Pelvic floor muscle training in female athletes: a randomized controlled pilot study

Key points

1. 01MVC increased significantly in the training group (p < 0.001) with no change in controls (p = 0.700)
2. 02Pad test urine loss fell significantly in the training group (p = 0.025) but not in controls (p = 0.741)
3. 03Prevalence of stress urinary incontinence dropped from 71.4% to 42.9% in the training group, while it rose from 50% to 83.3% in controls
4. 04Vaginal resting pressure decreased in both groups with no significant between-group difference (p = 0.533)
5. 05Quality of life scores were low at baseline in both groups and showed no significant between-group differences

How it was conducted

Design

Randomized controlled pilot trial with concealed allocation and intention-to-treat analysis

Participants

13 elite female volleyball players (nulliparous, aged 18-30, part of Portuguese Women's Volleyball Federation), training 450 min/week

Groups

Experimental group (n=7): 16-week pelvic floor muscle training program; Control group (n=6): no intervention

Intervention phases

Phase 1 - awareness/stabilization (2 weeks, home); Phase 2 - strength training (2 weeks, home); Phase 3 - power training (12 weeks, incorporated into volleyball training using knack technique)

Primary outcomes

Maximum voluntary contractions via perineometer (Peritron 9300) and urine loss via modified 2-hour pad test

Secondary outcome

Quality of life via King's Health Questionnaire (KHQ)

What they found

• MVC increased from 60.80 +/- 19.72 to 78.75 +/- 18.36 mmHg in the training group (p < 0.001); minimal change in controls from 55.68 +/- 29.12 to 55.13 +/- 30.97 mmHg (p = 0.700); interaction time x group p < 0.001
• Pad test urine loss decreased from 2.71 +/- 2.14 g to 1.29 +/- 1.70 g in the training group (p = 0.025); controls increased slightly from 1.83 +/- 2.40 g to 2.00 +/- 1.67 g (p = 0.741); interaction time x group p = 0.039
• Proportion with urine loss decreased from 71.4% (5/7) to 42.9% (3/7) in the training group; increased from 50% (3/6) to 83.3% (5/6) in controls
• Vaginal resting pressure decreased in both groups: training group from 17.33 +/- 7.74 to 12.31 +/- 3.70 mmHg (p = 0.100), controls from 16.18 +/- 15.71 to 13.67 +/- 8.80 mmHg (p = 0.428); interaction p = 0.533 (not significant)
• KHQ global score: 6.35 +/- 5.19 in training group vs 8.80 +/- 4.62 in controls at baseline; no significant between-group differences in any KHQ domain (all p > 0.05)

Limitations

• Very small sample (n=13 completers, 6-7 per group) severely limits statistical power and generalisability
• Assessor blinding was not possible, introducing potential measurement bias
• No follow-up beyond 4 months; long-term effects and maintenance of gains are unknown
• Modified 2-hour pad test deviated from standard protocol, limiting comparability with other studies

Why it matters

For patients

Female athletes who experience urine leakage during sport may benefit from a structured pelvic floor training program, as this study shows reduced leakage after 16 weeks.

For clinicians

A three-phase PFMT protocol incorporating awareness, strength, and sport-specific power training appears feasible and effective for elite volleyball players, but confirmation in larger trials is needed before broad clinical adoption.

For readers

This small pilot provides early evidence that PFMT reduces stress urinary incontinence in high-impact female athletes, a population known to have high prevalence of this often-hidden problem.