Pelvic floor dysfunction (PFD) is experienced by 1 in 4 female athletes, especially those in high impact sports such as soccer.  One of the most pervasive presentations PFD among female athletes is urinary incontinence (UI), which is characterized by the involuntary leakage of urine of which the mechanism among athletes remains to be fully elucidated (1).  PFD symptoms, such as urinary incontinence and pelvic pain, may adversely impact athletic performance (2,3).  Although football is a high-impact sport, with frequent running, jumping, and player contact, research on prevalence and risk factors of PFD among female football players remains limited.  Despite the forward leads with respect to female sport in general, PFD remains a barrier for female athletes from both a health and performance perspective. 

Given the lack of research on the prevalence, risk factors, and impact of PFD on perceived performance in women’s football this study aims to investigate the prevalence rate and risk factors associated with PFD in female football players, as well as to assess the impact on perceived performance.

A survey was developed by a multidisciplinary team (exercise physiologist, physician, physiotherapist, pelvic health physiotherapists, strength and conditioning coaches).   Female soccer players (>18 years, any level of play) were recruited using an online survey. Athletes were asked about their history of soccer participation, experiences with PFD using the International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI SF) and the Pelvic Floor Distress Inventory 20 questionnaire (PFDI-20), and their perceived impact on performance using the Athlete Subjective Performance Scale (ASPS). 
After all responses were collected, data were cleaned and verified for accuracy, and impossible (e.g., non-human body weight) data were removed. All exclusions were reviewed and discarded following consensus. The mean ± standard deviation was calculated for continuous variables, and frequency of responses (n and %) were calculated for categorical variables using Excel.

At the time of this submission over 300 participants (31.25 ± 9.53; 87.5% white, primarily from Canada and the United Kingdom) participated in the survey. Over half of respondents (51%) were recreational players and played an average 20.65 + 8.74 years. ICIQ-UI SF scores show 22% of players had slight PFD, 47% experienced moderate PFD, while 2.2% experienced severe PFD. Players with no or slight PFD symptoms scored 42.5 ± 10.2 on the ASPS, while players with moderate to severe PFD symptoms had a significantly lower ASPS score of 38.47 ± 11.17. Twenty nine percent of participants reported that PFD symptoms adversely impacted their sport performance, and 30% had seen a pelvic health physiotherapist (Table 1).

Despite 70% of participants reporting PFD symptoms, just under half of participants reported to have seen a pelvic health physiotherapists (PHPT) for care. The findings of the present study align with previous work that found there is limited awareness or screening for PFD in athletes. Given the high prevalence of PFD in football players, and negative impact on performance awareness, screening and treatment of PFD is clearly needed.

Approximately 70% of participants experienced some degree of urinary incontinence, with nearly half scoring in the moderate ICIQ-UI SF category. Perceived performance scores were lower among athletes with moderate to severe PFD symptoms compared to those with less severe symptoms.

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