Prevalence of Pelvic Floor Dysfunction in Male Athletes and Its Dose-Dependency in High-Intensity Exercise: A Scoping Review

Scoping review of 10 studies finds LUTS rates up to 18.8% in male athletes, with a strong dose-response correlation (R = 0.87) between weekly exercise volume and urinary symptoms.

Journal: Journal of Science and Medicine in Sport | Published: 2025-10-21 | Type: Scoping Review | PMID: 41198451 Authors: Myers C., Doma K., Cooke J., Nahon I. (University of Canberra; James Cook University, Australia) Funding/COI: Funding not listed. All authors declare no competing interests.

Summary

This scoping review set out to map what we know about pelvic floor dysfunction (PFD) in male athletes and whether exercise dose drives risk. After culling 6,031 publications down to 10 eligible studies, the authors found that higher weekly MET-minutes correlate strongly with lower urinary tract symptoms (LUTS) — but appear modestly protective against erectile dysfunction and chronic prostatitis/pelvic pain. The field is too fragmented to draw firm conclusions, but the dose-response signal for LUTS is hard to ignore.

Claims

• Six studies reported LUTS prevalence in male athletes ranging from 3.8% to 18.8%
• One study found anorectal incontinence in 61.8% of participants — an outlier that the review does not explain away
• Cross-sectional studies showed a dose-dependent relationship between weekly MET-minutes and LUTS: R = 0.86 (minimum weighted average) and R = 0.87 (maximum weighted average)
• Studies reporting ED and chronic prostatitis/pelvic pain (CP/CPPS) as hazard and odds ratios found that higher weekly MET-minutes were slightly protective compared to sedentary or low-activity groups
• 4,493 abstracts were screened; only 10 articles met inclusion criteria

Study Quality

This is a scoping review, not a meta-analysis — it maps a literature, it does not synthesize effect sizes. The 10 included studies are methodologically heterogeneous: they use different definitions of "athlete," different exercise metrics, different PFD outcome measures, and different populations. The authors explicitly flag "substantial reporting differences of exercise-related variables," which is the core problem. The dose-response correlation (R = 0.86–0.87) sounds impressive but is derived from weighted averages across cross-sectional studies with non-standardized MET-minute reporting — treat it as a signal, not an estimate.

The CINAHL, PEDro, PubMed, Scopus, and Web of Science search up to January 2025 is comprehensive. The PRISMA-ScR framework (standard for scoping reviews) appears to have been followed.

Red Flags

• Ten studies is a thin base. The entire evidence landscape fits on one hand.
• The 61.8% anorectal incontinence figure comes from a single study and is far enough from the others to demand scrutiny — sport type, measurement method, and definition matter enormously here.
• LUTS prevalence range (3.8%–18.8%) is so wide that pooling it into a dose-response curve requires strong methodological assumptions that a scoping review cannot validate.
• Funding not reported. No way to assess industry influence on the constituent studies.
• Cross-sectional constituent studies cannot establish causality; healthy athlete selection effects could explain the ED/CP/CPPS protective signal entirely.
• MET-minute heterogeneity across studies is the authors' own stated limitation — the R = 0.86–0.87 correlation is built on non-comparable inputs.

Strengths

• Five-database search with broad MeSH coverage is genuinely thorough
• Honest about what a scoping review can and cannot conclude
• Identifies a real gap: male pelvic floor health in athletes is barely studied
• Separating LUTS from ED and CP/CPPS is methodologically appropriate — they have different mechanistic relationships to exercise load

Verdict

This paper earns its place in the literature as an honest gap-mapping exercise. The dose-response correlation between exercise volume and LUTS is the most actionable signal here, but it rests on 10 heterogeneous studies, six of which reported LUTS. The 61.8% anorectal incontinence finding is either a major story or a methodological artifact — the review cannot tell you which. Read it if you're designing a study on male athlete pelvic health; don't read it if you want effect estimates you can trust.