The importance of training the pelvic floor in female athletes

Imagine: you try to lift a weight at the gym and notice a slight loss of urine. This situation could embarrass you, not knowing that it may be due to a weakness in the pelvic floor. One of the most striking examples was that of Ecuadorian weightlifter María Alexandra Escobar Guerrero, who in the London 2012 Olympic Games, while lifting in the 58kg category, urinated during her performance, a fact that was disseminated in social networks and the media. However, behind this involuntary and unfortunate incident is the importance of strengthening all muscle groups, including one of the most unknown by athletes, which are those that make up the pelvic floor. This is a set of muscles and connective tissue that is responsible for supporting the structures of the abdomen and pelvis and controlling urinary and fecal continence, among other functions.

The positive benefits of strength training on health are widely known. We go to the gym to work all the muscles of our body as a whole, but we often forget a very important one: the pelvic floor. If the normal functions of the muscles that make up the pelvic floor suffer any alteration, dysfunctions appear. These can include urinary incontinence, which is understood as any loss of urine that occurs involuntarily and affects one in four women throughout their lives. It has usually been associated with pregnant and postpartum women, but it also affects many female athletes who have not had children. But what does the scientific evidence tell us about it? Why does it occur? How is it possible?

The practice of high-impact sports has traditionally been observed as a risk factor for the development of urinary incontinence. One possible explanation is that the reaction force of the feet against the ground when jumping and handling moderate and high loads, together with a lack of contraction of the pelvic floor muscles, generates an increase in intra-abdominal pressure that compromises the proper closure of the urethra.

Urinary incontinence can be a taboo subject, which can lead many women to give up sports. However, there is a solution: training the pelvic floor muscles to improve their ability to contract under stress and prevent or treat the onset of urinary incontinence.

These trainings consist of voluntary contractions of the pelvic floor musculature to improve pelvic floor strength and support of the pelvic floor structures to counteract the increased intra-abdominal pressure and floor reaction forces during exercise. This leads to an improvement in automatic pelvic floor function and leads to a reduction in urinary incontinence when it occurs or prevention of a possible future occurrence.

Although most studies on urinary incontinence in female athletes are limited to describing the problem, there are studies that have analyzed the efficacy of a pelvic floor training program in this group to prevent or treat dysfunction. Specifically, a recent meta-analysis on a sample of 187 female athletes with an average age of 23 years, who have not had children and who undergo a pelvic floor training protocol, shows that they saw an improvement in the maximum voluntary contraction of the pelvic floor, with the intervention program proving to be effective. This parameter is important for creating structural support during increases in intra-abdominal pressure caused by physical exercise and daily activities, such as coughing or sneezing. In addition, the amount of urine leakage was also significantly reduced after the weeks of training.

Regarding pelvic floor training protocols, the studies included interventions with durations of six to 16 weeks. Half of them divided the protocol into different stages: (i) identification and awareness of contractions; (ii) stabilization and strengthening of the pelvic floor musculature with progressive overload; and (iii) power contractions during sports practice. This last stage aims to improve urethral closure during sports and other actions that lead to urine leakage. For this purpose, the knack technique was used, consisting of a voluntary and strong contraction before performing sports exercises (for example, before performing a squat or a jump).

Regarding the contractions, it was observed that it is beneficial to combine shorter contractions (2-3 seconds) with others of longer duration (6-10 seconds) while producing a progressive overload. The analysis also found that it is favorable to increase the intensity and duration of the contractions and reduce rest times.

A different case was the use of a training protocol based on the hypopressive technique. These exercises have generated controversy in recent years because they lack the necessary scientific evidence to be recommended as a line of treatment for the pelvic floor, despite being widely used to improve the tone of the pelvic floor musculature.

It is essential that female athletes, especially those involved in high-impact activities, become aware of the importance of strengthening their pelvic floor muscles. These exercises can be performed on a regular basis as part of their training routine, and can prevent the onset of problems in the future.

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