Urinary incontinence and other pelvic floor dysfunctions in female athletes in Brazil: A cross-sectional study

Measurement of the Vaginal Pressure Profile with the Femfit® and Leakage Events Using a Newly Developed Pad Test during Selected Sports Activities: A Pilot Study

INTRODUCTION AND HYPOTHESIS

Measuring changes in the vaginal pressure profile (VPP) with the Femfit® by JUNOFEM during various sports will help improve understanding of the magnitude of pressures generated during such activities and the pelvic floor's response to those pressures. This could aid in selecting safe exercises for women with pelvic floor dysfunction. The primary aim of this study was to measure intravaginal pressure changes using a novel pressure sensor array (Femfit®) during high-risk sports activities in elite female athletes with and without stress urinary incontinence (SUI). The secondary aim was to quantify the amount of urine leakage during these activities using a newly developed innovative pad weighing test (iPWT).

METHODS

We used the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) to assess participants and measured the VPP using the Femfit® device during ground jumps, trampoline jumps, weightlifting, slow running and fast running. Urine leakage was assessed using the iPWT during the five sports activities.

RESULTS

The highest VPP (53.7 ± 21.6 mmHg) was recorded during ground jumps, followed by trampoline jumps. The second-highest values (24.7 ± 8.1 mmHg) were measured during fast and slow running, while the lowest values were observed during weightlifting (11.6 ± 4.0 mmHg). Measurements of VPP during sporting activities revealed lower pressure values in elite female athletes with SUI than in those without SUI. The overall mean urine leakage in the SUI group during the five activities was 6.6 ± 1.8 g.

CONCLUSION

On the basis of the VPP and the newly developed iPWT, sports involving jumps and lunges have been identified as revealing SUI and should therefore be included in testing female athletes. The iPWT may prove suitable for measuring SUI in elite female athletes but requires further testing and validation.

CLINICALTRIALS

gov Registration: NCT06224335.

Sport practice and hemorrhoidal disease: results from a self-assessment questionnaire among athletes

BACKGROUND

Hemorrhoidal disease (HD) is a common proctologic disease. Dietary and lifestyle play a role in the genesis of the disease or in its progression to more severe forms, although the exact mechanism is still not fully understood. We performed a pilot observational cross-sectional analytical association study to evaluate the possible association between sport activities and HD.

METHODS

We included subjects aged 18 years old or more, competitive and non-competitive, practicing at least one sport activity, at least twice a week. Data were collected using an online questionnaire, developed on the Microsoft Teams communication platform.

RESULTS

Out of the 312 study participants, 34% reported HD. Among subjects who practiced cycling or horseback riding, 57% reported suffering from HD; among those practicing bodybuilding, 48% complained of HD. In the multivariate logistic regression analysis, age and bodybuilding practice showed a statistically significant association with HD.

CONCLUSIONS

Some sport activities could play a role in the onset or worsening of HD. Our results showed a positive association between cycling, horseback riding, bodybuilding, and HD occurrence. Given the numerous health benefits of physical activity, patients should be provided with correct information regarding the practice of sports in relation to their pathology.

Prevalence of Urinary Incontinence in Female Professional Soccer Players by Category and Specific Position: A Comparative Study with a Control Group

BACKGROUND/OBJECTIVES

Urinary incontinence (UI) significantly impacts quality of life, with varying prevalence in women depending on factors such as age, childbirth, and type of sport practiced. This study compared the prevalence, types, and severity of urinary incontinence (UI) between professional female soccer players and sedentary students, analyzing its relation to playing position and competitive level.

METHODS

A descriptive, observational, and analytical cross-sectional study was conducted, assessing the prevalence, severity, and types of UI among 235 nulliparous professional female soccer players (experimental group, EG) and 252 sedentary female students (control group, CG). Data were collected using the short version of the International Consultation on Incontinence Questionnaire (ICIQ-SF). Statistical analyses included Fisher's exact test to compare prevalence rates.

RESULTS

The findings revealed that 35% of soccer players and 31% of sedentary students reported experiencing UI. Stress urinary incontinence (SUI) was the most prevalent type in both groups, affecting 26% of soccer players and 14% of sedentary students, while mixed UI was more frequent among sedentary women (17%) (p < 0.05). No significant differences were observed in UI prevalence based on playing position or competitive level (p ≥ 0.05). However, female soccer players exhibited a significantly higher prevalence of UI during physical exertion or exercise compared to the control group (p ≤ 0.001), suggesting that high-impact sports may contribute to pelvic floor dysfunction. Additionally, 23.8% of soccer players reported mild-to-moderate UI severity.

CONCLUSION

Female soccer players showed higher UI prevalence during exercise, underscoring the need for targeted interventions like pelvic floor training.

Up for the tackle? The pelvic floor and rugby. A review

The pelvic floor and its associated disorders are a unique and often overlooked aspect of women's rugby. This review discusses relevant biopsychosocial considerations specific to the pelvic floor and rugby. Pelvic floor disorders can present at any time across the female lifespan but are more prevalent during pregnancy and postpartum. This is due to the substantial physiological and anatomical changes experienced during pregnancy and vaginal childbirth. Consequently, pelvic floor disorders can impact a player's ability to perform, maintain engagement with, or return to, rugby due to symptoms. Players need to be informed, supported, and guided through focused pelvic floor muscle training to condition the muscles and 'ready' them for the varied demands of rugby. Health and fitness professionals should understand the risk of pelvic floor disorders across the female lifespan and screen players for symptoms when supporting them to maintain or return to rugby. Rugby players who are symptomatic of pelvic floor disorders should be signposted to specialist services and/or resources to manage their symptoms. Once engaging in rugby training, ongoing evaluation of player load tolerance and implementation of individualized strategies to support managing rugby-related loads to the pelvic floor should be considered. Finally, surveillance and research focusing specifically on rugby players and pelvic floor function are needed.

Pelvic Floor Disorders Among U.S. Military Active-Duty Females

IMPORTANCE

Women are a growing cohort within the U.S. military. Pelvic floor health is a component of health maintenance for which support needs vary by sex. The American Journal of Obstetrics & Gynecology reports that 1 in 4 women is affected by moderate to severe pelvic floor dysfunction (PFD). Understanding the specific experience of female service members is warranted for health care optimization and preservation of force readiness.

OBJECTIVE

We aimed to identify the prevalence, incidence, and risk factors associated with incident PFD in active-duty females during an 11-year window.

STUDY DESIGN

We used the Medical Assessment and Readiness System at Womack Army Medical Center, which includes medical record and personnel data from 2011 to 2022. Pelvic floor dysfunction diagnoses were identified using diagnosis codes and analyzed with respect to demographic parameters.

RESULTS

Between 2011 and 2022, 32,996 of 550,303 active-duty females were diagnosed with PFD (period prevalence: 6.00%). Using 2011-2012 as a washout period, 27,046 of 486,558 participants were diagnosed during 1,879,990.90 person-years of follow-up (incidence rate: 14.39 cases per 1,000 person-years). The incidence rate of PFD increased in both new and established active-duty females. Increasing time since service entry was the strongest, statistically significant independent predictor of PFD. Three or more deployments and specific physical fitness scoring were also predictors of PFD.

CONCLUSIONS

The incidence rate of PFD among female service members is increasing, and multiple military-specific factors predict PFD. As the percentage of women in active-duty service continues to grow, additional investigation is needed to confirm PFD trends, illuminate other predictors, and prevent adverse outcomes.

Self-reported reproductive health of retired elite women's footballers: a cross-sectional study

Objectives

The primary objective of this study was to describe the self-reported reproductive health of retired elite women's footballers with specific reference to menstrual function, pregnancy and motherhood, contraceptive use and pelvic floor function.

Methods

An electronic survey was disseminated to women's footballers (18 years or older) who had retired from elite football within 10 years of completing the survey.

Results

69 respondents completed the survey (mean age 35.8 years, mean age at retirement 30.3 years). One-third of participants self-reported experiencing at least one episode of amenorrhoea (>3 months without menstruation) for reasons other than hormonal contraceptive use or pregnancy. Three participants (mean age of 41 years, range 30-54) reported having reached menopause at the time of the study. 54 (78.3%) participants were not using any form of contraception. 17 (24.6%) of the participants are mothers (range 1-3 children). 51 of the participants (73.9%) had never been pregnant, and the majority of those who had been pregnant (86.7%) became pregnant in less than 2 years following the onset of desire for pregnancy. Four of the retired players gave birth during their playing career, and the mean time to return to competitive matches following delivery was 22 weeks. The mean Pelvic Floor Distress Inventory-20 score for participants was 72.

Conclusion

These insights can be used to inform future efforts to promote positive reproductive health outcomes for current, former and future women's footballers. Research efforts should focus on improving the understanding of how to effectively support women's footballers in the perinatal period. Best practice guidelines on the use of menstrual cycle monitoring and pelvic health support would improve standards of care for women's footballers. Stakeholders should consider gender-specific postretirement care for women's footballers.

Symptomatology and knowledge regarding pelvic floor dysfunctions and influence of gender stereotypes in female athletes

Pelvic floor dysfunctions (PFD) are highly prevalent among females who do athletics, a sport requiring jumping, strength, and running. Although educational approaches are useful options, the educational need for this particular population remains unknown. The objective of the present study was to describe the level of knowledge regarding PFD and its relationship with symptomatology and gender stereotypes in female athletes in Spain. A total of 255 female athletes completed an anonymous online survey to explore their knowledge regarding urinary incontinence (UI), pelvic organ prolapse (POP), anal incontinence (AI), and sexual dysfunction (SexD), as well as their PFD symptoms and gender stereotyped beliefs related to sport. Educational level and sports characteristics (training volume, experience, and athletic modality) were also explored. Participants demonstrated a low level of knowledge in terms of POP (52.5%), AI (64.0%), and SexD (40%), but not for UI (70.8%). The proportion of PFD complaints was 63.5% for dyspareunia, 51.8% for urine leakage, 42.4% for pelvic pain, 17.3% for AI, and 9.0% for POP, with no associations with knowledge (p > 0.05). Lower knowledge about UI and SexD was related to greater gender stereotypes (p < 0.05) and rejection of professional healthcare (p = 0.010). As a conclusion, the level of knowledge about PFD was low in female athletes who train and compete in athletics in Spain, mainly with regard to sexual dysfunction. Although 63.5% of athletes had dyspareunia and 51.8% urinary leakages, symptomatology was not associated with level of knowledge. However, a lower level of knowledge was associated with more stereotyped beliefs and rejection of professional healthcare for PFD. These findings confirm the need to design appropriate educational interventions to disseminate information on all the types of PFD, particularly sexual contents. The potential influence of gender stereotypes makes it appropriate to include the gender perspective in these interventions.

Women's preferences for pelvic floor screening in sport and exercise: a mixed-methods study integrating survey and interview data in Australian women

OBJECTIVES

One in two women experiencing pelvic floor (PF) symptoms stop playing sport or exercising. The study examines the perspective of women with PF symptoms to inform acceptable screening practices within sport and exercise settings.

METHODS

Explanatory, sequential, mixed-methods design. Phase 1: survey of 18-65 years, symptomatic, Australian women (n=4556). Phase 2: semistructured interviews with a subset of survey participants (n=23). Integration occurred through connection of phases (study design, sampling) and joint display of data.

RESULTS

Findings are represented in three threads: (1) 'women (not) telling'; a majority of women had told no-one within a sport or exercise setting about their PF symptoms due to shame/embarrassment, lack of pelvic health knowledge and not wanting to initiate the conversation, (2) 'asking women (screening for PF symptoms)'; women endorsed including PF symptom questions within existing sport and exercise screening practices but only when conducted in a respectful and considered manner and (3) 'creating safety'; professionals can assist women to disclose by demonstrating expertise, trustworthiness and competency. If health and exercise professionals are provided with appropriate training, they could raise pelvic health awareness and promote a supportive and safe sport and exercise culture.

CONCLUSION

Women with PF symptoms support health and exercise professionals initiating conversations about PF health to normalise the topic, and include PF symptoms among other pre-exercise screening questions. However, women should be informed on the relevance and potential benefits of PF screening prior to commencing. Safe screening practices require building trust by providing information, gaining consent, displaying comfort and genuine interest, and being knowledgeable within one's scope of practice to the provision of advice, exercise modifications and referral as appropriate.

Prevalence of pelvic floor dysfunction in recreational athletes: a cross-sectional survey

INTRODUCTION AND HYPOTHESIS

Pelvic floor dysfunction (PFD) affects many women and participation in elite sport and high-impact exercise has been reported as a potential risk. However, few studies have investigated the effects of exercising at recreational levels on PFD. Our aim was to investigate levels of PFD in women exercising at, or above, UK guidelines for health and compare them with levels in non-exercisers.

METHOD

Data on levels of PFD and potential risk factors (age, hormonal status, body mass index, constipation, parity, forceps delivery, and recreational exercise) were collected using a cross-sectional survey distributed via social media. The International Consultation Incontinence Questionnaire (ICIQ) Urinary Incontinence Short Form was used to estimate prevalence of urinary incontinence (UI). Selected questions from the ICIQ vaginal symptom and bowel symptom questionnaires were used to estimate prevalence of anal incontinence (AI) and pelvic organ prolapse (POP). Logistic regression analysis was used to compare exercisers and non-exercisers after adjusting for potential confounders.

RESULTS

We recruited 1,598 adult women (1,141 exercisers and 457 non-exercisers). The majority were parous. High prevalence of UI (70%), AI (52%) and POP (18%) was reported. No significant association was found between recreational exercise and PFD despite adjustment for confounders, or further investigation regarding exercise involving impact, although some increased reporting of AI was seen in those exercising for over 10 hours per week.

CONCLUSION

High levels of all PFD were reported but no significant association was found between recreational exercise and symptoms. However, data suggest that women modify their exercise regimes as required. Few symptomatic women sought professional help.

Current Perspectives in Vaginal Laxity Measurement: A Scoping Review

This scoping review aimed to identify and categorize the available measurement options for vaginal laxity (VL), their indications of use, and whether these measurements can sufficiently provide objective clinical judgment for cases indicated for vaginal rejuvenation with many treatment options nowadays. Systematic searches were conducted on five electronic databases, manually searching articles' bibliographies and predetermined key journals with no date or study design limitations. We included all studies involving VL in their inclusion criteria, treatment indications, and outcome parameters. We used the Arksey and O'Malley frameworks as the guideline in writing this scoping review. Of the 9,464 articles identified, 66 articles and 11,258 subjects were included in the final analysis. The majority of studies were conducted in obstetrics and gynecology (73%), followed by plastic surgery (10%), medical rehabilitation (4.5%), dermatology (4.5%), and others (8%). Most studies originated from the North American region (30%). The following measurement tools were used: (1) interviews, (2) questionnaires, (3) physical/digital examinations, (4) perineometers, and (5) others. Our results suggested that subjective perception of laxity confirmed by directed interview or questionnaire is sufficient to confirm VL. Additional evaluation of pelvic floor muscle through digital examination or perineometer or other preferred tools and evaluation of sexual function through validated questionnaire (Female Sexual Function Index, Female Sexual Distress Scale-Revised, etc.) should follow to ensure holistic care to patients. Future research on the psychometric properties (reliability and validity) of commonly used measurements and the correlation in between subjective and objective measurements should be initiated before their clinical applications.

Electromyographic Activity of the Pelvic Floor Muscles and Internal Oblique Muscles in Women during Running with Traditional and Minimalist Shoes: A Cross-Over Clinical Trial

The study aimed to investigate the effects of footwear on the electromyographic (EMG) activity of pelvic floor muscles (PFMs) and internal oblique (IO) muscles during running at different speeds. The study also aimed to explore the correlation between EMG activity of PFMs and IO muscles and participants' morphological characteristics. Ten nulliparous female runners were included in the study. The participants ran for 90 s at speeds of 9, 11, and 13 km/h wearing both traditional and minimalist shoes. EMG outcomes were presented as a percentage of maximum voluntary contraction (%MVC). Comparative analysis was conducted using the Wilcoxon rank test. Correlational analysis was performed using the Rho-Spearman correlation coefficient. The %MVC for the IO muscles was significantly lower when using minimalist shoes compared to traditional shoes (p = 0.04). No statistically significant differences were found for the PFMs (p > 0.05). The study also observed large correlations between age and %MVC of the PFMs and IO muscles (rho = -0.64; p = 0.04). Minimalist shoes decreased the activity of IO muscles in female runners. However, no significant differences in EMG activity of PFMs were found when comparing traditional and minimalist footwear. The long-term effects of minimalist footwear on EMG activity of PFMs and IO muscles, as well as their relationship to morphological characteristics, require further investigation.

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.

Can running influence women's sexual function?

INTRODUCTION AND HYPOTHESIS

Studies have shown that athletes have three times increased risk of urinary incontinence compared to non-athletes, in addition to anal incontinence and sexual dysfunction (SD). This study aimed to assess the sexual and pelvic floor muscle (PFM) functions and to compare these variables among female athlete runners with and without SD and to identify predictive factors that may be associated with sexual function among the athletes.

METHODS

Cross-sectional study including 90 female runners, who ran ≥ 20 km/week for at least 6 months, had had sexual intercourse in the last 4 weeks and were > 18 years old. PFM function was assessed by vaginal palpation and manometry. Women also answered the International Consultation on Incontinence Questionnaire-Short Form to investigate presence of urinary incontinence. Sexual function was assessed by Female Sexual Function Index (FSFI); total scores ≤ 26.5 were considered to indicate SD. The scores of each FSFI domain and the total score were compared individually between each predictor using simple linear regression. In addition, multiple linear regression analysis was performed.

RESULTS

Athletes with SD presented lower PFM strength. The results of the multiple linear regression analysis among all the predictor variables, FSFI domains and total score show that the Modified Oxford Scale is a predictor for the desire, excitation, lubrication, orgasm, pain and total score domains.

CONCLUSIONS

Female runners with lower PFM strength presented worse sexual function regardless of age, parity, BMI and running practice time.

Pelvic floor dysfunctions in women with fibromyalgia: A cross-sectional study

BACKGROUND

Fibromyalgia (FM) is a rheumatic syndrome that causes musculoskeletal disorders and is associated with several problems that affect quality of life. As the musculoskeletal system is affected, it can have an impact on the pelvic floor muscles, leading to pelvic floor dysfunction (PFD).

OBJECTIVE

Investigate the occurrence of PFD, such as urinary incontinence (UI) and anal incontinence (AI), sexual problems, and pelvic organ prolapse (POP), in women with FM compared to a control group composed of women without FM; and investigate the association between FM and PFD.

STUDY DESIGN

This was an online cross-sectional survey. Demographic and anthropometric data, the description of PFD (UI, nocturia, AI, genital-pelvic pain/penetration disorder, and POP), and previous obstetric history were collected through a web-based questionnaire. The groups were compared using the independent t-test for quantitative variables and the chi-square test for categorical variables. The association between FM and PFD was tested using logistic regression analysis.

RESULTS

A total of 175 women answered the questionnaire (97 with FM and 78 healthy controls). The women with FM reported significantly more UI, mixed urinary incontinence, AI, POP, and vaginismus than the healthy controls (p ≤ 0.05). FM was associated with mixed urinary incontinence (OR: 2.6; 95 % CI: 1.1-6.4; p = 0.04), anal incontinence (OR: 2.9; 95 % CI: 1.3-6.1; p = 0.01), and flatus incontinence (OR: 2.6; 95 % CI: 1.2-5.4; p = 0.01).

CONCLUSION

The prevalence of PFD was significantly higher in women with FM compared to healthy women. Indeed, the women with FM were 2.6-fold to 2.9-fold more likely to report mixed urinary incontinence, anal and flatus incontinence than those in the control group. The present findings show possible impairment of the pelvic floor musculature in women with FM.

Screening for pelvic floor symptoms in exercising women: a survey of 636 health and exercise professionals

OBJECTIVES

This study aimed to establish health and exercise professionals' (i) current practice of screening for pelvic floor (PF) symptoms in women within sports/exercise settings (ii) between-professional group differences in screening practice (iii) confidence and attitudes towards screening for PF symptoms and (iv) barrier/enablers towards engagement in future screening practice.

DESIGN

Observational, cross-sectional survey.

METHODS

Australian health and exercise professionals (n = 636) working with exercising women participated in a purpose-designed and piloted, online survey about PF symptom screening in professional practice. Data were analysed descriptively and groups compared using Chi-square/Kruskal-Wallis tests.

RESULTS

Survey respondents included physiotherapists (39%), personal trainers/fitness instructors (38%) and exercise physiologists (12%), with a mean of 12 years of practice (SD: 9.7, range: 0-46). One in two participants never screened women for PF symptoms; 23% screened when indicated. Pregnant/recently post-natal women (44%) were more commonly screened for PF symptoms than younger women (18-25 years:28%) and those competing in high-impact sports (32%). Reasons for not screening included waiting for patients to disclose symptoms (41%) and an absence of PF questions on screening tools (37%). Most participants were willing to screen PF symptoms but cited a lack of knowledge, training and confidence as barriers.

CONCLUSIONS

Screening for PF symptoms in exercising women is not common practice, especially in at-risk groups such as young, high-impact athletes. Including PF questions in existing pre-exercise questionnaires and providing professional development to improve knowledge of indications for screening and evidence-based management options may facilitate early symptom identification and prevent secondary exercise cessation.

Comparison of First Childbirth Characteristics between Elite Judo Athletes and Non-Athletes: The Preliminary Retrospective Case-Control Study

It has been speculated that elite athletes are more likely to have obstetric interventions during labor and delivery. So far, the impact of many years of competitive sports participation on childbirth characteristics has not been well-established. This preliminary retrospective case-control study aimed to determine whether the first labors of elite judo competitors required obstetric interventions more frequently and were longer than those of non-athletes. The study comprised 32 parous women: 16 elite judo athletes and 16 non-athletes. Women were included if they had access to the following obstetric data (from their first childbirth hospital discharge reports and/or first child's health record books): induction and augmentation of labor, mode of delivery, the duration of labor and its second stage, episiotomy, perineal tear, and the neonate's Apgar score. Electronic surveys were completed concerning childbirth characteristics, level of "eliteness" (judo athletes), and recreational physical activity (non-athletes). The statistical analysis showed no significant between-group differences in any of the first childbirth outcomes under analysis. The preliminary results indicate elite judo practice before first pregnancy had no negative impact on the rates of labor induction and augmentation, delivery mode, duration of labor, the rates of episiotomy and perineal tear, and the neonate's Apgar score. Due to the small sample size, the conclusions should be considered with caution.

Elite female athletes' experiences of symptoms of pelvic floor dysfunction: A systematic review

INTRODUCTION AND AIMS

Pelvic floor dysfunction (PFD) is a collection of signs, symptoms and conditions affecting the pelvic floor and urinary incontinence (UI) is the most common type of PFD. Recent systematic reviews have indicated a higher prevalence of UI among female athletes compared to their non-athletic counterparts. To date, no review has been undertaken to investigate female athletes' experiences of PFD. This review aims to offer insight and understanding, through aggregation, summary, synthesis and interpretation of findings from studies that report elite female athletes' experiences of symptoms of PFD.

METHODS

The review protocol was registered in PROSPERO in August 2020. A systematic search was conducted in Embase, MEDLINE (OVID), Cochrane Library, CINAHL, PsycINFO and Web of Science for studies published in the English language reporting elite female athletes' experiences of symptoms of PFD. This review included primary research studies that involved elite female athletes of any age or ethnicity.

RESULTS

Of the 1922 citations retrieved in the search, 32 studies met the methodological criteria for data extraction and analysis. Five main themes emerged: (1) triggers for symptoms of PFD; (2) strategies adopted by athletes to manage/mitigate symptoms of PFD; (3) impact on QOL/daily life; (4) impact on performance; (5) impact on emotions.

CONCLUSIONS

The findings of this review suggest a need to further explore the experiences of PFD among elite female athletes and it is suggested that future research should adopt qualitative methods or incorporate a qualitative component.

Pelvic floor dysfunctions in women with systemic lupus erythematosus: A cross-sectional study

INTRODUCTION AND HYPOTHESIS

As a result of the impairment of the musculoskeletal system, the pelvic floor muscles are likely compromised in women with systemic lupus erythematosus (SLE). We hypothesized that women with SLE would report more symptoms of pelvic floor dysfunction (PFD) and there will be an association between SLE and PFD.

METHODS

An online cross-sectional survey was conducted. Data were collected on demographic and anthropometric characteristics, PFD (urinary incontinence, nocturia, anal incontinence, genital-pelvic pain/penetration disorder and pelvic organ prolapse) and obstetric history using a web-based questionnaire. The groups were compared using the Mann-Whitney test for quantitative variables and the chi-squared test for categorical variables. The association between SLE and PFD was tested using logistic regression analysis.

RESULTS

A total of 196 women answered the questionnaire (102 with SLE and 94 healthy controls). Women with SLE reported significantly more urinary incontinence, nocturia, anal incontinence, pelvic organ prolapse and genital-pelvic pain/penetration disorder than the healthy controls (p ≤ 0.05). Women with SLE were 2.8- to 3.0-fold more likely to report genital-pelvic pain/penetration disorder than healthy women.

CONCLUSIONS

The prevalence of PFD was significantly higher in women with SLE compared to healthy women. Thus, PFD seems to be an important problem in women with this disease. An in-depth investigation of these disorders could contribute to the understanding of how SLE impacts pelvic floor function.

INCONTINÊNCIA URINÁRIA EM MULHERES JOVENS E NULÍPARAS: FATORES ASSOCIADOS E PREVALÊNCIA

Objetivo:Verificar a prevalência e os fatores de risco associados à incontinência urinária em mulheres jovens nulíparas. Método: Revisão integrativa da literatura, realizada através de busca nas bases de dados: Medical Literature Analysis and Retrieval System Online (MEDLINE), Literatura Latino-Americana e do Caribe em Ciências de Saúde (LILACS), Índice Bibliográfico Espanhol em Ciências da Saúde (IBECS) e na Base de Dados de Enfermagem (BDENF), no período de março a junho de 2021, utilizando os descritores: “incontinência urinária”, “prevalência”, “mulheres”, “estudantes” e “adulto jovem” combinados através do operador booleano “AND”. Resultados: A busca inicial resultou em 234 artigos e, após aplicação dos critérios de elegibilidade, obteve-se uma amostra final de 5 artigos. Após as análises, evidenciou-se prevalência de incontinência urinária em mulheres jovens nulíparas de 48%. Os fatores de risco foram: atividade física de alto impacto, duração da atividade física, sintomas intestinais e urinários concomitantes. Conclusão: Observou-se que a ocorrência de incontinência urinária em mulheres jovens nulíparas é uma condição comum, os fatores de risco associados demonstram a necessidade de orientação em saúde a essas mulheres para evitar a cronificação do agravo.

URINARY INCONTINENCE IN YOUNG AND NULLIPAROUS WOMEN: ASSOCIATED FACTORS AND PREVALENCE

Objective: To verify the prevalence and risk factors associated with urinary incontinence in nulliparous young women. Methods: Integrative literature review, performed by searching the following databases: Medical Literature Analysis and Retrieval System Online (MEDLINE), Latin American and Caribbean Literature in Health Sciences (LILACS), Spanish Bibliographic Index in Health Sciences (IBECS) and in the Nursing Database (BDENF), from March to June 2021, using the descriptors: “urinary incontinence”, “prevalence”, “women”, “students” and “young adult” combined with the Boolean operator “AND”. Results: The initial search resulted in 234 articles and, after applying the eligibility criteria, a final sample of 5 articles was obtained. After the analyses, a prevalence of urinary incontinence in young nulliparous women of 48% was evidenced. Risk factors were: high-impact physical activity, duration of physical activity, concomitant bowel and urinary symptoms. Conclusion: It was observed that the occurrence of urinary incontinence in nulliparous young women is a common condition. The associated risk factors demonstrate the need for health guidance to these women to avoid the chronification of the disease.

Pelvic floor disorders stop women exercising: A survey of 4556 symptomatic women

OBJECTIVES

To establish the impact of pelvic floor (PF) symptoms (urinary incontinence [UI], anal incontinence [AI] and pelvic organ prolapse [POP]) on exercise participation in women.

DESIGN

Observational, cross-sectional survey.

METHODS

Australian, 18- to 65-year-old women with self-identified PF symptoms during exercise (current, past or fear of) were included. This survey included validated questionnaires: Questionnaire for female Urinary Incontinence Diagnosis, Incontinence Severity Index, Pelvic Floor Bother Questionnaire, International Physical Activity Questionnaire and purpose-designed questions on the impact of PF symptoms on sport/exercise participation. Analysis utilised descriptive statistics. Chi-square tests for independence and t-tests were used to explore differences between groups.

RESULTS

Of 4556 women, 46% stopped exercise they had previously participated in due to their PF symptoms. Urinary incontinence had the largest impact; 41% with UI, followed by 37% with POP and 26% with AI stopped at least one form of exercise. Forty-two percent of women who experienced symptoms in high-impact sports stopped participation (versus low-impact: 21%). Sports commonly ceased included volleyball (63%), racquet-sports (57%) and basketball (54%). Exercise cessation was reported amongst younger (18-25 years: 35%) and nulliparous women (31%). Common exercise modifications included lowering the intensity (58%) or frequency (34%) of participation or changing to a low-impact form of sport/exercise (45%).

CONCLUSIONS

Pelvic floor symptoms stop women of all ages and levels of participation from exercising. High-impact sports were most affected but low-impact sports were also ceased. Symptomatic women also modify exercise to less vigorous/frequent participation, which may place them at risk of physical inactivity, and chronic illness.

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.

High-impact aerobics programme supplemented by pelvic floor muscle training does not impair the function of pelvic floor muscles in active nulliparous women: A randomized control trial

BACKGROUND

We aimed to test the hypothesis that high-impact aerobics programme, combined with pelvic floor muscle training does not impair pelvic floor muscle function in young active women.

METHODS

A randomized control trial was conducted among active nulliparous, sport university students (age 23 ± 3 years, mean ± SD). Experimental group (n = 13) attended high-impact aerobics programme, supplemented by pelvic floor muscle training with one biofeedback session, for 6 weeks. The control group (n = 19) did not get any intervention. Before and after the experiment, we assessed pelvic floor muscle function in both groups with surface electromyography using vaginal probes. In both groups, we assessed the participants' quality of life related to pelvic floor functions with the Incontinence Impact Questionnaires.

RESULTS

We recorded no impairments in neuromuscular activity of pelvic floor muscles and in quality of life in women regularly performing high-impact aerobics. What is even more positive, after 6 weeks, experimental group presented better skills both in contracting and relaxing their pelvic floor muscles, although the pre-post intervention EMG change was not statistically significant. All participants maintained good quality of life related to pelvic floor functions.

CONCLUSIONS

High-impact aerobics, supplemented by pelvic floor muscle training can be recommended for active nulliparas.

Influence of sports groups on the risk of stress urinary incontinence in sportswomen

OBJECTIVES

To evaluate sports groups on the risk of stress urinary incontinence (SUI) in sportswomen and its impact on their quality of life.

STUDY DESIGN

Cross-sectional study. The group consisted of 249 sportswomen with a mean age of 22.18 ± 6.11 years. We used the International Physical Activity Questionnaire (IPAQ), the International Consultation on Incontinence Questionnaire (ICIQ-UI), the Overactive Bladder Questionnaire (OAB-q) and the Quality of Life Assessment Questionnaire Concerning Urinary Incontinence (Contilife) were used for evaluation. We divided the sports into the following six groups: 1. Functional mobilization sports (FMS); 2. Strength sports (SS); 3. Aesthetic-coordination and sensory-concentration sports (ACS); 4. Heuristic-individual and martial arts (HIS + MAS); 5. Heuristic-collective sports with a hockey stick (HCS-A); and 6. Heuristic-collective sports with a ball (HCS-B).

RESULTS

The symptoms of SUI according to the ICIQ-UI SF were 1.80 ± 2.93. The estimate of the relative risk (OR) of developing SUI was most significant in the FMS group (OR = 1.96, 95% CI: 1.04-3.68; p < 0.03). Other sports groups did not pose a significant relative risk of developing SUI and had a lower incidence of SUI. In SS was OR = 0.77, in EKS, OR = 0.69, in (HIS + BS), OR = 1.26, in (HKS-A) was OR = 0.63, in (HKS-B) was OR = 1.02. There were no significant differences between the groups in the overall score of the Contilife, which assesses quality of life.

CONCLUSION

The Functional mobilization sports group had a 1.96 times higher risk of SUI compared to that in other sports groups.

Low energy availability and impact sport participation as risk factors for urinary incontinence in female athletes

INTRODUCTION

Relative Energy Deficiency in Sport (RED-S) is a clinical syndrome that includes the many complex health and performance consequences of low energy availability (EA) in athletes, when there is insufficient caloric intake to meet exercise-related energy expenditure and to support basic physiologic functions. There is a high prevalence of urinary incontinence (UI) in female athletes and it is more common in female athletes than non-athletes. The objective of this study was to determine if low EA is associated with UI in a population of adolescent and young adult female athletes and to evaluate for an association between sport categories and UI.

MATERIAL AND METHODS

1000 nulliparous female patients, ages 15-30 years, presenting to a sports medicine subspecialty clinic, provided informed consent/assent to participate in a cross-sectional study involving a comprehensive survey, anthropomorphic measurements, and medical record review. Low EA was defined as meeting ≥1 criterion: self-reported history of eating disorder/disordered eating (ED/DE), and/or a high score on the Brief Eating Disorder in Athletes Questionnaire (BEDA-Q), and/or a high score on the Eating Disorder Screen for Primary Care (ESP). UI was assessed using questions adapted from the International Consultation on Incontinence-Urinary Incontinence Short Form (ICIQ-UI-SF), questions regarding timing of UI onset/duration, and a binary question regarding UI during sport activities. A total of 36 sport types were included in the survey and sub-divided into categories.

RESULTS AND DISCUSSION

Of the 1000 female athletes surveyed, 165 (16.5%) reported a history of experiencing UI during athletic activities. ICIQ- UI-SF responses indicated that 14% (137/1000) of the cohort experienced slight incontinence, 4% (35/1000) moderate incontinence, and 2 athletes experienced severe incontinence. There was a significant difference between UI categories in age (p = 0.01), low EA (p < 0.001), and sport category (p < 0.001). Females who had low EA had twice the likelihood (OR = 1.97; 95% CI = 1.39 to 2.81; p < 0.001) of UI compared to those with adequate EA, controlling for sports category and menstrual dysfunction. Females who participated in high impact sports were 4.5 times more likely (OR = 4.47; 95% CI = 2.29 to 8.74; p < 0.001) to have had UI compared to females who participated in ball sports, controlling for EA and menstrual dysfunction.

CONCLUSIONS

UI during athletic activities is a common problem among nulliparous adolescent and young adult female athletes, occurring in 16.5% of female athletes surveyed. UI was significantly associated with low EA across all sport categories. Sport type was significantly associated with UI, with the highest impact sport group demonstrating a higher prevalence and symptom severity compared to other sport categories.

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.

The Prevalence of Urinary Incontinence among Adolescent Female Athletes: A Systematic Review

This review aimed to synthesize the most up-to-date evidence regarding the prevalence of urinary incontinence (UI) among adolescent female athletes. We conducted a systematic review of studies regarding UI in female athletes less than 19 years of age. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRIMSA). The electronic databases of PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science (WOS) were searched between October and November 2020. After blinded peer evaluation, a total of 215 studies were identified and nine were included. Risk of bias was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. This review identified a prevalence of UI in adolescent female athletes between 18% to 80% with an average of 48.58%. The most prevalent sports were trampolining followed by rope skipping. The prevalence of UI among adolescent female athletes practicing impact sports was significantly prevalent. There is a need for further research, education, and targeted interventions for adolescent female athletes with UI.

Avaliação da função dos músculos do assoalho pélvico e incontinência urinária em universitárias: um estudo transversal

RESUMO O objetivo deste estudo foi avaliar a função e pressão de contração dos Músculos do Assoalho Pélvico (MAP) e a prevalência de Incontinência Urinária (IU) em universitárias. Realizou-se um estudo transversal, com universitárias entre 18 e 35 anos, nulíparas, que já tiveram relação sexual e que nunca realizaram tratamento fisioterapêutico para Disfunções dos Músculos do Assoalho Pélvico (DMAP). Todas as voluntárias realizaram a anamnese, responderam aos questionários international consultation on incontinence questionnaire - Short Form (ICIQ-SF) e incontinence severity index questionaire (ISI-Q), e realizaram avaliação da função e manometria dos MAP. Foi utilizado o teste de Shapiro-Wilk e os valores da amostra são expressos em medianas, intervalos interquartílicos, frequências absolutas e relativas. Foram avaliadas 35 mulheres, das quais 65,72% apresentaram tônus normal, mas apenas 5,71% realizavam a contração adequada dos MAP, com medianas baixas para todas as etapas do PERFECT e na manometria dos MAP. A prevalência de IU foi 57,14%, sendo a Incontinência Urinária de Urgência (IUU) a queixa mais prevalente (50%) e com severidade moderada (55%). Este estudo permitiu identificar déficit na função dos MAP e altos índices de IU em universitárias, demostrando a importância de conscientizar esse público sobre essa DMAP.

Urinary incontinence in female road runners from the Brazilian Federal District - occurrence and associated risk factors

ABSTRACT Urinary incontinence (UI) is defined as the involuntary leakage of urine and stress urinary incontinence (SUI) is a common type of UI, characterized by the loss of urine during physical effort, including running. Objective Analyze UI and associated factors in female road runners in the Brazilian Federal District (DF). Method Cross-sectional descriptive study that investigated UI by applying an adapted questionnaire to female road runners in DF. Results 94 runners, 3.2% of whom reported UI and 56.6% complained of SUI. Body mass index (BMI), birth weight of largest baby and episiotomy were factors associated of SUI. Conclusion Although few women reported UI while running, the results suggest that SI needs to be addressed, especially when associated with risk factors.

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.

Pelvic floor dysfunctions and associated factors in female CrossFit practitioners: a cross-sectional study

INTRODUCTION AND HYPOTHESIS

It is known that high-impact exercises can cause an increase in intra-abdominal pressure and provide overload in the pelvic floor structures. We hypothesized that female CrossFit practitioners would report symptoms of pelvic floor dysfunction (PFD) and that there will be factors associated with these dysfunctions.

METHODS

The study design is an online cross-sectional survey. Demographic and anthropometric data, the characterization of CrossFit activity, the description of PFD and previous obstetric history were collected through a structured web-based questionnaire. Associations between PFD and the clinical and CrossFit-related independent variables were tested using logistic regression analysis.

RESULTS

A total of 828 female CrossFit practitioners answered the questionnaire. The most prevalent symptom was anal incontinence (AI) (52.7%), with flatus incontinence (FI) being the most reported (93.3%). Women who reported constipation are 1.7 times more likely to have FI, and women who practice CrossFit more than five times a week are 3.0 times more likely to have FI. Urinary incontinence(UI) affected 36% of women, and 84.2% of participants reported urinary loss during CrossFit practice. The occurrence of dyspareunia was reported by 48.7% and showed an inverse association with age and body mass index. POP was reported by only 1.4% of the sample.

CONCLUSION

There is a high prevalence of PFD in female CrossFit practitioners, with AI being the most reported symptom, especially FI. In addition, constipation and weekly training frequency were significantly associated with FI. UI occurred primarily in CrossFit exercises, and dyspareunia was the most prevalent sexual symptom.

Benefits of Physiotherapy on Urinary Incontinence in High-Performance Female Athletes. Meta-Analysis

Introduction: High performance female athletes may be a risk group for the development of urinary incontinence due to the imbalance of forces between the abdomen and the pelvis. Pelvic floor physiotherapy may be a useful treatment in these patients. Objectives: (1) To identify the scientific evidence for pelvic floor (PF) dysfunctions that are associated with urinary incontinence (UI) in high-performance sportswomen. (2) To determine whether pelvic floor physiotherapy (PT) corrects UI in elite female athletes. Materials and methods: Meta-analysis of published scientific evidence. The articles analyzed were found through the following search terms: (A) pelvic floor dysfunction elite female athletes; (B) urinary incontinence elite female athletes; (C) pelvic floor dysfunction elite female athletes physiotherapy; (D) urinary incontinence elite female athletes physiotherapy. Variables studied: type of study, number of individuals, age, prevalence of urinary incontinence described in the athletes, type of sport, type of UI, aspect investigated in the articles (prevalence, response to treatment, etiopathogenesis, response to PT treatment, concomitant health conditions or diseases. Study groups according to the impact of each sport on the PF: G1: low-impact (noncompetitive sports, golf, swimming, running athletics, throwing athletics); G2: moderate impact (cross-country skiing, field hockey, tennis, badminton, baseball) and G3: high impact (gymnastics, artistic gymnastics, rhythmic gymnastics, ballet, aerobics, jump sports (high, long, triple and pole jump)), judo, soccer, basketball, handball, volleyball). Descriptive analysis, ANOVA and meta-analysis. Results: Mean age 22.69 years (SD 2.70, 18.00–29.49), with no difference between athletes and controls. Average number of athletes for each study was 284.38 (SD 373,867, 1–1263). The most frequent type of study was case-control (39.60%), followed by cross-sectional (30.20%). The type of UI was most often unspecified by the study (47.20%), was stress UI (SUI, 24.50%), or was referred to as general UI (18.90%). Studies on prevalence were more frequent (54.70%), followed by etiopathogenesis (28.30%) and, lastly, on treatment (17.00%). In most cases sportswomen did not have any disease or concomitant pathological condition (77.40%). More general UI was found in G1 (36.40%), SUI in G2 (50%) and unspecified UI in G3 (63.64%). In the meta-analysis, elite athletes were found to suffer more UI than the control women. In elite female athletes, in general, physiotherapy contributed to gain in urinary continence more than in control women (risk ratio 0.81, confidence interval 0.78–0.84)). In elite female athletes, former elite female athletes and in pregnant women who regularly engage in aerobic activity, physiotherapy was successful in delivering superior urinary continence compared to the control group. The risk of UI was the same in athletes and in the control group in volleyball female athletes, elite female athletes, cross-country skiers and runners. Treatment with PT was more effective in control women than in gymnastics, basketball, tennis, field hockey, track, swimming, volleyball, softball, golf, soccer and elite female athletes. Conclusions: There is pelvic floor dysfunction in high-performance athletes associated with athletic activity and urinary incontinence. Eating disorders, constipation, family history of urinary incontinence, history of urinary tract infections and decreased flexibility of the plantar arch are associated with an increased risk of UI in elite female athletes. Pelvic floor physiotherapy as a treatment for urinary incontinence in elite female athletes, former elite female athletes and pregnant athletes who engage in regular aerobic activity leads to a higher continence gain than that obtained by nonathlete women.

Urine Loss during a Volleyball Competition: Comparison between Amateur and Professional Athletes

BACKGROUND

High-impact sports can cause dysfunction to the female pelvic floor that leads to the occurrence of stress urinary incontinence.

OBJECTIVE

To identify and compare the presence of urine loss between professional and amateur female volleyball athletes during a competition.

METHODS

A cross-sectional and comparative study was conducted on 75 volleyball athletes, including 30 amateurs and 45 professional athletes. Female athletes 18 years of age or older were included. Urine loss during the competition was evaluated by self-report and measured by a pad test (in grams). Day-to-day urinary incontinence was identified using the Urinary Distress Inventory 6 (UDI-6). Before the beginning of the game, the instruments were applied by individual interview for data collection and the pad was positioned. After the game, the pad was removed and weighed again. Descriptive and inferential statistics were used, with a significance level of 5%.

RESULTS

Half of the professional (50.0%) and amateur (55.6%) athletes have symptoms of urine loss during a competition. Objective urine loss was higher among professional athletes (4.5 ± 1.4 g) compared to amateur athletes (3.8 ± 1.4 g). There was a significant difference (P < .001) in objective urine loss between symptomatic (mean = 5.41, standard deviation [SD] = 0.8) and asymptomatic professional athletes (mean = 3.40, SD = 1.3).

CONCLUSION

Self-report of urinary incontinence during the competition was common among professional and amateur athletes. However, objective urine loss was significantly higher among professional athletes.

Assessing prevalence of urinary incontinence in Scottish fitness instructors and experience of teaching pelvic floor muscle exercises: an online survey

Background

The aim of this study was to assess the prevalence of urinary incontinence in fitness instructors, experience of teaching pelvic floor muscle exercises (PFME), and attitudes to incorporating such exercises into classes.

Method

An online survey was undertaken of fitness instructors working in Scotland based on the Urinary Incontinence Short Form (ICIQ-UI).

Results

The survey was at least partially completed by 106, of whom 73.6% (53/72) were female and 52.8% (38/72) were in the 35–54 years age group. Prevalence of UI was 28.2% (24/85), and severity based on ICIQ-UI scores was ‘slight’ 65.2% (15/23), or ‘moderate’ in 26.1% (6/23). Leakage of urine was associated with physical activity in 36% (9/25), of whom 31.8% (7/22) had not taken actions to reduce the impact, and 86.4% (19/22) had not sought professional advice or treatment. There was widespread willingness to incorporate PFME into classes if given appropriate training 86.1% (62/72), and 67.1% (49/73) would be happy to recommend a PFME app.

Conclusion

A significant proportion of fitness instructors are in need of PFME and those who perform PFME do so at a level below that which is recommended. However, many have had some training on PFME or are willing to provide this.

Pelvic floor dysfunctions in female cheerleaders: a cross-sectional study

INTRODUCTION AND HYPOTHESIS

Cheerleaders perform high-impact maneuvers that can be associated with pelvic floor dysfunction. We hypothesized that female cheerleaders would report more symptoms of pelvic floor dysfunction and fewer symptoms of premenstrual syndrome than nonathletic women.

METHODS

This cross-sectional study included high-performance female cheerleaders and young nonathletic, nulliparous, and normal-weight females. Demographics, sports practices, and pelvic floor dysfunction data were collected through an electronic questionnaire. Urinary symptoms were collected through the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and King's Health Questionnaire. Intestinal symptoms were collected through the use of Criterion F of item C3, referring to functional constipation of Rome III and Fecal Incontinence Severity Index. Data on sexual function were collected through the Female Sexual Function Index. Data on pelvic organ prolapse were obtained through the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS). In addition, questions about premenstrual syndrome-dysmenorrhea, irritability, headache, tiredness, fluid retention, and constipation-were collected through the Menstrual Symptom Questionnaire. The comparison between groups of the quantitative variables was performed using the Mann-Whitney U test. Odds ratios (OR) and 95% confidence intervals (CI) were estimated for comparison between groups on the occurrence of pelvic floor muscle dysfunction symptoms. A significance level of 5% was adopted.

RESULTS

A total of 156 women (78 cheerleaders and 76 nonathletes) completed the electronic questionnaire. Anal incontinence was the most prevalent symptom of pelvic floor muscle dysfunction. Cheerleaders were 2.3 times more likely to report symptoms regarding anal incontinence than nonathletic women. For the other symptoms of pelvic floor dysfunction, no statistical differences between the groups were found. Cheerleaders reported fewer symptoms of tiredness and constipation during the premenstrual period than did nonathletic women.

CONCLUSION

Pelvic floor dysfunction, particularly anal incontinence, appears to be more prevalent among cheerleaders than among nonathletic women. In addition, cheerleaders demonstrated fewer symptoms of tiredness and constipation during the premenstrual period.

The relationship between running kinematics and the pelvic floor muscle function of female runners

INTRODUCTION AND HYPOTHESIS

To date, no study has investigated the correlation between pelvic floor muscle function and urinary incontinence in female runners. The aim of the study was to investigate the relationship between pelvic floor muscle function and to correlate urinary leakage as measured by the modified pad test with kinematic variables of running.

METHODS

The sample consisted of 11 incontinent and 17 continent runners. On day 1, they performed a maximum velocity test on a treadmill using an incremental protocol. Their pelvic floor muscles were evaluated using vaginal palpation and manometry, and the adapted pad test was used to evaluate the severity of urinary incontinence. Then, running kinematics were evaluated on a treadmill using a circuit camera to capture vertical displacement, knee flexion during the load response phase, and the initial contact of the foot with the ground for subsequent analysis. The pad test was performed during the kinematic evaluation.

RESULTS

The vaginal squeeze pressure of the continent group (mean = 43.40 mmHg, SD = 21.75) was higher in descriptive terms than that of the incontinent group (mean = 38.94 mmHg, SD = 31.08), but the difference was not statistically significant (p = 0.66). There was an association between the weekly training load and urinary leakage. No associations were found between pelvic floor muscle function or urinary leakage and the kinematic variables.

CONCLUSIONS

Despite the correlation between the weekly training load and the severity of urinary leakage, no relationships were found between pelvic floor muscle functioning and the kinematics of running.

Correlates of vaginal laxity symptoms in women attending a urogynecology clinic in Saudi Arabia

OBJECTIVE

To evaluate the prevalence of vaginal laxity (VL) and its correlates in a cohort of women attending a urogynecology clinic in a tertiary referral center in Saudi Arabia.

METHODS

In this retrospective study, demographic information, clinical characteristics, and POP-Q system measurements for women attending the King Fahad Medical City Urogynecology Clinic (January 2013 to April 2015) were analyzed. Women with and without VL were compared across these variables.

RESULTS

Out of 376 women attending the clinic for various reasons, 135 (35.9%) reported VL. VL was more common in younger women (P<0.001). Parity, menopausal status, and diabetes were not associated with this symptom. A history of cesarean delivery was protective (aOR 0.39; 95% CI, 0.17-0.90). A bulge symptom and "vaginal wind" were predictors (aOR 3.25; 95% CI, 1.46-7.23 and aOR 15.48; 95% CI, 6.93-34.56, respectively). There was no correlation between VL and POP-Q measurements. VL was not associated with the presence of clinically significant prolapse (stage 2-4), compared with nonsignificant prolapse (stage 0-1) (P=0.869, P=0.152, and P=0.783 for anterior, posterior, and central vaginal compartment, respectively).

CONCLUSIONS

In this cohort, VL was common, more prevalent in younger women, and had poorly defined clinical correlates.

The pilates method in the function of pelvic floor muscles: Systematic review and meta-analysis

BACKGROUND

Many Pilates instructors believe that the method can produce significant improvement in the resistance of pelvic floor muscles, but it is known that about 49% of women who can contract this muscle do not perform an adequate contraction and cannot increase urethral closure pressure.

OBJECTIVES

To evaluate the response of the Pilates method in the function of the pelvic floor muscles, compared to the control group, in healthy women.

SEARCH METHODS

The following databases were searched from October to December 2016: PUBMED, SCIELO, LILACS, MEDLINE, WEB OF SCIENCE and CINAHL via PERIÓDICOS CAPES, without restriction of language and year of publication.

SELECTION CRITERIA

Randomized (RCTs), quasi-randomized, and non-randomized clinical trials assessing the effectiveness of the Pilates method for the fuction of pelvic floor muscles in healthy women were included.

DATA COLLECTION AND ANALYSIS

Two reviewers independently selected the studies, assessed the risk of bias and performed the data extraction. Primary outcomes were the method of evaluation of strength, function, coordination, and symmetry of contraction of the pelvic floor muscles.

RESULTS

4434 articles were identified and 2 articles were selected to compose this review and the meta-analysis. No between-group difference was demonstrated for the pelvic floor muscle function as measured by perineometry (p = 0.32).

CONCLUSIONS

No evidence showed a modification of the function of pelvic floor muscles in healthy women practicing the Pilates method.

Physical Activity, BMI, and Risk of Fecal Incontinence in the Nurses' Health Study

BACKGROUND

Higher body mass index (BMI) and low physical activity have been associated with increased prevalence of fecal incontinence (FI) in cross-sectional studies, but prospective studies examining the role of these factors are lacking. We sought to determine whether BMI and/or physical activity are associated with risk of FI among older women.

METHODS

We prospectively examined the association between BMI and physical activity and risk of FI in the Nurses' Health Study among 51,708 women who were free of FI in 2008. We defined FI as at ≥1 liquid or solid FI episode/month during the past year reported in 2010 or 2012. We used Cox proportional hazards models to calculate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for FI according to physical activity and BMI, adjusting for potential confounding factors.

RESULTS

During more than 175,000 person-years of follow-up, we documented 5954 cases of incident FI. Compared with women in the lowest activity category (<3 metabolic equivalent of task (MET)-hrs/week), multivariable-adjusted HRs for FI were 0.86 (95% CI 0.80-0.93) for women doing 3-8 MET-hrs/week, 0.78 (95% CI 0.72-0.84) for 9-17 MET-hrs/week, 0.76 (95% CI 0.69-0.83) for 18-26 MET-hrs/week, and 0.75 (95% CI 0.70-0.81) for 27 + MET-hrs/week (P_trend = <0.0001). There was no association between BMI and risk of FI.

CONCLUSIONS

Higher levels of physical activity were associated with a modest reduction (25%) in risk of incident FI among older women. These results support a potential role of ongoing physical activity in the neuromuscular health of the anorectal continence mechanism with aging.

TRANSLATIONAL IMPACT

These results support a potential role of ongoing physical activity in the neuromuscular health of the anorectal continence mechanism with aging.

Female sexual function and urinary incontinence in nulliparous athletes: An exploratory study

OBJECTIVES

To estimate the prevalence of Female Sexual Dysfunction (FSD) and Urinary Incontinence (UI) symptom in nulliparous athletes and analyze the risk factors for these dysfunctions.

DESIGN

A cross-sectional study.

SETTING

The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI-SF) and the Female Sexual Function Index (FSFI) were applied to assess the UI and the FSD.

PARTICIPANTS

50 athletes with ≥18 years old.

RESULTS

We found a prevalence of 48% of UI and 44% of FSD among nulliparous athletes. The rate of athletes having concomitant FSD and UI was 24%. We found a significant difference between high and low impact sports in the ICIQ-UI-SF score (p = 0.028). Hours of training (p = 0.007; R² = 0.21) was found to be a risk factor for UI. Incontinent athletes demonstrated a Relative Risk of 2.7 to develop sexual desire problem when compared to the continents (p = 0.04; 95% CIs: 1.50-4.89).

CONCLUSIONS

This study found a high prevalence of both UI and FSD among nulliparous athletes. Furthermore, nulliparous athletes practicing high-impact modalities are the most susceptible to UI. The hours of training per day was considered a risk factor to develop UI, and incontinent athletes have more chances of showing difficulties in sexual desire.

Role of chronic exercise on pelvic floor support and function

PURPOSE OF REVIEW

To summarize recent literature about the potential role of chronic exercise on pelvic floor support and function.

RECENT FINDINGS

Stress urinary incontinence is common during physical activity. Scant evidence suggests a dose-response association between higher volumes of exercise and urinary incontinence. Athletes do not appear to have greater pelvic floor muscle strength or worse pelvic floor support compared to nonathletes. Pelvic floor muscle electromyographic activity increases substantially as running speeds increase.

SUMMARY

Based on the current literature, no strong conclusions can be drawn about whether chronic exercise exerts a positive or negative influence on pelvic floor support and function. Adopting longitudinal research methodology that prospectively monitors exercise exposure and subsequent changes in pelvic floor support and function would help to reduce selection bias associated with cross sectional studies on groups of athletes.

Intraabdominal pressure in women during CrossFit exercises and the effect of age and parity

To determine intraabdominal pressure (IAP) in women during CrossFit and to determine whether parity, age, or CrossFit experience affects IAP during CrossFit exercises, we evaluated 10 women: 5 experienced and active CrossFitters and 5 who were not regularly engaged in CrossFit. A Laborie urodynamics abdominal pressure probe with the Goby wireless system measured IAP during 10 repetitions of 13 different CrossFit exercises. Women had a mean age of 36 years. A significant difference was found between mean peak IAP of the 5 parous vs the 5 nulliparous women (P = 0.009). Experience with CrossFit did not affect mean peak IAP achieved with exercise. In some exercises, there was a significant change in IAP as participants progressed through repetitions (P = 0.003 for back squats and 0.04 for sit-ups). Participants achieved IAP values that were markedly higher than those previously published.

Prevalence and risk of sport types to stress urinary incontinence in sportswomen: A cross-sectional study

OBJECTIVE

The objective of our study was to investigate the prevalence and risk of developing stress urinary incontinence (SUI) in each type of high-intensity sport, and the associated impact on quality of life in sportswomen.

METHODS

This cross-sectional study was conducted between March and November 2016. The study included 278 sportswomen. The basic inclusion criteria were being nulliparous and engaging in high-intensity physical activity. The exclusion criteria were childbirth, surgical treatment of gynecological and urological illnesses and urinary tract infection. For evaluation were used: The International Physical Activity Questionnaire (IPAQ), The International Consultation on Incontinence Questionnaire Urinary Incontinence (ICIQ-UISF), the Overactive Bladder Questionnaire (OAB-q), the Urinary Incontinence Quality of Life Scale (I-QOL).

RESULTS

The highest percentage of SUI was found in athletes (23.8%), followed by volleyball players (19.6%). We found that cumulative metabolic equivalent (MET) did not affect SUI, but the type of sport did. The risk of SUI was highest in volleyball sportswomen (odds ratio[OR] = 2.16,95% confidence interval[CI] = 0.96-4.89, P < 0.05) and athletes (OR = 2.56,95%CI = 0.87-7.51, P = 0.08). As assessed by the I- QOL, SUI in people who participated in fitness and athletics (e.g., basketball, volleyball and handball) had a negative impact on quality of life including behavior, psychosocial impacts and social embarrassment score.

CONCLUSION

Volleyball players have a 116% chance of getting SUI compared to women who play other types of sports that were analyzed as part of this study. Healthcare professionals should inform the population of sportswomen with risk factors for SUI in order to implement preventive physiotherapy for strengthening pelvic floor muscles.

Urinary incontinence prevalence in the day-by-day life and during sports practice in volleyball athletes: a systematic review

Urinary incontinence (UI) is perceived as a problem that affects older and multiparous women. However, recent studies report that involuntary loss of urine also affects athletes, young and nulliparous. There is controversy over the role of exercise in UI. Thus the purpose of the review is to describe and evaluate scientific evidence concerning the prevalence of UI in female volleyball athletes.

The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The selected databases were PubMed, LILACS, PEDro, Medline, Cochrane, and ScienceDirect. The searches were performed between December 2016 and January 2017. The descriptors and Boolean operators used in the search were as follows: ‘urinary incontinence AND athletes AND volleyball.’ After peer evaluation, 47 studies were identified, and 6 articles were selected for review. The methodological evaluation was based on Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).

The review identified the UI prevalence of 9–30% during sports practice and 17–18% in the day-by-day life. Practising physical exercise of high impact appears to be a causing factor of UI in women.

Practising volleyball in the female population can be an important UI risk factor. Owing to the high prevalence of UI, coaches and athletes must be aware of the importance of training the pelvic floor muscles simultaneously with the sports practice.