At the Francophone Days of Hepatology, Gastroenterology, and Digestive Oncology 2026, data showed that high-impact physical activities such as running, CrossFit training, and team sports are associated with an increased risk for anal incontinence, particularly among women.

Jean Michel Didelot, MD, from France's Centre Hospitalier Universitaire de Montpellier, noted that the condition remains underrecognized and underdiagnosed, partly because of stigma. He emphasized the need for greater awareness and preventive strategies, particularly in women during the postpartum period.

Anal or fecal incontinence is defined as the involuntary loss of flatus or feces, reflecting impaired control of the continence mechanisms, most commonly involving dysfunction of the anal sphincter complex. It can present as passive leakage without awareness, urge incontinence with an inability to defer defecation, or a combination of both.

Its prevalence is estimated at 5%-10% of the general population, although the true burden is likely to be higher because of underreporting and underdiagnosis.

Risk Factors

Symptoms have been reported to substantially affect the performance of athletes. "Fecal incontinence leads to limitations in physical activity, reduced training intensity, avoidance of specific technical movements, and impaired concentration," Didelot said. In 1 out of 2 cases, the symptoms resulted in discontinuation of sports.

During running, the pelvic floor is exposed to an increased mechanical load, with forces estimated to be 3-4 times the body weight, and up to 16 times the body weight during the long jump.

The effect of physical activity on the pelvic floor varies depending on its type, intensity, and duration. Although exercise can strengthen the pelvic floor muscles and reduce the risk for incontinence, weakening is more often observed, particularly with high-impact activities.

High-impact activities affecting the pelvic floor included floor gymnastics, long jumps, football, volleyball, handball, and basketball, all of which had a strong dynamic component. Activities with a high impact and strong isometric component included martial arts, CrossFit training, weightlifting, and shot put.

Running is a moderate-impact activity on the perineum with a strong dynamic component. This category also included horseback riding at a trot; racket sports such as tennis, badminton, and padel; and skiing, skating, and trekking.

"In sports with a strong dynamic component, intra-abdominal pressure increases in proportion to vertical ground reaction forces at impact," Didelot said. "During running, the pelvic floor experiences a load equivalent to 3 to 4 times body weight, and up to 16 times body weight during long jump."

Low-impact sports with a strong isometric component included rowing, fencing, and windsurfing. Activities considered low risk for the perineum included swimming, cycling, hiking, and golfing.

"Athletes are aware of the risk for urinary incontinence related to sport, but much less so of the risk for fecal incontinence," said Didelot. "A survey showed that 41% of gymnasts had never heard of it."

In women, the risk factors for anal incontinence associated with physical activity included older age, higher BMI, and intensive participation in high-intensity sports exceeding 8 hours per week.

Prevention Strategies

A study found that intensive running posed a higher risk than CrossFit and weight training, particularly in women. The risk was greater when running on roads than on natural terrain.

Didelot noted that the prevention of pelvic floor disorders relies on awareness. Prevention involves targeted muscle exercises, including perineal contraction and relaxation through Kegel exercises, strengthening of the transverse abdominal muscle through co-contraction during exertion, and hypopressive abdominal training.

"Yoga and Pilates also support gentle strengthening of the pelvic floor," Didelot said.

In pregnant women, low-impact activities such as cycling and swimming are recommended after the fifth month of pregnancy, and Pilates is appropriate during this period. As higher BMI is a risk factor, excessive weight gain should be avoided.

After childbirth, "physical activity can be resumed beginning at 6 weeks of postpartum, with a focus on exercises that protect the perineum." Running should be delayed until after the third month. The perineum should be assessed between 6 and 8 weeks postpartum, and rehabilitation should be initiated if necessary.

Didelot emphasized that gastroenterologists play an important role in screening for pelvic floor disorders and referring individuals for proper rehabilitation, particularly because these conditions are underreported.

This story was translated from Medscape's French edition.