Nearly half of 325 athletes reported pelvic floor symptoms. A cross-sectional study at the Lima 2024 world athletics U20 championships

Objectives Pelvic floor dysfunction (PFD) symptoms are common among athletes but remain underexplored in youth of both sexes competing in track and field. The primary objective was to assess the prevalence of PFD. Secondary objectives evaluated symptoms impact, awareness of pelvic floor health, related behaviours and gynaecological health in females. Methods This observational, cross-sectional study was conducted during the Lima 2024 World Athletics U20 Championships. All athletes were eligible and invited to complete a multilingual, anonymous web-based survey assessing pelvic floor health. Results Of the 325 athletes who participated (59.1% females, 40.9% males), 43.7% (n=142) reported PFD symptoms. Prevalence was similar across daily life and athletics activities. Overactive bladder and pelvic pain were the most common conditions. Females had higher PFD rates (n=103, 53.7%) compared with males (n=39, 29.3%). Athletes with athletics-related urinary incontinence (n=42; 12.9%) reported frustration and reduced concentration during performance. Symptomatic athletes had low body mass index and reported more maladaptive pelvic floor-related behaviours than asymptomatic athletes (p<0.05). Menstrual issues and contraceptive use were more frequent among females with PFD (p<0.05). Fewer than 30% (n=95) were aware of pelvic floor health, and 88% (n=286) had never undergone screening. Most did not disclose symptoms (n=111; 78.2%) or seek specialised care (n=135; 95.1%). Conclusions PFD was prevalent among elite youth athletes, particularly females. These findings highlight the need for proactive strategies, including education, embedding pelvic floor health in medical evaluations and addressing sex-specific needs to optimise athletes' health throughout their careers.