Prevalence of Pelvic Floor Disorders in Female CrossFit Athletes

Impact of Lifestyle Modifications on the Prevention and Treatment of Pelvic Organ Prolapse

INTRODUCTION AND HYPOTHESIS

This manuscript is a part of the International Urogynecology Consultation (IUC) on pelvic organ prolapse (POP) chapter three, committee three, on the impact of lifestyle modifications (i.e., weight loss, treatment of constipation, activity restriction, etc.) on the prevention and treatment of POP.

MATERIALS AND METHODS

An international group containing ten female pelvic medicine specialists and one university-based medical librarian performed a systematic search of the literature in Medline using the MeSH terms: pelvic organ prolapse (ID: D056887), cystocele (ID: D052858), uterine prolapse (ID: D014596), rectocele (ID: D020047), and women (ID: D014930) to identify studies addressing lifestyle modifications as prevention or treatment for POP on 10/18/21. Relevant studies were included in this review.

RESULTS

A total of 18,483 studies were identified in the initial literature search; 187 full-text articles were deemed pertinent and independently reviewed and double-screened by ten reviewers. After full-text review, information from 86 articles was included in this review.

CONCLUSION

Women may consider various lifestyle modifications to help prevent and treat POP, even if it is challenging to quantify the efficacy of these interventions.

Thickness of the abdominal wall and pelvic floor dysfunctions in men who practice crossfit vs no crossfit: An observational study

INTRODUCTION

The objective of this study is to compare the thickness of the transverse abdominis, internal oblique, external oblique, rectus abdominis, and rectus abdominis distance, the quality of life (SF-36), the presence of chronic pelvic pain (CPPQ-Mohedo), and sexual dysfunction (IIEF) in men who practice CrossFit® versus men who do not.

DESIGN, SETTING, PARTICIPANTS, AND MAIN OUTCOME MEASURES

Sixty-four healthy men with an average age of 37.19 were recruited at a private sports club and divided into two groups for this cross-sectional observational study. Additionally, participants completed the CPPQ-M, IIEF, and SF-36 questionnaires.

RESULTS

Significant differences were found in the thickness of the internal oblique at rest (p = 0.018, d = 0.61), which was greater in the CrossFit® group. In the SF-36 quality of life questionnaire (p = 0.05, d = 0.50), the CrossFit® group also obtained a higher score.

CONCLUSION

CrossFit® improves the quality of life and self-esteem of the participants, in addition to increasing the thickness of the internal oblique. Neither more chronic pelvic pain nor more erectile dysfunction was observed in the CrossFit® group.

Strenuous physical activity, exercise, and pelvic organ prolapse: a narrative scoping review

INTRODUCTION AND HYPOTHESIS

High-intensity physical activity and exercise have been listed as possible risk factors for pelvic organ prolapse (POP). The aim of the present study is to conduct a literature review on the prevalence and incidence of POP in women who engage in regular physical activity. In addition, we review the effects of a single exercise or a single session of exercise on pelvic floor support. Finally, the effect of exercises on POP in the early postpartum period is reviewed.

METHODS

This is a narrative scoping review. We searched PubMed and Ovid Medline, the Physiotherapy Evidence Database (PEDro), and the Cochrane Database of Systematic Reviews up to May 2022 with the following MeSH terms: "physical activity" AND "exercise" AND "pelvic floor" AND "pelvic organ prolapse".

RESULTS

Eight prevalence studies were retrieved. Prevalence rates of symptomatic POP varied between 0 (small study within different sports) and 23% (Olympic weightlifters and power lifters). Parity was the only factor associated with POP in most studies. Three studies evaluated the pelvic floor after a single exercise or one session of exercise and found increased vaginal descent or increased POP symptoms. One prospective cohort study reported the development of POP after 6 weeks of military parashot training, and one randomized trial reported increased POP symptoms after transverse abdominal training. There is scant knowledge on exercise and POP in the postpartum period.

CONCLUSIONS

Prevalence of POP in sports varies widely. Experimental and prospective studies indicate that strenuous exercise increased POP symptoms and reduced pelvic floor support.

Prevalence of urinary incontinence in female CrossFit athletes: a systematic review with meta-analysis

INTRODUCTION AND HYPOTHESIS

Studies on the prevalence of urinary incontinence (UI) among CrossFit practitioners are on the rise. This systematic review with meta-analysis was aimed at determining the prevalence of UI among CrossFit practitioners.

METHODS

A systematic review of the literature was performed by searching MEDLINE/PubMed, Scopus, and SPORTDiscus through January 2021. The search strategy included the keywords CrossFit, urine incontinence, exercise, high impact and pelvic floor dysfunction. The inclusion criterion was any study with a sample of CrossFit practitioners and results separated from the other fitness modalities analysed. The subjects were women with no restriction of age, parity, experience or frequency of training. Quality assessment of the studies included was conducted using the Oxford Centre of Evidence-Based Medicine scale and the Newcastle-Ottawa Scale (NOS) adapted for cross-sectional studies.

RESULTS

Thirteen studies (6 comparative and 7 non-comparative) were included for the systematic review, all using a cross-sectional design. The level of evidence was 4, with their quality ranging from poor (n = 10) to fair (n = 3). A total of 4,823 women aged 18 to 71 were included, 91.0% participated in CrossFit, and 1,637 presented UI, which indicates a prevalence of 44.5%. Also, 55.3% and 40.7% presented mild or moderate UI respectively. Stress UI was the most common type reported (81.2%).

CONCLUSIONS

The factors that increased the likelihood of UI were age, body mass index and parity. Exercises based on jumps were commonly associated with urine leakage. CrossFit practitioners presented higher UI than control groups.

Pelvic Floor Symptoms Are an Overlooked Barrier to Exercise Participation: A Cross-Sectional Online Survey of 4556 Women Who Are Symptomatic

OBJECTIVE

This study aimed to: (1) investigate barriers to exercise in women with pelvic floor (PF) symptoms (urinary incontinence [UI], anal incontinence [AI], and pelvic organ prolapse [POP]); (2) determine factors associated with reporting PF symptoms as a substantial exercise barrier; and (3) investigate the association between reporting PF symptoms as an exercise barrier and physical inactivity.

METHODS

In this cross-sectional survey, Australian women who were 18 to 65 years of age and had PF symptoms completed an anonymous online survey (May-September 2018) containing validated PF and physical activity questionnaires: Questionnaire for Female Urinary Incontinence Diagnosis, Incontinence Severity Index, Pelvic Floor Bother Questionnaire, and International Physical Activity Questionnaire. Participants reported exercise barriers and the degree to which the barriers limited participation. Binary logistic regression was used to identify variables associated with (1) identifying PF symptoms as a substantial exercise barrier and (2) physical inactivity.

RESULTS

In this cohort (N = 4556), 31% (n = 1429) reported PF symptoms as a substantial exercise barrier; UI was the most frequently reported barrier. Two-thirds of participants who identified POP and UI as exercise barriers had stopped exercising. The odds of reporting PF symptoms as a substantial exercise barrier were significantly higher for women with severe UI (odds ratio [OR] = 4.77; 95% CI = 3.60-6.34), high symptom bother (UI OR = 10.19; 95% CI = 7.24-14.37; POP OR = 22.38; 95% CI = 13.04-36.60; AI OR = 29.66; 95% CI = 7.21-122.07), those who had a vaginal delivery (1 birth OR = 2.04; 95% CI = 1.63-2.56), or those with a third- or fourth-degree obstetric tear (OR = 1.47; 95% CI = 1.24-1.76). The odds of being physically inactive were greater in women who identified PF symptoms as an exercise barrier than in those who did not (OR = 1.33; 95% CI = 1.1-1.59).

CONCLUSION

One in 3 women reported PF symptoms as a substantial exercise barrier, and this was associated with increased odds of physical inactivity.

IMPACT

Physical inactivity is a major cause of mortality and morbidity in women. Pelvic floor symptoms stop women participating in exercise and are associated with physical inactivity. Screening and management of PF symptoms could allow women to remain physically active across their life span.

LAY SUMMARY

Pelvic floor symptoms are a substantial barrier to exercise in women of all ages, causing them to stop exercising and increasing the odds of being physical inactive. Physical therapists can screen and help women manage their PF symptoms so that they remain physically active.

Impact of urinary incontinence on quality of life in female CrossFit practitioners: A cross-sectional study

OBJECTIVE

Investigate the impact of urinary incontinence (UI) on quality of life (QoL) in female CrossFit practitioners and to verify the strategies used by them to minimize the occurrence of urine leakage. In addition, to verify whether anthropometric and clinical characteristics increase the UI impact on QoL of female CrossFit practitioners.

STUDY DESIGN

This was an online cross-sectional survey. The impact of UI on QoL was investigated by International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). Associations between the impact of UI on QoL and the clinical (age, BMI, gestations, mode of delivery, practice of other physical activities) and the others pelvic floor dysfunctions (PFD) related independent variables were tested using logistic regression analysis.

RESULTS

A total of 828 female CrossFit practitioners answered the questionnaire and 36% reported UI symptoms. The women who obtained the highest score on the ICIQ-SF have high UI interference in QoL. Previous history of two or more gestations and sexual dysfunctions (dyspareunia or vaginismus) or pelvic organ prolapse increase 2.65 and 1.82 times the risk of female CrossFit practitioners with UI having a high impact of UI on their QoL, respectively (OR = 2.65 95% CI 1.30-5.40, p = 0.01; and OR = 1.82 95% CI 1.04-3.21, p = 0.04, respectively). The most strategies used by them to minimize the occurrence of urine leakage were emptying the bladder before training (77.5%) and use absorbent (17.8%).

CONCLUSIONS

Women who had higher scores on the ICIQ-SF reported greater impact on QoL, and the previous history of two or more gestations and sexual dysfunction/pelvic organ prolapse increase the risk of women with UI who practice CrossFit to have a greater impact on QoL. Multigravida and women with sexual dysfunction/pelvic organ prolapse who practice CrossFit could have more attention on the UI symptoms due to the high impact on their QoL.

Pelvic floor evaluation in CrossFit® athletes and urinary incontinence: a cross-sectional observational study

Athletic urinary incontinence is characterized by urinary loss during sports practice. This condition occurs in the case of CrossFit®, a modality based on high intensity training and functional movements, it can also be considered as having a high impact on the pelvic floor. This study aimed to compare the force and the contraction capacity of the pelvic floor musculature and urinary incontinence between female CrossFit® practitioners (AG) and non-practitioners (CG). We performed a cross-sectional observational study in the period from December 2018 and May 2019. Complaints of urinary incontinence was assessed by the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF); the functional evaluation of the pelvic floor was performed by digital palpation; resting tone, maximum voluntary contraction, fast contractions and sustained contraction of the pelvic floor muscles was tested by electromyography. The prevalence of urinary incontinence was significantly higher in AG compared with CG (p < .001). Nevertheless, we did not find significant differences between the two groups for functional assessment and electromyographic parameters. The AG presented a prevalence 60% of UI, while CG only 9,5 (p < 0,001). Considering this point, tailored prevention strategies seem mandatory in this population, in order to allow early identification and management of urinary incontinence.

Prevalence of Pelvic Floor Dysfunction, Bother and Risk Factors and Knowledge of the Pelvic Floor Muscles in Norwegian Male and Female Powerlifters and Olympic Weightlifters

Skaug, KL, Bø, K, Engh, ME, and Frawley, H. Prevalence of pelvic floor dysfunction, bother, and risk factors and knowledge of the pelvic floor muscles in Norwegian male and female powerlifters and Olympic weightlifters. J Strength Cond Res XX(X): 000-000, 2020-Strenuous exercise has been suggested as a risk factor of pelvic floor dysfunction (PFD). Powerlifters and Olympic weightlifters compete with high external loads. To date, knowledge of PFD in these athletes has been sparse. The aim of this study was to investigate prevalence, risk factors, and bother of PFD in powerlifters and Olympic weightlifters and their knowledge of the pelvic floor muscles (PFM). All athletes aged ≥18 years competing in ≥1 National Championship in powerlifting or Olympic weightlifting in 2018/2019 were invited. The International Consensus on Incontinence Questionnaires were used to assess PFD. One hundred eighty women and 204 men participated. The prevalence of urinary incontinence (UI), anal incontinence (AI), and pelvic organ prolapse in women was 50.0, 80.0, and 23.3%, respectively. Stress UI (SUI) was reported by 41.7% of the women and 87.8% reported a negative influence on sport performance. The prevalence of UI and AI in men was 9.3 and 61.8%. In women, increasing body mass index was significantly associated with SUI (odds ratio [OR]: 1.09, 95% confidence interval [CI]: 1.01-1.17) and international level of competition (OR: 3.27, 95% CI: 1.32-8.07) and weightlifting ≥4 d·wk (OR: 0.26, 95% CI: 0.08-0.86) with AI. In men, increasing age (OR: 1.03, 95% CI: 1.00-1.07) and frequently straining to void (OR: 4.84, 95% CI: 1.02-22.94) were significantly associated with AI. Forty-three percent of the women and 74% of the men did not know why and 44.4 and 72.5% how to train the PFM. In conclusion, the prevalence of PFD was high, and the athletes had limited knowledge of the PFM.

Do women runners report more pelvic floor symptoms than women in CrossFit®? A cross-sectional survey

INTRODUCTION AND HYPOTHESIS

Women who perform high-impact activities might be at greater risk of pelvic floor dysfunction (PFD) than those participating in low-impact exercise; however, little is known about whether PFD is more common in one type of high-impact activity than another. The aim of this study was to compare the prevalence of PFD symptoms in women who engage in high-impact activity compared with CrossFit®-brand training (CF).

METHODS

An online survey collected data from 1,379 women (521 runners, 858 CF) on exercise participation, parity, and PFD symptoms, via the Pelvic Floor Distress Inventory (PFDI-20). Specific questions from each PFDI-20 subscale further investigated symptoms of pelvic organ prolapse (POP), anal incontinence (AI), as well as stress (SUI) and urgency (UUI) urinary incontinence.

RESULTS

Symptoms of POP and AI were significantly higher in runners (POP 12.7%, AI 34.0%) than in CF (POP 7.8%, p = 0.003; AI 27.7%, p = 0.014). There was no significant difference in SUI symptoms between groups (37.0% vs 41.0% respectively, p = 0.141). Vaginally parous runners reported significantly more symptoms of POP (19.0% vs 12.2%, p = 0.023), AI (39.3% vs 27.2%, p = 0.001), and UUI (36.3% vs 29.0%, p = 0.037) than CF.

CONCLUSION

Women, particularly parous women, who participate in running, have a higher prevalence of POP and AI symptoms than women who participate in CF. This suggests that CrossFit®-brand training might not be more detrimental to PFD symptoms than other high-impact activity, such as running. This study does not conclude a pelvic floor health benefit of one exercise over another, but highlights that exercise options can be provided to women.

CrossFit® – Development, Benefits and Risks

CrossFit is a form of high-intensity interval training and comparable to other high-intensity exercises. CrossFit exercises increase VO_2max, strength, endurance, and improves the body composition (e. g. lean body mass).

The injury risk in CrossFit is similar to that of other, comparable sports such as Olympic weightlifting, powerlifting and gymnastics and lower than that of competitive contact sports such as rugby union and rugby league. Shoulder joint, shoulder girdle and spine injuries are predominating in CrossFit and require special attention from physicians and coaches. In particular, this includes expert instruction for CrossFit beginners as well as an initial orthopedic examination before starting CrossFit training. The involvement of well-educated coaches correlates with a decreased injury rate. For this reason, it is recommended that beginners complete a special program with slow load increase and instructions of the fundamental CrossFit techniques. In CrossFit, previous injuries also increase the risk of re-injury, which is consistent with the findings of other sport-related injury studies, and should also be taken into account.

Evidence Level III