This scoping review aimed to a) provide a comprehensive overview of all studies addressing pelvic floor dysfunction (PFD) interventions in female athletes, summarizing studies according to PFD classification provided by the International Continence Society (ICS) standardized terminology, the type of sport and treatments; b) to identify any gap in the knowledge of the topic.

The present review was conducted following the Joanna Briggs Institute methodology[1] for scoping reviews. The entire selection process was recorded and reported according to the latest published version of the Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA 2020) flow diagram[2]. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist[3] for reporting was used. The scoping review protocol was prospectively registered in MedRxiv.
MEDLINE, Cochrane Central, Scopus, CINAHLComplete, Embase, PEDro and SPORTDiscus were searched up on 9th May 2021 with no date limit. Additional studies were identified through grey literature and the reference lists of articles included. 
Studies considering female athletes practising sports at any performance level with any type of PFD were eligible for inclusion. Any clinical intervention (i.e. preventive, conservative, pharmacological, surgical) and any context were considered. No language, study design and publication type restrictions were applied.
Two authors 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. The results were presented numerically and thematically according to scoping reviews methodology.

From 2625 initial records, 2590 were excluded and 35 articles met inclusion criteria. 
Figure 1 synthesizes the main characteristics of the studies ranging from the year of publication to categories of intervention (Figure 1).
The majority of research designs were narrative review (n= 19; 54.3%), while seven (20%) were primary research. Only two randomized controlled clinical trials (RCTs) were conducted on female athletes over the years. 
Studies were identified from 12 different countries and in four languages (English, French, Spanish, and Slovenian).
In the majority of articles (n= 27; 77.1%), authors defined participants as “athletes,” but performance level was not clearly reported. A few of them reported about particular subgroups, such as post‐partum triathletes, adolescents, and wheelchair athletes. 
Regarding the PFD, urinary incontinence was the most common pelvic floor symptom explored (n= 24; 68.6%). In most cases, athletes suffered from stress urinary incontinence (SUI) (n= 19, 54.9%). For other disorders, in 10 studies (28.6%) more than one PFD was considered.
Nearly 70% of articles included more than one sport, mainly the high‐impact ones. Considering those that focused only on one sport, volleyball (n= 3; 8.6%) and running (n= 2; 5.7%) were the most frequently investigated.
Authors discussed a wide range of interventions. In particular, 23% of considered articles (8 out of 35) described only preventive interventions to manage PFD. 
Conservative approaches (n=35) were suggested by all authors of the included studies. 
Among these, Pelvic Floor Muscle Training, alone or combined with other treatments, is explicitly cited as an effective treatment in 85.7% of studies. Figure 2 graphically illustrates the pooled results of all the conservative interventions that were considered (Figure 2). 
More specifically, the analysis of treatments proposed for SUI showed several possibilities, including biofeedback, bladder training, lifestyle interventions, education, electrical stimulation, hypopressive techniques, intra‐abdominal pressure management, modification of the sport technique, vaginal tampons, pads, and vaginal cones.
Pharmacological options (n=12; 34.3%) and surgical procedures (n=10; 28.6%) for PFD were rarely cited and in general, were not supported by the opinion of the authors.

Although authors discussed a wide variety of interventions ranging from preventive or conservative treatments to surgery, the present scoping review confirmed that only a few authors evaluated the effectiveness of interventions dedicated to this population.
Athletes are a unique group of patients who have higher functional demands than the general population and may need a different and specific approach than nonathletic women.
Indeed, as happens with other disorders, like the musculoskeletal ones, the overall management should be specific and tailored to the athlete, considering the type of PFD and other factors such as: (a) training volume, (b) type of sport, (c) performance level, (d) other associated disorders (e.g., musculoskeletal), and (e) individual risk and contributing factors within multidisciplinary management. 
To provide better guidance for clinical practice and to fill the current gaps, these variables should guide high‐quality research.

This is the first scoping review to provide a comprehensive overview of the topic. 
The authors discussed different interventions for PFD among female athletes. Among these, the conservative approach was the most frequently suggested. Besides the great number of listed interventions, specific programs and RCTs for female athletes are still limited.
The findings of the present study showed that suggestions for clinical practice were basically supported by the transferability of the nonathlete population's results or by the expert opinion. Therefore, there is a great need of primary research considering individual characteristics, related‐variables sport, and PFD within multidisciplinary management.

Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E MZ (Editors)., ed. Joanna Briggs Institute Reviewer’s Manual, JBI. ; 2020.
Page MJ, Moher D, Bossuyt PM, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for  reporting systematic reviews. BMJ. 2021;372:n160. doi:10.1136/bmj.n160
Tricco AC, Lillie E, Zarin W, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169(7):467-473. doi:10.7326/M18-0850

Continence 2S2 (2022) 100352
DOI: 10.1016/j.cont.2022.100352