Written by Leah Morrow
Pelvic health is an important part of overall health and athletic performance, yet it is an area that is still often overlooked in sport.
Pelvic floor dysfunction (PFD) can affect female athletes across different sports and at different stages of their careers. Symptoms may include urinary leakage, urinary urgency, difficulty emptying the bladder or bowel, pelvic pressure, pelvic pain or sexual dysfunction.
Despite this, many athletes don't report their symptoms or may simply assume that they are an unavoidable consequence of training, childbirth or participating in high-impact sport.
They aren't something athletes should simply have to put up with.
The PFD-SENTINEL tool provides a framework for improving awareness, screening and ongoing monitoring of pelvic floor health in female athletes. Its principles highlight four important areas: education, screening, continuous monitoring and a multidisciplinary approach.
1. Education: making pelvic health part of the conversation
One of the biggest barriers to good pelvic health in sport is simply a lack of awareness.
Athletes may not recognise symptoms as something that can be assessed and treated. Healthcare professionals and coaches may also feel unsure about when or how to ask about pelvic health.
Creating a culture where pelvic health is discussed openly can help change this.
Education should include:
What pelvic floor dysfunction is
Common signs and symptoms
What is considered normal during exercise — and what isn't
When an athlete should seek professional support
Where athletes can access specialist pelvic health care
This education shouldn't be limited to athletes. Coaches, strength and conditioning professionals, sports medicine teams and physiotherapists all have a role to play.
The earlier someone understands that their symptoms are worth discussing, the earlier they can access appropriate support.
2. Screening: don't wait for symptoms to become a problem
Pelvic health assessment is often reactive — an athlete develops significant symptoms and only then seeks help.
A more proactive approach is to incorporate pelvic floor screening into routine athlete health assessments.
The PFD-SENTINEL tool can help provide a structured approach to identifying female athletes who may be experiencing pelvic floor dysfunction or who could benefit from further assessment.
Screening doesn't mean diagnosing every athlete with pelvic floor dysfunction.
Instead, it provides an opportunity to ask the right questions, identify potential concerns and refer an athlete to an appropriately qualified professional when needed.
For example, questions around urinary leakage during running, jumping or lifting may reveal a problem that an athlete has never previously discussed.
Early identification can mean earlier intervention — and potentially less disruption to training and competition.
3. Continuous monitoring: pelvic health can change throughout an athlete's career
Pelvic health isn't static.
An athlete's symptoms and risk factors can change depending on training load, injury, pregnancy, postpartum recovery, hormonal changes and periods away from sport.
For this reason, pelvic health shouldn't necessarily be considered a one-off assessment.
Regular check-ins could be particularly useful:
Pre-season
A preseason assessment provides an opportunity to establish a baseline and identify any symptoms before training volume increases.
During the season
Changes in training load, competition schedules and fatigue may influence symptoms. Checking in during the season can help identify changes early.
Following injury
An athlete returning from injury may suddenly increase their training load or movement exposure. Pelvic health should be considered alongside their musculoskeletal rehabilitation.
Following a prolonged break from sport
Returning to running, jumping or high-impact activity after time away requires a gradual progression. This can be particularly important following pregnancy or significant injury.
During pregnancy and postpartum
Pregnancy and childbirth can result in significant changes to the pelvic floor and wider pelvic health. A structured approach to rehabilitation can help athletes safely progress towards their chosen sport.
Continuous monitoring allows the healthcare team to respond to changes rather than waiting until symptoms become severe.
4. A multidisciplinary approach
Pelvic health shouldn't sit within a silo.
Female athletes often work with multiple professionals throughout their sporting careers, and effective pelvic health management may require collaboration between them.
This could include:
Sports and exercise medicine doctors
MSK and sports physiotherapists
Pelvic health physiotherapists
Strength and conditioning coaches
Coaches
Other relevant healthcare professionals
Each professional brings a different area of expertise.
For example, an MSK physiotherapist may manage an athlete's tendon or bone injury, while a pelvic health physiotherapist assesses urinary symptoms, pelvic floor function or postpartum recovery.
Working collaboratively allows these areas to be considered together rather than treating them as completely separate problems.
Pelvic health and return to sport
A particularly important application of this approach is return to sport.
Returning to sport isn't simply about whether an athlete is pain-free.
Following injury or pregnancy, we should also consider:
Symptoms during exercise
Bladder and bowel function
Pelvic pressure or heaviness
Pelvic pain
Strength and capacity
Training load
Impact exposure
Confidence
Sport-specific demands
A runner returning postpartum, for example, may be physically capable of completing a short run but still experience urinary leakage or pelvic heaviness.
That doesn't necessarily mean they cannot run.
It means their rehabilitation and return-to-running programme may need to be adapted to address those symptoms.
The goal should be a safe, individualised and progressive return to sport, rather than simply meeting an arbitrary timeline.
Why does this matter for performance?
Pelvic health is not separate from athletic performance.
If an athlete is avoiding certain movements because they are worried about leaking urine, changing their training because of pelvic pressure, or limiting their competition because of symptoms, their pelvic health may be affecting their sporting participation.
Addressing these issues can therefore be about much more than symptom management.
It's about helping athletes feel confident in their bodies and giving them the opportunity to train and compete without unnecessary limitations.
Changing the culture around pelvic health
Perhaps the biggest opportunity is to change the way we talk about pelvic health in sport.
Athletes shouldn't have to wait until symptoms become severe before someone asks about them.
Coaches shouldn't feel that pelvic health is "too personal" to discuss when it is relevant to an athlete's health.
And healthcare professionals should feel confident recognising when an athlete may benefit from specialist pelvic health assessment.
The PFD-SENTINEL framework highlights the importance of moving towards a more proactive model:
Educate → Screen → Monitor → Collaborate
Rather than waiting for problems to become significant, we can build pelvic health into the wider approach to athlete health.
Pelvic health is athlete health.
Whether you're an elite athlete, recreational runner, returning to sport after pregnancy or simply someone who wants to stay active throughout life, pelvic floor symptoms are worth talking about.
They are common — but they don't have to be something you simply accept.
If you're experiencing symptoms such as urinary leakage, urgency, pelvic heaviness or pelvic pain during exercise, a pelvic health physiotherapist can assess your symptoms and help develop an individualised plan to get you back to the activities you enjoy.
Evidence:
Giagio S, Salvioli S, Innocenti T, et al. (2023). PFD-SENTINEL: Development of a screening tool for pelvic floor dysfunction in female athletes through an international Delphi consensus. British Journal of Sports Medicine, 57(14), 899–905. doi:10.1136/bjsports-2022-105985.
This is the primary reference for the PFD-SENTINEL framework and supports the education, screening, referral and continuous-monitoring approach described in the blog.Domínguez-Pérez N, Sevilla-Arrabal I, Navarro-Brazález B, Torres-Lacomba M, et al. (2026). Urinary Incontinence in Women Athletes: Umbrella Review and Meta-analysis of Sport-Related Factors. Sports Medicine, 56, 2185–2208.
This is a particularly useful recent reference for your blog. The 2026 review included 32 primary studies and 4,649 participants and found substantial variation in urinary incontinence prevalence, with weekly training volume positively associated with urinary incontinence odds.Lourenço TR, Matsuoka PK, Baracat EC, Haddad JM. (2018). Urinary incontinence in female athletes: a systematic review. International Urogynecology Journal, 29(12), 1757–1763. doi:10.1007/s00192-018-3629-z.
A systematic review of 22 studies involving 7,507 female athletes, demonstrating that urinary incontinence occurs across a range of sporting activities and may be particularly prevalent in higher-impact sports.Demeco A, Bartocci G, Astore N, et al. (2024). The Efficacy of Pelvic Floor Rehabilitation in the Treatment of Urinary Incontinence in Female Athletes: A Systematic Review. Sports, 12(12), 338. doi:10.3390/sports12120338.
Useful for supporting the section around individualised pelvic floor rehabilitation, with the review finding benefits from personalised pelvic floor muscle training programmes in female athletes with urinary incontinence.Syeda A, et al. (2024). Urinary Incontinence in Female Athletes: A Systematic Review on Prevalence and Physical Therapy Approaches. Cureus.
This review further supports the prevalence of urinary incontinence in female athletes and the role of pelvic floor muscle training and education in prevention and management.Haylen BT, de Ridder D, Freeman RM, et al. (2010). An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourology and Urodynamics, 29(1), 4–20. doi:10.1002/nau.20798.
A useful foundational reference for terminology and definitions of pelvic floor dysfunction.Bø K, Artal R, Barakat R, et al. (2018). Exercise and pregnancy in recreational and elite athletes: 2016/2017 evidence summary from the IOC expert group meeting, Lausanne. Part 5: Recommendations for health professionals and active women. British Journal of Sports Medicine. doi:10.1136/bjsports-2018-099351.
Particularly relevant to your pregnancy, postpartum and return-to-sport sections, including pelvic floor dysfunction and the recommendation for appropriate pelvic health assessment where symptoms are present.