PURPOSE: Pelvic floor (PF) symptoms are highly prevalent in female athletes and negatively impact on performance and well-being. Women do not commonly tell professionals within sport settings about their PF symptoms. The reasons for non-disclosure and women’s preferred methods for screening were not previously understood. The study purpose was to establish women’s preferences towards PF screening and management in sport settings and inform organisations of acceptable PF screening practices. 

 

METHODS: Explanatory sequential mixed-methods design. Phase one (quantitative): large, cross-sectional, online questionnaire of 18-65-year-old, Australian, women with PF symptoms (n=4,556 [n=230 elite/semi-elite athletes]). Preliminary analysis of the quantitative data guided development of the qualitative research. Phase two (qualitative): semi-structured interviews with a subset of phase one participants (n=23). Transcribed interviews were content analysed, coded, and grouped into themes.  Quantitative and qualitative data were integrated through ‘following a thread’ between data-sets; threads were compared and contrasted. 

 

RESULTS: Thread one was ‘women (not) telling’; most women had told no-one within a sport setting about their PF symptoms due to embarrassment, lack of PF knowledge or because no had asked. Thread two, ‘screening for PF symptoms’; women endorsed carefully considered implementation of screening within sport settings, conducted in a sensitive and safe manner. Professionals should initiate the conversation and demonstrate knowledge, trustworthiness and benefits of telling. Including PF symptom questions on pre-exercise screening tools could help normalise the conversation. Thread three ‘creating safety’; the culture of the sporting environment influenced whether symptomatic women, continued or stopped participating. Positive role models (other members or support staff), discreet education and re-design of uniform to allow covert containment of leakage were strategies identified to promote a pelvic health safe culture. Women endorsed professionals receiving appropriate training, so they could screen appropriately and be advocates for pelvic health. If symptoms were disclosed, women requested provision of exercise modifications, referral and management appropriate to the professional’s scope of practice.  

 

CONCLUSION: Screening for PF symptoms within sport settings is not currently common practice. Women are reluctant to self-disclose symptoms and are waiting for professionals to initiate the conversation. This study provides key messages from symptomatic, Australian women on the best practice for PF symptom screening in sport settings. Safe PF screening practice requires building trust by careful consideration of how and when to screen in sport settings. Suitable and supportive pelvic health screening will allow women to access help with the aim of reducing or treating their symptoms to facilitate sport performance, participation and health.

DISCLOSURES: This research was supported by funding from the Physiotherapy Research Foundation Seeding Grant (Grant number: S17-011 [questionnaire]) and the Australian Bladder Foundation Grant managed by the Continence Foundation of Australia (questionnaire and qualitative study). The funders had no input into the study design, data collection, interpretation, analysis or writing of the manuscript.