What is pelvic health?

Gráinne Donnelly is an advanced physio working within pelvic health. She explains what the pelvic floor is, how it affects players, and what clubs and coaches can do to help.

The tackle is a high risk activity for the provocation of pelvic floor symptoms. Photo credit: Omega Photography

The pelvic floor is a group of muscles and connective tissues that form layers across the base of the pelvic outlet. In females, the pelvic outlet is wider, meaning that the pelvic floor muscles span a larger area.

Additionally they have an extra orifice in the form of the vagina, meaning that the structural support and function of the muscles and connective tissues is very important.

The pelvic floor muscles have a role in pelvic organ support, continence control of the bladder and bowel, emptying of the bladder and bowel and sexual function.

Compromise to the structural support and function of the pelvic floor can lead to symptoms in any of these roles, e.g. leaking from the bladder or bowel, a sudden urge to go to the toilet, heaviness or pressure in the vaginal region or pain in the pelvis.

Traditionally sports medicine has tended to overlook the pelvic floor. This is likely to be for several reasons:

• The topic of pelvic floor function and dysfunction is embarrassing and taboo

• Lack of awareness, education and training for staff in the importance and relevance of the pelvic floor or how to approach speaking about it

• Lack of research within sports medicine contexts about the pelvic floor until recent years

Not only do symptoms of pelvic floor dysfunction negatively impact a players quality of life and self confidence, but they also have implications for performance capabilities and may even present a barrier to players continuing training or matches.

For example, if a player leaks every time they sprint hard, they may limit how much they exert during runs. If they leak with tackles they may avoid putting themselves in a position to be tackled.

They may stop training and may not disclose why. They may alter their bladder behaviour by limiting fluid intake or running back and forth to the toilet regularly.

As females, we are predisposed to the odds of developing symptoms of pelvic floor dysfunction by our anatomical design. Across our lifespan other factors further this risk e.g. BMI, history of chronic straining or constipation, pregnancy and childbirth, and natural aging.

Furthermore, if we do not train our pelvic floor and build up its functional reserve, it may not be able to withstand the level of load being placed upon it during sports like Rugby.

Originally from ‘Up for the tackle’. “Getting Pelvic Floor ‘Ready’ for Rugby. *These recommendations are based on exercise prescription principles and research on the general population. Research specific to women's rugby players across all ages and levels is needed to better inform this population.”

Load tolerance and pelvic health

Load tolerance refers to the body’s ability to respond to physical stresses and loads. Load tolerance applies to the muscles and tissues including passive tissue structure and active forces within a bodily area.

It considers whether they can accept, support and dissipate the load and if they can consistently do this over time. E.g., do the muscles fatigue with repeated exposure to a given load?

In the context of the pelvic floor, load tolerance means they can manage a given load without provoking symptoms (leaking, heaviness, pain). Coaches can regularly screen for signs of pelvic floor dysfunction during training.

A useful tool is the PFD (pelvic floor dysfunction) Sentinel which has 5 quick questions to screen. It also has a risk profiling section to identify those at risk of load intolerance at the pelvic floor. We have some further information on load tolerance in this special edition paper on the Pelvic Floor and Rugby.

Coaches can help by firstly not ignoring the topic of the pelvic floor. Speaking about it regularly helps break down the barriers to a player disclosing symptoms and accessing help.

Coaches can educate players on what their pelvic floor is, signs and symptoms of dysfunction and how to train their pelvic floor. The RFU created a toolkit of pelvic health which I co-created and offers useful advice.

Coaches may also chat to other team members who notice players are restricting fluids or performance, which may indicate an underlying problem.

Players can be receptive to discussions and education about pelvic floor and wellbeing. They can access resources e.g. the RFU toolkit and increase their understanding of it.

Players should engage in regular pelvic floor muscle training even in the absence of symptoms, to ensure the area is fit for purpose to manage the expected loads during Rugby.

If experiencing symptoms, players should speak to a member of their support team and chat to each other. The more we openly discuss these common issues, the less taboo and shame that surrounds them.

Clubs should embed pelvic floor screening into normal sports surveillance so that it is a regular and normal topic coming up.

Clubs can provide useful resources for players to see and access, e.g. the Rugby Toolkits. They can also display posters or host educational events on topics like pelvic floor in Rugby to raise discussion and break down barriers.

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