Why pelvic health matters for female skiers (and what you can do about it)

If you've ever laughed, sneezed or landed a jump on the slopes and felt a small leak you weren't expecting, you're far from alone - and it's not something you have to just put up with. The pelvic floor muscles are essential for any active woman, but they're often overlooked, partly because they can feel like a taboo subject to bring up. For one in two women, pelvic floor issues such as leaking urine or prolapse symptoms get in the way of the sport and activity they love. We don't want that to be the reason anyone misses out on snowsports.

Skiing and snowboarding are dynamic, high-intensity, full-body sports, which means our pelvic floor muscles need to be both strong and flexible enough to cope with the changes in load and movement involved. Whether you're a complete beginner or ski every season, pelvic floor awareness matters for every active woman on the mountain.

As a specialist pelvic health physiotherapist who loves to ski myself, my aim is simple: to help women who take part in snowsports understand their pelvic floor and how to look after it for life, so they can keep doing the activities they love.

The pelvic floor is a group of muscles that sits within the pelvis, and it plays several important roles:

• Continence - the muscles respond to increases in pressure in the abdomen by contracting upwards, closing off the vagina, urethra and anal sphincter.
• Organ support - they hold the bladder, bowel and uterus in place, helping to prevent changes in anatomy and symptoms of prolapse.
• Core stability - as deep core muscles, they're the connecting point between your upper and lower body, and need to absorb the pressure changes that dynamic movement puts on them.

The anatomy is genuinely fascinating, and most people underestimate just how substantial these muscles are - cup your two hands together, and that gives you a sense of how big your individual pelvic floor muscles actually are. They attach to the pubic bone at the front and the coccyx at the back, forming a bowl-like shape, though functionally we need them to work more like a trampoline. There are three layers, made up of muscle, connective tissue and fascia, and ideally they should be strong, have good endurance, react quickly, and above all be flexible enough to adapt to changing pressure.

Most of the time, we don't have to think about our pelvic floor at all - it quietly gets on with supporting our organs and keeping us continent. But hormonal changes across life, whether that's pregnancy, perimenopause or the post-menopausal years, can disrupt that natural "trampoline" function. When the muscles, ligaments and connective tissue become too tight, too weak, or simply lose coordination, pelvic floor dysfunction can follow.

A couple of conditions are particularly common:

Stress incontinence affects around one in three women globally (Milsom et al, 2019). This is when urine leaks during activities that increase pressure in the abdomen - the twisting motion of a turn, jumping over bumps, hopping off a chairlift, or carrying equipment for long periods can all trigger it. A related issue, urge incontinence, is that sudden, overwhelming need to go that seems to escalate from nothing in seconds - familiar to anyone who's queued for the loo at the bottom of a lift.

Pelvic organ prolapse affects around one in two women who have given birth vaginally (Hagen and Stark, 2011). This happens when one or more pelvic organs slip down from their normal position, usually because the connective tissue holding them up has weakened or stretched. It typically presents as a heaviness or dragging sensation.

It's also worth knowing that elite skiing is associated with notably high rates of stress incontinence, linked to intense training loads, repeated pressure spikes through the abdomen, and muscle fatigue. One 2014 study found that 45% of elite cross-country skiers experienced leaking with coughing, sneezing or exertion (Poswiata et al, 2014). If it can affect elite athletes at that rate, it's clearly not a niche issue.

NICE guidelines recommend pelvic floor muscle training as the first line of treatment for pelvic floor dysfunction - but it's worth knowing this is a bit more involved than simply "squeezing." For an effective contraction, it helps to think about the muscles around the back passage as much as the front, since that's where much of the muscle bulk sits.

A good starting exercise:

• Inhale through your nose.
• As you exhale through your mouth, imagine stopping yourself from passing wind. You should feel a lifting, tightening sensation.
• Keep your buttocks and legs relaxed throughout.
• Release the squeeze fully.
• Repeat ten times.

As this becomes more comfortable, start holding the squeeze for a few seconds at a time, breathing normally as you hold. Following the principle of progressive overload, if ten reps at 3-4 seconds starts to feel easy, gradually increase the hold length, the number of repetitions, or the position you're working in.

Research suggests pelvic floor exercises are best done three times a day to see real strength changes and build a lasting habit (Kari Bø and Hilde, 2013). That sounds like a lot at first, but it tends to become second nature fairly quickly once it's part of your routine.

Position matters too - many women find it easier to feel the contraction lying down than standing up. Since skiing itself is done upright, in a semi-squat position, it's worth eventually practising your pelvic floor work in that "ski prep" stance as well - though only once you feel confident doing it lying and sitting down first.

Lower limb strength plays a bigger role in pelvic floor health than most people realise, simply because of how much load skiing places on the core, hips and lower body. Your legs and pelvic floor work together to stabilise the spine and pelvis while your balance is constantly being tested.

Strong legs - quads, hamstrings, glutes and calves - help with:

• Pelvic alignment and stability during dynamic movement
• Reducing the compensatory load placed on the pelvic floor
• Absorbing force from changing terrain and turns more effectively

Since skiing keeps you in a semi-squat position for long periods, weak legs tend to shift the burden elsewhere: more reliance on the pelvic floor and lower back, increased pressure through the abdomen, and posture changes that can contribute to pelvic floor dysfunction over time. Tired or weak legs also tend to mean poorer technique and weaker core engagement, which compounds the problem across a season.

If you're skiing regularly, or even just have one week away planned this year, pairing lower body strength work - particularly for the glutes, hamstrings and quads - with pelvic floor exercises is genuinely one of the best things you can do for both performance and injury prevention. Three exercises worth adding into your training: split squats, single leg squats, and alternating lunge jumps. All three build the eccentric control, balance and light plyometric strength that skiing demands, and gradually increasing the reps, sets or resistance over time is the best way to prepare your body for the season ahead.

Sarah Tyler is a Specialist Pelvic Health Physiotherapist and runs SHE SKIS, a six-week programme combining ski-specific strength training with pelvic floor and core work, for anyone wanting to get slope-ready from the inside out. You can find out more at sarahtylerphysiotherapy.co.uk or on Instagram..