The aim of this scoping review is to systematically map and summarize the literature in order to identify the available evidence concerning pelvic floor dysfunction (PFD) among athletes.

This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews [1] and the Joanna Briggs Institute methodology [2]. 
Inclusion criteria: any studies involving male and female athletes of any age and performance level. Studies dealing with any PFD, according to the ICS-IUGA Standards Terminology, and any type of sport were included. Any context and setting were considered for inclusion. MEDLINE, Cochrane Central, Scopus, CINHAL, Embase and PEDro database were searched from inception to March 2020. Additional records were identified through searching in grey literature (e.g. Google scholar, direct contact with experts in the field of pelvic floor dysfunction and sport medicine) and the reference lists of all relevant studies. No study design and language restrictions were applied. Two reviewers independently screened all abstracts and full-text studies for inclusion. An ad-hoc data collection form was developed by the research team to extract the characteristics of included studies.

2609 records were identified with an initial search. 99 studies met criteria for inclusion. [Figure 1]
The number of studies and the interest about the topic increased over the years. In particular, 6 studies were published between 1990 and 1999, 23 in the years 2000-2009 and 70 between 2010 and March 2020.  
United States and Brazil yielded the largest number of publications (n=26; n= 16, respectively). The majority of study design were cross-sectional (n=70), while 17 were narrative review.  
Participants represented a variety of sport participation level: 21 studies focused only in elite athletes and 6 in amateur/recreational athlete. In 50% of cases performance level is not specified. The target study population included female athlete (n= 82) practicing multiple sports (n= 57). 
Considering studies that focused only in one sport, cycling (n=11), running (n=5) and crossfit (n=5) were the most investigated. 
Among male athletes, 12% of studies explored pelvic floor disfunction in this population. Only 5 studies included both genders. 
Urinary incontinence was the most common pelvic floor symptom; it is considered in 64 studies. 25 studies reported results about multiple PFD. 
There is limited evidence related to male population, certain sports and other PFD (e.g. anal incontinence, pelvic organ prolapse, pelvic pain).

Pelvic floor dysfunction among athletes is an important medical issue, but what is known from the existing literature? 
This scoping review highlighted a broad spectrum of studies dealing with sport and PFD.
Clinicians addressing musculoskeletal disorders and sports medicine should be encouraged to assess the presence of potential pelvic floor dysfunction in all athletes, both male and female. Not only as regards the high impact sports. From a researcher’s prospective, further research is needed to better evaluate the overall pelvic floor among athletes, in a larger number of sports and more specifically in male athletes.

This study is the first scoping review to provide a comprehensive overview of the topic. 
Pelvic floor disfunction among athletes is an evident issue that should be carefully evaluated by clinicians. 
The sharp rise in published work in recent years is encouraging, however gaps in the literature are still evident.

Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009;151(4):264-9
The Joanna Briggs Institute Reviewers' Manual 2015: Methodology for JBI Scoping Reviews. Adelaide, Australia: Joanna Briggs Institute; 2015 [Available from: http://joannabriggs.org/assets/docs/sumari/Reviewers-Manual_Methodology-for-JBI-Scoping-Reviews_2015_v2.pdf accessed 18th March 2020]