Training for a triathlon means doing hardcore workouts to build endurance and sculpt muscle. But there’s a crucial muscle group that might suffer under all that training: your pelvic floor muscles. These are the muscles and ligaments that support your bladder, uterus, and bowel—the ones you clench up when you hold in your pee. A new study out of Loyola University found that a surprising one in three female triathletes had a pelvic floor disorder.
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For the study, which was presented at the American Urogynecologic Society 2014 Scientific Meeting and has yet to be published, researchers surveyed 259 women between the ages of 35 and 44. All the women were involved with triathlete groups, with most actively training for a tri at the time—their average workout involved running 3.7 days, biking 2.9 days, and swimming 2.4 days per week. The research team had the women report any symptoms of pelvic floor muscle issues. As mentioned above, they found that one in three of the female triathletes had a pelvic floor disorder—that's compared to about 25 percent of women in the U.S. overall, according to previous studies that the researchers referenced. Of those survey participants who had symptoms, 54 percent had some form of urinary incontinence, 28 percent had bowel incontinence, and five percent were diagnosed with something called pelvic organ prolapse—when the muscles supporting an organ in your pelvis weaken so much, the organ, such as your bladder, drops against the walls of your vagina (ow!).
What's the connection between a tri and these conditions? Any time you run, bike, or do another high-impact, high-speed activity, you engage your pelvic floor muscles—they're actually part of your core muscle group, the way your abs and back muscles are. So the researchers' theory is that, if you train vigorously enough, you're putting your pelvic floor muscles at risk for fatigue—which could make them weaker and possibly set you up for things like incontinence or a prolapse, according to study investigator Johnny Yi, M.D., a urogynecologist at Loyola University in Chicago. "However, more robust studies are needed to prove this theory," he says.
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Before you give up your goal of killing it at the Ironman someday, keep a few caveats in mind. First, though the study did find a higher prevalence of pelvic floor disorders in the study subjects as opposed to the general population, more research needs to be done to know for sure if training for a tri actually caused the conditions. And though unpleasant and annoying, pelvic floor disorders aren't life-threatening. In fact, they're often a consequence of childbirth—which could account for some of the pelvic floor issues reported in the study. Forty-six percent of the study participants were moms, and this group was more likely to report stress urinary incontinence (55 percent of moms versus 24 percent of non-mothers) as well as pelvic organ prolapse (eight percent versus five percent). Finally, participants with pelvic floor problems were also more likely to show signs of what the researchers call the "female athlete triad," which means decreased energy, menstr ual irregularities, and low bone density. This raises the possibility that having one or more of these characteristics played a role.
Bottom line: If you're a triathlete or do some other heavy-duty physical activity, and you feel healthy and have no pelvic floor disorder symptoms, there’s no reason to dial back your workouts. "We hope that this study does not deter women from exercising," says Yi. "We encourage exercise and healthy activity, but we hope that women seek care for symptoms if they have them." If you do, he recommends seeing a urogynecologist, who specializes in pelvic floor disorders.
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