Hiding in plain sight: the pelvic floor in hip and groin pain

Pelvic floor dysfunction (PFD) is defined as a compromise of the neuromyofascial pelvic floor to achieve its role in continence, excretion, pelvic organ support or sexual function, and it is common in athletes.1 2 The reported prevalence in female athletes varies depending on the specific function, including anal symptoms such as urgency or incontinence of stool or gas in up to 80% of weightlifters, urinary incontinence in 34%–36% of athletes and pelvic pain in up to 37% of endurance athletes.3–7 The prevalence of PFD in males is less clear due to a sparsity of research. Existing evidence suggests anal symptoms are present in 62% of male weightlifters, urinary incontinence in 18% of male elite athletes, and pelvic pain occurs commonly in male cyclists.2 6 Modifiable and non-modifiable risk factors for PFD include, but are not limited to, sex, genetic predisposition, higher body mass, chronic constipation, medication, sports-specific demands (impact and intensity) and relative energy deficiency in sport (REDs)1 8 (table 1). Increasing evidence and recognition suggest that the pelvic floor should be considered within the interdisciplinary management of both male and female athletes