Were you an athlete before you developed bladder and/or pelvic pain?

pelvicfloortriathlonriskOne of the trends currently being tracked in patients struggling with pelvic floor dysfunction and bladder/pelvic pain disorders is a history of athletics. A new study presented at the 2014 American Urogynecologic Society Scientific meeting has shown a direct relationship between long distance endurance training (aka triathlons) and pelvic floor disorders. Of the 311 female triathletes participating in the study, 16% suffered from urinary incontinence, 28% from bowel incontinence and 5% from pelvic organ prolapse.(1) It appears that the constant training and repetitive motion results in muscle tension and/or weakness which, over time, creates a risk for the development of more chronic pelvic conditions.

Principal investigator Colleen Fitzgerald (LUHS) offered “There has been a surge in popularity of high-impact sports such as triathlons, but little has been known until now about the prevalence of pelvic health and certain other issues associated with endurance training and events.” Triathlons are composed of three stages: distance swimming, cycling and running. In this study, participants ran an average of 3.7 days a week, biked 2.9 days a week and swam 2.4 days a week. Of the three sports, biking and running are extremely pelvic floor intensive.

Running has long been associated with pelvic floor muscle dysfunction and weakness. Physical therapist Michelle Kenway explained “Running is a high impact exercise which involves both feet being off the ground simultaneously. When the heel strikes the ground during running, the physical force associated with landing passes down through the pelvic floor and then to the ground… this impact can have the effect of stretching the pelvic floor muscles and connective tissue supports… when repeated over time the pelvic floor can become progressively stretched and weakened…”(2) This weakness generally drives the symptoms of incontinence and, in the most severe cases, pelvic floor prolapse.

On the other hand, cycling can trigger nerve trauma, numbness and, for some men, erectile dysfunction. Known as bicycle seat neuropathy, it is the result of the compression various nerves and blood vessels. Several studies of long distance riders have found pain and/or numbness in the perineal area for both men and women. Bicycle seat shape and position are the major factors.(3) This does not, however, address one key problem. Repetitive nerve pain will provoke a guarding response in the pelvic floor muscles which can result in chronic muscle tension as well as the development of painful trigger points. This can result in unusually tight, painful muscles which may make it difficult to sit comfortably, enjoy intimacy, urination and defecation.

If you are an athlete struggling with pelvic floor and/or bladder & pelvic issues, there are a number of things you should do:

#1 – Have your pelvic floor checked. While an OB-GYN or urologist are can do a preliminary exam, the most thorough pelvic floor assessments are performed by physical therapists who specialize in pelvic disorders. They will look for tension or weakness patterns both externally (i.e. in the legs, butt, lower back, etc) and also internally. The internal exam is nothing to fear and takes just a few minutes to perform. The therapist will gently touch various muscle groups inside the pelvis, looking for painful trigger points, weakness and so forth.

#2 – Work the muscles daily – If weakness is found, patients generally perform regular daily pelvic floor exercises that are designed to strengthen the muscles, lift them higher into the pelvis and make them more resistant to downward strain. If tension or painful trigger points are the problem, you’ll be doing daily relaxation and/or stretches to help restore proper muscle tone.

#3 – Moderation is key. – Until the problem is resolved, it’s important to be moderate with your exercise routines and even something as simple as sitting at a desk. I, for example, have a partially compressed nerve on the lower, left side of my pelvic floor which, if I sit too long, will begin to spasm (which it just started doing). I immediately raised the level of my desk, got out of my chair and am now typing while standing up to reduce strain.

#4 – Mix up your exercise routines. Yes, we all have exercises that we love. The problem is that repetitive motion can cause long term muscle dysfunction. Try mixing up your workout routine. Throw in more swimming and rowing that minimize pelvic floor trauma. To lengthen and strengthen muscles, consider adding yoga and/or pilates. I challenge anyone who believes that running is the best exercise to do the same amount of time on a rower. They’ll see, very quickly, that the best exercises use both the arms and legs which then shares the overall load and burden of the workout.

#5 – Try different bike seats! If you’re using an old, hard leather seat that pushes up into the perineum, try a different bike seat and/or changing the position of the nose of the seat so that it’s pointing downward. A seat which has a split nose or cutout under the pelvic floor has been shown to reduce pressure by up to 50%.(3)

Were you an athlete before you developed pelvic problems? We’d love to hear your story! Please share it below!


Female Triathletes at Risk for Pelvic Floor Disorders and Other Complications. Loyola University Health System. July 17, 2014

Martinez J. Bicycle Seat Neuropathy. Medscape. June 27, 2014

Kenway M. Your Pelvic Floor and Running. Sue Croft Physiotherapist Blog. May 16, 2012