was no significant association between PFD and the Triad.

Conclusions: 1 in 3 triathletes endorse symptoms of pelvic floor disorders. About 1 in 4 triathletes screen positive for at least one component of the Triad. While both disorders are prevalent in female athletes, both are often ignored. Healthcare providers should be aware of this significant prevalence and screen and treat patients appropriately to avoid long term sequelae and improve overall quality of life.

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Thanks for sharing. Hope you got it published in a good journal :wink:

About 1 in 4 triathletes screen positive for at least one component of the Triad.

This is frightening, and a finding that should be of interest not only to medical professionals, but also triathlon coaches.

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Thank you, I was wondering what your findings would be… not shocking but definitely some higher values than I expected. Can you comment on how these results would compare against the general population as a whole? Say typical NA caucasian non-smoking female aged 20-50? Just curious. AP

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Did your study include questions on pregnancychild birth? I know that my body is significantly different post-pregnancy.

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Thank you for the interesting responses. I expect that most female triathletes are very health conscious, but as with the general population, pelvic floor health is often ignored. Pelvic floor disorders are considered “common” or a “natural part of aging” and I find that women often think they need to just live with the condition.

To give some perspective, here are some values for the general population according to an article that is publicly available by the Journal of American Medical Association.
Age 20-39 Urinary incontinence- 6.9%, fecal incontinence 2.9%, pelvic organ prolapse 1.6%
Age 40-59 Urinary incontinence- 17.2%, fecal incontinence 9.9%, pelvic organ prolapse 3.8%
Age 60-79 Urinary incontinence 23.3 %, fecal incontinence 14.4%, pelvic organ prolapse 3%
Nonhispanic white Urinary incontinence 16%, fecal incontinence 9.8%, pelvic organ prolapse 2.8%
Nygaard, et al. Prevalence of Symptomatic Pelvic floor disorders in US Women. JAMA Sep 17, 2008; 300(11): 1311-1316.

We do know that vaginal deliveries and age are probably the greatest risk factors for pelvic floor disorders.
According to our study, we did find that women that delivered a baby (parous or parity refers to delivering a baby) reported urinary loss with activity (stress incontinence) and a vaginal bulge (prolapse) more commonly than women who never delivered a baby. However, women who never delivered a baby had significant rates of pelvic floor disorders, which may suggest that endurance events may lead to pelvic floor muscle fatigue.

We look forward to continuing our work, especially to look at what the barriers are to seeking care for pelvic floor disorders, what types of treatments are optimal for this population and also how they respond to treatments. We are currently seeking funding to continue our research. Thank you!

Johnny Yi MD