The pelvic floor muscles must counteract the increase in intra-abdominal pressure during physical exertion and high-impact activities. Overworked and weakened muscles can increase the risk of pelvic floor disorders (PFD). The participation of women in sports such as powerlifting and weightlifting has grown over the years, and there is no consensus on the role of these exercises in PFD. The aim of this systematic review was to identify the impact of powerlifting and weightlifting on PFDs.

A literature review was conducted on PubMed, PubMed BMC, SportDiscuss, Embase, and BVSalud, with no language restriction, from inception to January 20, 2024. We included observational studies or randomized controlled trials investigating female athletes in powerlifting or weightlifting. Studies on specific populations (CrossFit trainers, non-female athletes, and those under 18) and congress abstracts were excluded. Two researchers independently performed the data screening, data extraction and quality assessment. The risk of bias was assessed using the ROBINS-I. The main outcomes were the prevalence of PFD in women practicing powerlifting or weightlifting, the factors associated with PFD, and the exercise more closely related to urinary loss.

Of 132 articles found by the search strategy, five studies with 1809 participants were included in the qualitative synthesis. The prevalence of urinary incontinence in powerlifters ranged from 41.0% - 48.8% and from 36.6% - 54.1% in weightlifters. The main associated factors were age, parity and body mass index. Deadlift was the exercise most commonly associated with urinary incontinence (42.5%), followed by squats (36.3%). High loads and repetitions, along with competitions, were associated with UI. The prevalence of anal incontinence (80%) and pelvic organ prolapse (42%) was presented in one study. The quality of assessment by ROBINS-I found an overall moderate risk of bias in three studies and an overall serious risk of bias in two studies.

Regarding powerlifting, deadlifts and squats were identified as causing urinary incontinence, with some attributing it to wearing a lifting belt. Urinary incontinence was experienced with very heavy or maximal weights, with the trigger weight increasing with strength. Jumping movements and sneezing were mentioned as triggers for urinary incontinence outside of training. Considering weightlifting, higher performance levels and longer training hours were reported, and physical activity levels demonstrated a non-linear effect on urinary incontinence probability during clean & jerks. Nulliparous women with depressive mood were twice as likely to experience moderate/severe urinary incontinence. Squats were more likely to cause urine leakage compared to other lifts like snatch, clean and jerk, or pulls in competitive women weightlifters.

This systematic review highlights a substantial link between pelvic floor dysfunction, particularly urinary incontinence, and the engagement of women in powerlifting and weightlifting.