Obstetrics & Gynecology · Medical Literature
Prevalence and Impact of Pelvic Floor Symptoms in Performing Artists and Artistic Athletes: A Systematic Review With Meta-analysis.
Abstract
OBJECTIVES: To (1) estimate the prevalence of pelvic floor symptoms in performing artists and artistic athletes and (2) quantify the impact of symptoms during and outside performance and training. DESIGN: Epidemiology systematic review with meta-analysis. LITERATURE SEARCH: Six databases were searched from inception to February 2025. STUDY SELECTION CRITERIA: Studies involving participants from any artistic discipline and with data on pelvic floor symptom or disorder prevalence or impact were included. DATA SYNTHESIS: Critical appraisal was conducted using the JBI (Joanna Briggs Institute) Critical Appraisal Checklist, and the certainty of evidence was judged using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. Data were pooled for pelvic floor symptom proportions in performing artists and artistic athletes, with subgroup analyses for any type of urinary incontinence by discipline. We descriptively synthesized pelvic floor symptoms and impact data that were not included in the meta-analysis. RESULTS: Nineteen articles were included. Half (52%; 95% confidence interval [CI]: 38%, 66%; I2 = 92.7%) of the performing artists and artistic athletes reported urinary incontinence, 79% (95% CI: 69%, 88%; I2 = 80.6%) reported anal incontinence, and 47% (95% CI: 41%, 53%; I2 = not reported (NR)) reported dyspareunia. The discipline most affected by any type of urinary incontinence was trampolining (87%; 95% CI: 70%, 98%; I2 = NR). Up to 83% of the performing artists and artistic athletes reported some negative impact from their symptoms. CONCLUSION: At least half of the performing artists and artistic athletes reported pelvic floor symptoms, particularly urinary and flatal incontinence. The symptoms negatively impacted 83% of the athletes during performance. J Orthop Sports Phys Ther 2026;56(8):530-545. Epub September 19 2025. doi:10.2519/jospt.2025.13452.
Clinical relevance
This systematic review with meta-analysis addresses a critical and underrecognized gap in sports and women's health medicine: the high burden of pelvic floor dysfunction among performing artists and artistic athletes, a population rarely screened in standard gynecologic or sports medicine practice. The findings affect a broad cohort of female (and potentially male) performers across disciplines including dance, gymnastics, and trampolining, who are often reluctant to disclose symptoms due to performance culture stigma. Clinicians in OB/GYN, urogynecology, and sports medicine should proactively screen this population given the prevalence data now available from high-quality pooled evidence.
Key findings
1. Urinary incontinence (UI) was reported in 52% of performing artists and artistic athletes (95% CI: 38%–66%; I² = 92.7%), indicating that UI affects at least half of this population with substantial heterogeneity across studies. 2. Anal incontinence was reported by 79% of participants (95% CI: 69%–88%; I² = 80.6%), making it the most prevalent pelvic floor symptom identified in this review. 3. Dyspareunia was reported by 47% of performing artists and artistic athletes (95% CI: 41%–53%; I² = not reported), highlighting a significant sexual health burden in this cohort. 4. Trampolining was the discipline most severely affected by any type of urinary incontinence, with a prevalence of 87% (95% CI: 70%–98%; I² = not reported), substantially exceeding the pooled overall estimate. 5. Up to 83% of symptomatic performing artists and artistic athletes reported some degree of negative impact from their pelvic floor symptoms during performance or training. 6. The review incorporated 19 articles identified across six databases searched from inception to February 2025, with evidence certainty assessed via the GRADE framework and study quality appraised using the JBI Critical Appraisal Checklist.
Practice implications
OB/GYN and sports medicine clinicians should routinely incorporate validated pelvic floor symptom screening tools (e.g., ICIQ, PFDI-20) into pre-participation and annual health evaluations for performing artists and artistic athletes across all disciplines, with heightened vigilance in trampolinists given the 87% UI prevalence. Given that anal incontinence affects nearly 4 in 5 of this population and dyspareunia affects nearly half, clinical assessment should extend beyond urinary symptoms to encompass anorectal and sexual health domains, with low threshold for referral to pelvic floor physical therapy. Recognizing that up to 83% of symptomatic athletes report performance-related impact, multidisciplinary care models integrating pelvic floor physiotherapy, urogynecology, and sports psychology should be considered standard of care rather than a reactive intervention for this underserved population.