Pelvic health issues affect far more athletes than most people realize, yet they remain one of the least discussed aspects of sports performance and wellbeing. At Auckland Physiotherapy, our pelvic health physiotherapists work with athletes across all sports and levels - from recreational runners to elite competitors - helping them address conditions that significantly impact training, performance, and quality of life.
The silence around pelvic health problems often leaves athletes suffering unnecessarily, believing their symptoms are normal consequences of sport or childbirth, or feeling too embarrassed to seek help. Let's break this silence and explore the common pelvic health issues we see in sport, understand why they happen, and outline evidence-based solutions that can restore function and confidence.
The pelvic floor is a group of muscles, ligaments, and connective tissues forming a supportive hammock at the base of the pelvis. These muscles perform crucial functions:
Just like any other muscles, the pelvic floor can become too weak, too tight, poorly coordinated, or injured - all of which can cause symptoms and functional limitations.
What It Is: Involuntary leakage of urine during activities that increase intra-abdominal pressure - such as running, jumping, coughing, sneezing, or lifting weights.
How Common Is It? Research shows that 25-45% of female athletes experience urinary incontinence, with higher rates in high-impact sports. Studies of elite athletes find rates up to 80% in trampolining and gymnastics, and 50% in running and team sports.
Why It Happens:
Sports Most Affected: Running, CrossFit, gymnastics, trampolining, netball, basketball, volleyball, tennis, high-intensity interval training.
Impact on Athletes: Many athletes modify or stop activities they love. Some wear pads during training, limit fluid intake (which creates other health problems), or withdraw from sport entirely. The psychological impact - embarrassment, shame, loss of confidence—can be as significant as the physical symptoms.
What It Is: Descent of pelvic organs (bladder, uterus, or rectum) from their normal position due to weakened support structures. This can create sensations of heaviness, dragging, bulging, or visible protrusion.
Prevalence: While exact rates in athletes are unclear, studies suggest 40-50% of women who've had children have some degree of prolapse, many asymptomatic. Athletes who return to high-impact training too quickly postpartum have increased risk.
Why It Happens:
Symptoms: Sensations of pelvic heaviness or pressure, feeling of something "dropping down," visible or palpable bulge, difficulty emptying bladder or bowel, lower back ache.
Sports Most Affected: Weightlifting, CrossFit, running (particularly postpartum), gymnastics.
What They Include:
Why They Happen:
Sports Most Affected: Cycling (saddle-related issues), rowing, horse riding, gymnastics, yoga (extreme positions).
Impact: Pain can occur during sport, interfere with sexual function, affect daily activities like sitting, and significantly impact quality of life.
What It Is: Separation of the rectus abdominis muscles (six-pack muscles) along the midline, most commonly occurring during pregnancy but also seen in heavy lifters and some male athletes.
Why It Matters for Pelvic Health: The abdominal wall and pelvic floor work as an integrated system. When abdominal integrity is compromised, the pelvic floor often compensates, leading to dysfunction, pain, or incontinence.
Symptoms: Visible bulging or doming along the midline with exertion, poor core stability, lower back pain, pelvic floor symptoms.
Sports Most Affected: Weightlifting, CrossFit, gymnastics, any sport requiring significant core strength.
What It Is: Dysfunctional breathing patterns that create excessive downward pressure on the pelvic floor, often involving chronic breath-holding, bearing down, or paradoxical breathing.
Why It Matters: Poor breathing mechanics can create constant downward pressure on the pelvic floor, contributing to weakness, prolapse, or incontinence. Many athletes hold their breath during exertion, creating massive intra-abdominal pressure spikes.
Signs: Breath-holding during lifts, chest breathing rather than diaphragmatic breathing, inability to coordinate breathing with movement.
Understanding barriers to care helps us address them:
Normalization: Many athletes believe leakage during sport is normal or inevitable, particularly after childbirth. While common, it's not normal and is treatable.
Embarrassment: Pelvic health remains a taboo topic. Athletes feel uncomfortable discussing intimate symptoms.
Lack of Awareness: Many don't know pelvic health physiotherapy exists or that these issues are treatable.
Fear of Being Told to Stop Sport: Athletes worry they'll be advised to quit activities they love.
Minimization by Healthcare Providers: Some athletes report their concerns being dismissed as "part of being a mum" or "just do more Kegels."
The reality? Pelvic health physiotherapists are specialists who understand sport demands and work to keep you active while addressing symptoms.
Pelvic health physiotherapy begins with thorough assessment:
History Taking:
Physical Examination:
The internal examination allows direct assessment of pelvic floor muscle strength, tone, coordination, and presence of trigger points or pain. This is optional but provides valuable information that guides treatment.
Functional Testing:
Pelvic Floor Muscle Training (PFMT): The gold standard treatment for SUI, with strong research support showing 40-70% cure rates and significant improvement in most others.
Effective PFMT requires:
The Knack: A timing strategy where you pre-contract the pelvic floor just before activities that cause leakage (like jumping). Research shows this significantly reduces leakage episodes.
Load Management: Modifying training loads temporarily while building pelvic floor capacity, then progressively increasing demands.
Breathing Coordination: Teaching proper breathing patterns that reduce downward pelvic pressure during exertion.
Whole-Body Strengthening: Addressing hip, core, and lower limb strength that supports optimal load distribution.
Pessaries: Medical devices inserted into the vagina that support pelvic organs. Research shows sports pessaries can effectively manage symptoms during high-impact activity while you build pelvic floor strength.
Conservative Management:
Surgical Intervention: Reserved for cases where conservative management doesn't provide adequate symptom relief. Post-surgical physiotherapy optimizes outcomes.
Return to Sport: Structured, progressive return to impact and loading. Research suggests 12 weeks minimum before returning to high-impact activity postpartum, often longer with prolapse.
Pelvic Floor Muscle Relaxation: For overactive muscles, treatment focuses on downtraining, relaxation, and stretching rather than strengthening.
Manual Therapy:
Dilator Therapy: Progressive use of vaginal dilators for conditions like vaginismus or dyspareunia.
Pain Education: Understanding pain mechanisms and that pain doesn't always equal damage.
Stress Management: Addressing psychological factors that contribute to muscle tension.
Behavioral Modifications: Adjusting activities or positions that aggravate symptoms while working on underlying causes.
Functional Core Restoration:
Realistic Expectations: Some separation may persist, but function can be fully restored. The goal is effective core function, not complete gap closure.
Diaphragmatic Breathing: Teaching proper breathing mechanics that create balanced pressure distribution.
Exercise Integration: Coordinating breathing with movement patterns (exhaling during exertion, for example).
Pressure Management: Avoiding excessive breath-holding or bearing down.
Common Issues: Stress urinary incontinence, pelvic organ prolapse symptoms, pelvic pain.
Solutions:
Common Issues: Prolapse symptoms during heavy lifts, stress incontinence during box jumps or double-unders, diastasis recti.
Solutions:
Common Issues: Pelvic pain, pudendal neuralgia, vulvar pain, numbness.
Solutions:
Common Issues: Very high rates of stress urinary incontinence, pelvic organ prolapse risk.
Solutions:
Prevention is always better than treatment. Here's how to maintain pelvic health:
Include Pelvic Floor Training: Just like training other muscle groups, include pelvic floor exercises in your regular routine. Even 5 minutes daily makes a difference.
Breathe Properly: Never hold your breath during lifts or exertion. Exhale during the effort phase.
Progress Gradually: Avoid sudden jumps in training volume or intensity, particularly postpartum.
Maintain Healthy Body Weight: Excess weight increases pressure on the pelvic floor.
Manage Constipation: Chronic straining damages pelvic floor support. Address with adequate fiber, hydration, and proper toileting posture.
Postpartum Considerations: Return to sport gradually with professional guidance. The standard 6-week clearance doesn't mean you're ready for high-impact training.
Regular Check-Ups: Consider pelvic health assessment part of your athletic preparation, especially if planning pregnancy or experiencing any symptoms.
Consult a pelvic health physiotherapist if you experience:
Early intervention prevents minor issues from becoming major problems and allows faster return to full training.
Specialized Expertise: Pelvic health physiotherapists have advanced training in pelvic anatomy, function, and dysfunction. We understand both the clinical aspects and the demands of sport.
Individualized Treatment: Cookie-cutter advice doesn't work. We design programmes specific to your symptoms, sport, and goals.
Empowerment: We teach you to understand your body, recognize warning signs, and manage your condition long-term.
Sport-Focused: Our goal is keeping you active. We work with you to modify, adapt, and progress training while addressing underlying issues.
Collaborative Care: We may work with your GP, obstetrician, sports physician, or other healthcare providers to ensure comprehensive care.
As pelvic health physiotherapists, we're passionate about changing the culture around these issues. Pelvic health should be discussed as openly as knee or shoulder injuries. Leaking during sport isn't a badge of honor or inevitable consequence of motherhood—it's a treatable condition.
By seeking help, speaking openly, and sharing experiences, athletes help break down stigma and encourage others to get the treatment they deserve.
Pelvic health issues affect countless athletes but remain undertreated due to embarrassment, lack of awareness, and misconceptions about what's normal. The reality is that these conditions are common, treatable, and should never force you to give up activities you love.
At Auckland Physiotherapy, our pelvic health physiotherapists provide specialized, evidence-based care in a comfortable, non-judgmental environment. We understand the unique demands athletes face and work to restore function, eliminate symptoms, and keep you doing what you love.
You don't have to suffer in silence. You don't have to accept leakage as normal. You don't have to give up sport. With appropriate assessment and treatment, most pelvic health issues improve significantly or resolve completely.
Experiencing pelvic health symptoms affecting your sport or daily life? Visit www.aucklandphysiotherapy.co.nz or contact Auckland Physiotherapy today to book a confidential appointment with our pelvic health physiotherapists.
Housed in the beautiful Foundation Precinct, sandwiched in-between Newmarket, Parnell & Remuera
This blog provides general information and is not a substitute for individual assessment. Pelvic health concerns require personalized evaluation and treatment. All internal examinations are performed with full consent and are optional.
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