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Hyvärinen M, Karvanen J, Karppinen JE, Karavirta L, Juppi HK, Tammelin TH, Kovanen V, Laukkanen J, Aukee P, Sipilä S, Rantalainen T, Laakkonen EK. The role of cardiorespiratory fitness and body composition in the association between physical activity and menopausal symptoms. Menopause 2024; 31:828-836. [PMID: 39042026 DOI: 10.1097/gme.0000000000002397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
OBJECTIVE The aim of the study was to conduct exploratory analyses on the role of cardiorespiratory fitness (CRF) and body composition in the association between physical activity and menopausal symptoms. METHODS This was a cross-sectional (N = 298) study of women aged 51-59 years including a subsample of 82 women followed for 4 years. The severity of menopausal symptoms was assessed with the Menopause Rating Scale in total symptoms as well as using the somato-vegetative, psychological, and urogenital subscales. Physical activity was assessed with accelerometers and self-reports, body composition with dual-energy x-ray absorptiometry, and CRF with a custom-made prediction model based on the six-minute walking distance and spiroergometry. The associations of interest were studied using unstandardized regression coefficients derived from multiple linear regression models with the severity of menopausal symptoms as the outcome. RESULTS Higher total body and fat mass (kg) were associated with more severe total symptoms (B = 0.06 [95% CI, 0.01 to 0.12] and 0.07 [0.01 to 0.14], respectively) as well as somato-vegetative (0.03 [0.01 to 0.05]; 0.04 [0.01 to 0.06]) and psychological symptoms (0.03 [0.00 to 0.05]; 0.03 [0.00 to 0.06]) in cross-sectional design. Total and lean body mass interacted with physical activity in total and psychological symptoms with stronger indirect associations being observed in participants with lower total and lean body mass. CRF was not associated with menopausal symptoms and did not interact with physical activity. CONCLUSIONS Maintaining a healthy weight is associated with less severe menopausal symptoms in middle-aged women. The association between physical activity and the severity of menopausal symptoms varied based on the differences in total and lean body mass.
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Affiliation(s)
- Matti Hyvärinen
- From the Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Juha Karvanen
- Department of Mathematics and Statistics, University of Jyväskylä, Jyväskylä, Finland
| | - Jari E Karppinen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Laura Karavirta
- From the Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Hanna-Kaarina Juppi
- From the Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | | | - Vuokko Kovanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | | | - Pauliina Aukee
- Department of Obstetrics and Gynecology, Wellbeing services county of Central Finland, Jyväskylä, Finland
| | - Sarianna Sipilä
- From the Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Timo Rantalainen
- From the Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Eija K Laakkonen
- From the Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Barbosa PN, Rodrigues MP, Costa E Silva ADA, Lemos CIL, Magno E Silva MP. Prevalence of urinary incontinence in Brazilian para athletes. Br J Sports Med 2024; 58:895-901. [PMID: 38830751 DOI: 10.1136/bjsports-2024-108076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVE To describe the prevalence of urinary incontinence (UI) in para athletes in Brazil. METHODS This is a cross-sectional study with Brazilian para athletes with physical impairments from all para sports. The data from 86 participants of both sexes (60 males and 26 females) were collected through an online survey that gathered sociodemographic data and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, from March to July 2023. RESULTS The prevalence of UI was 45.3% (n=39), with the average impact on quality of life scored at 6.1±3.5 on a scale of 0-10. Most para athletes reported moderate (43.5%) or severe (38.4%) symptoms. The most common type was mixed UI (46.1%), with an average of 3±1.9 episodes of urinary loss per athlete in the last 4 weeks. Adjusted Poisson regression (controlling for sex, age and level of competition) revealed that para athletes with orthopaedic impairments had a 58% lower prevalence of UI (prevalence ratio=0.42; 95% CI 0.24, 0.83) compared with those with neurological impairments. Furthermore, ordinal regression indicated that para athletes with neurological impairments were 147% more likely to experience a progression from 'severe' to 'very severe' UI (OR=2.47; 95% CI 1.59, 3.93). CONCLUSIONS UI is highly prevalent among para athletes, particularly those with neurological impairments, underscoring the need for specialised genitourinary healthcare and the need for further treatment and monitoring of the condition. There is a critical need to raise awareness among coaches, healthcare providers and the athletes themselves about UI and its impact to foster the comprehensive well-being of these athletes.
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Affiliation(s)
- Pê Nascimento Barbosa
- Human Movement Sciences Graduate Program, Institute of Health Sciences, Federal University of Pará, Belém, Pará, Brazil
| | - Marina Petter Rodrigues
- School of Rehabilitation Science, Faculty of Health Science, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Marília Passos Magno E Silva
- Human Movement Sciences Graduate Program, Institute of Health Sciences, Federal University of Pará, Belém, Pará, Brazil
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Petter Rodrigues M, Bérubé MÈ, Charette M, McLean L. Conservative interventions for female exercise-induced urinary incontinence: a systematic review. BJU Int 2024. [PMID: 39043585 DOI: 10.1111/bju.16474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
OBJECTIVE To systematically review and synthesise what is known about the effectiveness of non-pharmaceutical conservative interventions for the management of urinary incontinence (UI) experienced by women during physical exercise. METHODS A systematic search was performed in the following databases in September 2023: the Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica dataBASE (EMBASE), Scientific Electronic Library Online (SciELO), Latin American and Caribbean Health Sciences Literature (LILACS), and Physiotherapy Evidence Database (PEDro). Studies were deemed eligible if population consisted of females who reported symptoms of UI while participating in physical exercise, and the interventions involved any non-pharmaceutical conservative treatment to manage symptoms during exercise. The primary outcome was severity of UI signs and symptoms. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO identifier: CRD42022379138). RESULTS Of the 3429 abstracts screened, 19 studies were retained. Pelvic floor muscle training (PFMT) and intravaginal devices were the most commonly investigated modalities. Only two randomised controlled trials (RCTs), both among volleyball players, compared PFMT with no PFM exercise, showing a reduction in pad weight gain after the intervention in the experimental groups only. PFMT with and without biofeedback randomised among soldiers demonstrated a reduction in the frequency of urine leakage episodes in both groups, while supervised and unsupervised PFMT randomised among athletes from different sports showed pad weight gain reduction in the supervised group only. Seven single-arm studies suggested that PFMT alone or combined with other modalities may reduce UI severity in active women based on questionnaires, bladder diaries, and self-reported symptoms. A single-arm and a crossover study found pessary use beneficial in reducing urine leakage based on questionnaires and pad weight gain, respectively. When comparing pessary, tampon, and no intervention, two repeated-measures studies found tampons may reduce leakage more than pessaries in CrossFit exercisers and women performing aerobic exercises. A vaginal sponge also reduced pad weight gain during aerobic exercises. Other modalities (i.e., an intraurethral device, photobiomodulation, and combined therapies) were investigated using case series or single case studies. While all interventions showed some evidence of effectiveness, the results must be interpreted with caution due to methodological limitations and high risk of bias. In particular, despite a high reliance on pad tests as a primary outcome, we identified inconsistencies in how pad tests were administered and interpreted. CONCLUSION Only the effectiveness of PFMT to reduce urine leakage during exercise has been evaluated through RCTs, with some evidence of effectiveness. We identified a clear need for higher quality studies, with better reporting on the interventions, and more judicious use and interpretation of outcome measures.
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Affiliation(s)
| | - Marie-Ève Bérubé
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Marylène Charette
- Population Health, Interdisciplinary School of Health Science, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Linda McLean
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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Ron NJ, Dolbinski SC, Hodonicky EG, Middlebrook DO, Olmstead SR, Olsen SL, Ron ED, Hollman JH. Associations between running mechanics, functional lower extremity strength, and stress urinary incontinence in parous female runners. JOURNAL OF WOMEN'S & PELVIC HEALTH PHYSICAL THERAPY 2024; 48:147-153. [PMID: 39148952 PMCID: PMC11323885 DOI: 10.1097/jwh.0000000000000302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Background Women with stress urinary incontinence (SUI) may have altered running mechanics and reduced hip muscle strength compared to women without SUI. Little research has examined running metrics and functional lower extremity strength of parous runners. Objective To determine if stress urinary incontinence (SUI) severity correlates with running metrics and lower extremity muscle strength among parous women. Study Design Cross-sectional observational study of 22 parous participants (mean age 39.8 years, with a mean of 3.4 pregnancies and 8.1 years interval since last delivery). Methods Participants completed the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI), Urinary Distress Inventory (UDI) 6, Colorectal-Anal Distress (CRAD) Inventory 8, and Pelvic Organ Prolapse Distress Inventory (POPDI) 6, Questionnaire for Urinary Incontinence Diagnosis (QUID), and provided demographic, relevant running, and obstetric/gynecologic history information. After a brief warm-up, participants completed 30-second single leg sit to stand tests bilaterally and a standardized 10-minute treadmill run with pod cadence assessment. Pearson-product moment correlation coefficients were calculated (alpha = 0.05). Results Prolonged ground contact times were associated with higher ICIQ-UI SF (r = 0.523, p = 0.015), POPDI-6 (r = 0.694, p < 0.001), and UDI-6 scores (r = 0.577, p = 0.006), while lower cadences were associated with higher POPDI-6 (r = -0.550, p = 0.010) and UDI-6 scores (r = -0.444, p=0.044). Conclusion Parous female runners with more severe SUI and prolapse symptoms demonstrate altered running mechanics characterized by prolonged ground contact times and slower cadences.
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Affiliation(s)
- Nicole J. Ron
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Sarah C. Dolbinski
- Program in Physical Therapy, Mayo Clinic School of Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Elizabeth G. Hodonicky
- Program in Physical Therapy, Mayo Clinic School of Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Darby O. Middlebrook
- Program in Physical Therapy, Mayo Clinic School of Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Sally R. Olmstead
- Program in Physical Therapy, Mayo Clinic School of Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Sandra L. Olsen
- Program in Physical Therapy, Mayo Clinic School of Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Eyal D. Ron
- Department of Radiology, Mayo Clinic, Rochester, MN
| | - John H. Hollman
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
- Program in Physical Therapy, Mayo Clinic School of Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, MN
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de Jager E, Willemsen M, Kempe M, Janssen I. Breaking barriers: Exploring female-specific health challenges affecting performance in an elite multisport training environment. J Sci Med Sport 2024; 27:466-471. [PMID: 38734513 DOI: 10.1016/j.jsams.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVES Female-specific issues, such as breast injuries, pelvic floor dysfunctions, saddle sores, and menstrual symptoms, can significantly impact female athletes. This study examined the prevalence, perceived impact on performance, and role of the support staff in addressing and managing these issues in elite athletes based at a multisport training centre. DESIGN Anonymous online questionnaire. METHODS A total of 180 female athletes from various sport disciplines at the Dutch Olympic Training Centre were invited to participate in the study. An anonymous, 39-item questionnaire was developed and hosted on Qualtrics collecting data on respondents' characteristics, breast injuries, pelvic floor dysfunctions, saddle sores, menstrual symptoms, contraceptive use, and communication about these issues. RESULTS A total of 105 valid responses were analysed. The findings revealed that athletes regularly experience breast injuries (15.2 %), urinary incontinence (29.5 %), other pelvic floor problems (21.0 %), saddle sores (65.7 %), and menstrual cycle-related symptoms, with negative performance effects. Communication with support staff remained limited, with only 23.8 % of athletes discussing any of these issues, often due to concerns about understanding, shame, or a lack of opportunity for easy communication. CONCLUSIONS The findings underscore the crucial role of creating a supportive environment, promoting early intervention, and utilising multisport centres to comprehensively address these concerns, emphasising the need for open communication, education, and support to enhance female athletes' performance and well-being.
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Affiliation(s)
- Eline de Jager
- Sport Science and Innovation, National Sports Centre Papendal, the Netherlands; Medical Faculty, Rijksuniversiteit Groningen, the Netherlands.
| | - Maaike Willemsen
- Sport Science and Innovation, National Sports Centre Papendal, the Netherlands
| | - Matthias Kempe
- Medical Faculty, Rijksuniversiteit Groningen, the Netherlands
| | - Ina Janssen
- Sport Science and Innovation, National Sports Centre Papendal, the Netherlands
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Syeda F, Pandit U. Urinary Incontinence in Female Athletes: A Systematic Review on Prevalence and Physical Therapy Approaches. Cureus 2024; 16:e64544. [PMID: 39144856 PMCID: PMC11322629 DOI: 10.7759/cureus.64544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2024] [Indexed: 08/16/2024] Open
Abstract
Urinary incontinence (UI) is an involuntary leakage of urine and is classified as stress, mixed, or urge. It is more common in females due to anatomical and physiological body differences. Moreover, the literature remarks an evident presence of UI with high-intensity physical activities. Therefore, the present integrative systematic review focused on the studies aimed at investigating the prevalence of UI in nulliparous sportswomen, studies illustrating sport-specific prevalence of UI, and studies demonstrating the impact of physical therapy intervention on UI. A literature search was carried out systematically on electronic databases consisting of Cochrane and Google Scholar databases from 2018 to December 2023. The keywords utilized to perform the literature search and include relevant articles consisted of "urinary incontinence," AND "nulliparous," AND "sportswomen," OR "female athletes," AND "physical therapy". A total of nine studies were included in the present systematic review. The quality assessment of the studies was performed by using a measurement tool to assess systematic reviews (AMSTAR 2) scale, and the Mixed Methods Appraisal Tool was used for cross-sectional and randomized controlled trial studies. The data extracted included first author and year of publication, study design, sample or number of individuals involved in the study, age range of the participants, type of UI, type of sports involved, purpose of the study, methodological part, outcome measures derived, conclusion, and quality assessment of the studies. The review concluded that nulliparous athletes, especially those participating in high-impact activities, have a significant prevalence of UI. In addition, the physical therapy intervention consisting of pelvic floor muscle training (PFMT) along with education about pertinent pelvic anatomy was mostly performed on female athletes for the prevention and management of UI.
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Affiliation(s)
- Fizzia Syeda
- Department of Community Health Physiotherapy, D. Y. Patil School of Physiotherapy, D. Y. Patil University, Navi Mumbai, IND
| | - Unnati Pandit
- Department of Community Health Physiotherapy, D. Y. Patil School of Physiotherapy, D. Y. Patil University, Navi Mumbai, IND
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Cope ZS, Stewart JR, Gupta A, Hobson DTG, Warehime J, Feroz R, Scheidel S, Meriwether KV, Lenger SM, Gaskins JT, Sumy S, Francis S. Measurement of Physical Activity Using Fitness Trackers Before and After Midurethral Sling. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024:02273501-990000000-00244. [PMID: 38954609 DOI: 10.1097/spv.0000000000001549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
IMPORTANCE Urinary incontinence can be a barrier to performing physical activities for many women. A midurethral sling (MUS) has shown symptom improvement for women experiencing stress urinary incontinence (SUI), suggesting the hypothesis that physical activity rates should increase after treatment. OBJECTIVE The aim of this study was to determine the change in objectively measured physical activity levels in women following placement of MUS for SUI. STUDY DESIGN In this prospective cohort study, patients undergoing MUS placement, with or without concomitant pelvic reconstructive surgery, were provided a commercial activity tracker. Physical activity was tracked for at least 1 week preoperatively and up to 6 months postoperatively. Participants were required to wear the tracker for at least 2 weeks in the postoperative period. The primary outcome, mean caloric daily expenditure (MCDE), was compared preoperatively and postoperatively. RESULTS Seventy-two patients met criteria for data inclusion. The device was worn for a mean of 18.4 ± 12.1 days preoperatively and 91.7 ± 53.3 days postoperatively. Mean participant age was 51.9 ± 9.4 years. The MCDE was significantly higher postoperatively (preoperatively: 1,673 kcal/d vs postoperatively: 2,018 kcal/d; P < 0.01). There were no significant differences in postoperative MCDE in participants who had only MUS as the primary procedure versus participants who also had a concomitant procedure (2,020 ± 216 kcal/d vs 2,015 ± 431 kcal/d; P = 0.95). Of participants with class II/III obesity, 45% had at least a 500 kcal/d increase postoperatively. CONCLUSIONS Treatment of SUI with MUS is associated with a significantly greater caloric expenditure in the postoperative period.
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Affiliation(s)
- Zebulun S Cope
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Louisville, Louisville, KY
| | | | - Ankita Gupta
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Louisville, Louisville, KY
| | | | - Jenna Warehime
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Louisville, Louisville, KY
| | - Rehan Feroz
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Louisville, Louisville, KY
| | - Sarah Scheidel
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN
| | - Kate V Meriwether
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of New Mexico Hospitals, Albuquerque, NM
| | - Stacy M Lenger
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Louisville, Louisville, KY
| | - Jeremy T Gaskins
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY
| | - Sharmin Sumy
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY
| | - Sean Francis
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Louisville, Louisville, KY
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Tan Y, Zhang Y, An J, Xu X, Deng J, Chen B, Pan W. Safety and Efficacy of Erbium: Yttrium-Aluminum-Garnet Laser Treatment in Chinese Women with Mild-to-Moderate Stress Urinary Incontinence. J Womens Health (Larchmt) 2024; 33:685-691. [PMID: 38563974 DOI: 10.1089/jwh.2023.0609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Background: This study aims to evaluate the safety and efficacy of erbium:yttrium-aluminum-garnet (Er:YAG) laser treatment in female patients with mild-to-moderate stress urinary incontinence (SUI). Methods: From July 2018 to June 2020, 72 female patients with mild-to-moderate SUI were enrolled in this study. A baseline assessment was conducted, which included a 1-hour pad test, the validated International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF), postvoid residual (PVR) testing, pelvic organ prolapse quantification (POP-Q) testing, and a cough stress test. All patients underwent four sessions of Er:YAG laser treatment using a smooth mode. A reassessment was performed 6 months after treatment to evaluate the safety and efficacy of the Er:YAG laser. Results: All patients completed four clinic visits, with a 1-month interval, and were followed up for a minimum of 6 months. No severe adverse reactions were observed during the treatment process. The 1-hour pad test revealed a significant reduction in urinary leakage from baseline (6.30 ± 1.06 g) to the 6-month follow-up (2.70 ± 0.96 g, p < 0.001), with 34 of 72 (47.22%) patients achieving negative results. The ICIQ-UI-SF score significantly decreased from baseline to 6 months (10.82 ± 1.38 to 2.96 ± 0.52, p < 0.001). PVR experimental results showed a significant decrease in residual urine volume after treatment (103.72 ± 8.61 mL to 43.86 ± 4.92 mL, p < 0.001). At the 6-month follow-up, hematoxylin and eosin staining results demonstrated that Er:YAG laser treatment significantly facilitated an increase in the thickness of squamous epithelial cells. The efficacy of Er:YAG laser treatment for SUI was 77.78% (56/72). Conclusions: Several objective and subjective assessments confirmed the safety and efficacy of vaginal smooth mode Er:YAG laser treatment for mild-to-moderate SUI during the 6-month follow-up period. Nonablative Er:YAG laser in the smooth mode is a viable treatment option for SUI patients.
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Affiliation(s)
- Yi Tan
- Department of Obstetrics and Gynecology, Dongguan Nancheng Hospital, Dongguan, China
| | - Yuchan Zhang
- Department of Obstetrics and Gynecology, Dongguan Nancheng Hospital, Dongguan, China
| | - Junli An
- Department of Obstetrics and Gynecology, Dongguan Nancheng Hospital, Dongguan, China
| | - Xueqiong Xu
- Department of Obstetrics and Gynecology, Dongguan Nancheng Hospital, Dongguan, China
| | - Jun Deng
- Department of Obstetrics and Gynecology, Dongguan Nancheng Hospital, Dongguan, China
| | - Biaowei Chen
- Department of Obstetrics and Gynecology, Dongguan Nancheng Hospital, Dongguan, China
| | - Wenwei Pan
- Department of Obstetrics and Gynecology, Dongguan Maternal and Child Health Care Hospital, Dongguan, China
- Dongguan Key Laboratory of Female Reproductive Health, Dongguan, China
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Skaug KL, Engh ME, Bø K. Pelvic floor muscle training in female functional fitness exercisers: an assessor-blinded randomised controlled trial. Br J Sports Med 2024; 58:486-493. [PMID: 38413133 PMCID: PMC11103308 DOI: 10.1136/bjsports-2023-107365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE Stress urinary incontinence (SUI) is common among females during functional fitness training, such as CrossFit. The aim of this study was to assess the effect of pelvic floor muscle training (PFMT) on SUI in female functional fitness exercisers. METHODS This was an assessor-blinded randomised controlled trial with a PFMT group (n=22) and a control group (n=25). The PFMT group followed a 16-week home-training programme with 3 sets of 8-12 maximum pelvic floor muscle (PFM) contractions daily and weekly follow-up/reminders by phone. The primary outcome was change in a total score of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF). The secondary outcomes were perceived change of symptoms of SUI, change of PFM strength measured by vaginal manometry and symptoms of anal incontinence (AI) and pelvic organ prolapse (POP). RESULTS 47 women, mean age of 33.5 years (SD: 8.1), participated. At 16 weeks, there was a mean difference between groups of -1.4 (95% CI: -2.6 to -0.2) in the change of the ICIQ-UI-SF score in favour of the PFMT group. The PFMT group completed a mean of 70% (SD: 23) of the prescribed protocol. 64% in the PFMT group versus 8% in the control group reported improved symptoms of SUI (p<0.001, relative risk: 7.96, 95% CI, 2.03 to 31.19). There were no group differences in the change of PFM strength or AI/POP symptoms. CONCLUSION A 16-week home-training programme of the PFM led to improvements in SUI in female functional fitness exercisers. However, PFM strength and AI and POP symptoms did not improve significantly in the PFMT group compared with the control group.
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Affiliation(s)
| | - Marie Ellström Engh
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lorenskog, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kari Bø
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lorenskog, Norway
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Leao Ribeiro I, Lorca LA, Peviani Messa S, Berríos Contreras L, Valdivia Valdés FJ, Roteli Oyarzún VD, Rojas Soto CA. [Effectiveness of early pelvic muscle training on pelvic floor strength, urinary incontinence symptoms, sexual function, and quality of life in post-radical prostatectomy patients: Systematic review of randomized clinical trials]. Rehabilitacion (Madr) 2024; 58:100828. [PMID: 38141425 DOI: 10.1016/j.rh.2023.100828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 07/07/2023] [Accepted: 08/07/2023] [Indexed: 12/25/2023]
Abstract
This study aimed to evaluate the effectiveness of early pelvic muscle training in reducing urinary incontinence symptoms, improving quality of life, sexual function, and increasing pelvic floor strength in post-radical prostatectomy patients. A search was carried out in 8 databases until October 26, 2022, the methodological quality and the risk of bias of 14 included studies (n=1236) were evaluated, moreover, the evidence and the meta-analysis were calculated. The intervention significantly reduced urinary incontinence symptoms compared to a control group (SMD=-2.80, 95% CI=-5.21 to -0.39, P=.02), with significant heterogeneity (I2=83%; P=<.0001) and moderate evidence. In addition, it presented moderate evidence to improve quality of life, and very low evidence to improve sexual function and pelvic floor strength. These results should be viewed with caution due to the significant heterogeneity of the studies analysed.
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Affiliation(s)
- I Leao Ribeiro
- Departmento de Kinesiología, Facultad de Ciencias de la Salud, Universidad Católica del Maule, Talca, Chile.
| | - L A Lorca
- Hospital del Salvador, Servicio de Salud Metropolitano Oriente, Santiago de Chile, Chile
| | | | | | - F J Valdivia Valdés
- Departmento de Kinesiología, Facultad de Ciencias de la Salud, Universidad Católica del Maule, Talca, Chile
| | - V D Roteli Oyarzún
- Departmento de Kinesiología, Facultad de Ciencias de la Salud, Universidad Católica del Maule, Talca, Chile
| | - C A Rojas Soto
- Departmento de Kinesiología, Facultad de Ciencias de la Salud, Universidad Católica del Maule, Talca, Chile
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Muro S, Moue S, Akita K. Twisted orientation of the muscle bundles in the levator ani functional parts in women: Implications for pelvic floor support mechanism. J Anat 2024; 244:486-496. [PMID: 37885272 PMCID: PMC10862148 DOI: 10.1111/joa.13968] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/05/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
This study presents a comprehensive investigation of the anatomical features of the levator ani muscle. The levator ani is a critical component of the pelvic floor; however, its intricate anatomy and functionality are poorly understood. Understanding the precise anatomy of the levator ani is crucial for the accurate diagnosis and effective treatment of pelvic floor disorders. Previous studies have been limited by the lack of comprehensive three-dimensional analyses; to overcome this limitation, we analysed the levator ani muscle using a novel 3D digitised muscle-mapping approach based on layer-by-layer dissection. From this examination, we determined that the levator ani consists of overlapping muscle bundles with varying orientations, particularly in the anteroinferior portion. Our findings revealed distinct muscle bundles directly attached to the rectum (LA-re) and twisted muscle slings surrounding the anterior (LA-a) and posterior (LA-p) aspects of the rectum, which are considered functional parts of the levator ani. These results suggest that these specific muscle bundles of the levator ani are primarily responsible for functional performance. The levator ani plays a crucial role in rectal elevation, lifting the centre of the perineum and narrowing the levator hiatus. The comprehensive anatomical information provided by our study will enhance diagnosis accuracy and facilitate the development of targeted treatment strategies for pelvic floor disorders in clinical practice.
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Affiliation(s)
- Satoru Muro
- Department of Clinical AnatomyTokyo Medical and Dental UniversityTokyoJapan
| | - Shoko Moue
- Department of Clinical AnatomyTokyo Medical and Dental UniversityTokyoJapan
| | - Keiichi Akita
- Department of Clinical AnatomyTokyo Medical and Dental UniversityTokyoJapan
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12
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Mitteroecker P, Fischer B. Evolution of the human birth canal. Am J Obstet Gynecol 2024; 230:S841-S855. [PMID: 38462258 DOI: 10.1016/j.ajog.2022.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/07/2022] [Accepted: 09/07/2022] [Indexed: 03/12/2024]
Abstract
It seems puzzling why humans have evolved such a small and rigid birth canal that entails a relatively complex process of labor compared with the birth canal of our closest relatives, the great apes. This study reviewed insights into the evolution of the human birth canal from recent theoretical and empirical studies and discussed connections to obstetrics, gynecology, and orthopedics. Originating from the evolution of bipedality and the large human brain million years ago, the evolution of the human birth canal has been characterized by complex trade-off dynamics among multiple biological, environmental, and sociocultural factors. The long-held notion that a wider pelvis has not evolved because it would be disadvantageous for bipedal locomotion has not yet been empirically verified. However, recent clinical and biomechanical studies suggest that a larger birth canal would compromise pelvic floor stability and increase the risk of incontinence and pelvic organ prolapse. Several mammals have neonates that are equally large or even larger than human neonates compared to the size of the maternal birth canal. In these species, the pubic symphysis opens widely to allow successful delivery. Biomechanical and developmental constraints imposed by bipedality have hindered this evolutionary solution in humans and led to the comparatively rigid pelvic girdle in pregnant women. Mathematical models have shown why the evolutionary compromise to these antagonistic selective factors inevitably involves a certain rate of fetopelvic disproportion. In addition, these models predict that cesarean deliveries have disrupted the evolutionary equilibrium and led to new and ongoing evolutionary changes. Different forms of assisted birth have existed since the stone age and have become an integral part of human reproduction. Paradoxically, by buffering selection, they may also have hindered the evolution of a larger birth canal. Many of the biological, environmental, and sociocultural factors that have influenced the evolution of the human birth canal vary globally and are subject to ongoing transitions. These differences may have contributed to the global variation in the form of the birth canal and the difficulty of labor, and they likely continue to change human reproductive anatomy.
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Affiliation(s)
- Philipp Mitteroecker
- Unit for Theoretical Biology, Department of Evolutionary Biology, University of Vienna, Vienna, Austria.
| | - Barbara Fischer
- Unit for Theoretical Biology, Department of Evolutionary Biology, University of Vienna, Vienna, Austria
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13
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Peinado-Molina RA, Martínez-Vázquez S, Hernández-Martínez A, Martínez-Galiano JM. Impact and Influence of Urinary Incontinence on Physical Activity Levels. EUR UROL SUPPL 2023; 55:50-58. [PMID: 37693731 PMCID: PMC10485778 DOI: 10.1016/j.euros.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 09/12/2023] Open
Abstract
Background The benefits of physical activity are numerous on both physical and mental levels. Urinary incontinence (UI) can influence physical activity level; among US women, nearly two out of three view this problem as a barrier to physical activity, meaning that they do not exercise, exercise less, or even have to change their activity routines to accommodate this pelvic floor dysfunction. Objective To determine whether UI influences the pattern of physical activity and whether a greater impact of urinary symptoms could influence the level of physical activity. Design setting and participants An observational study was carried out with women in 2021 and 2022 in Spain. Outcome measurements and statistical analysis The main dependent variable was level physical activity, as measured by the International Physical Activity Questionnaire (IPAQ). The Urogenital Distress Inventory (UDI-6) scale was used to determine the presence of UI and its impact. Sociodemographic, health status, lifestyle and obstetric data were obtained. Bivariate and multivariate analyses were performed using binary logistic regression, obtaining adjusted odds ratio (aOR) with its 95% confidence interval (95% CI). Results and limitations A total of 1446 women participated, of whom 55.8% (807) had UI and 25.7% (371) reported low physical activity. Mixed incontinence (aOR: 1.53; 95% CI: 1.09-2.15) overall and a greater intensity of urinary symptoms (UDI-6 score; aOR: 1.014; 95% CI: 1.01-1.02) in the group of women with incontinence were statistically associated with a higher frequency of low physical activity. Other variables related to low physical activity were age, body mass index, pelvic pain, and income level (p < 0.001). Conclusions Mixed-type UI is associated with low-level physical activity or inactivity in the whole group of women, while among women with UI, the greater impact of the symptoms increases the probability of low physical activity or inactivity. Patient summary In this report, it is analyzed how urinary incontinence affects physical activity. It was found that women who suffer from mixed-type urinary incontinence have a low level of physical activity or inactivity, while those who experience a greater impact of urinary incontinence symptoms have an increased likelihood of having low physical activity or inactivity.
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Affiliation(s)
| | | | - Antonio Hernández-Martínez
- Department of Nursing, Physiotherapy and Occupational Therapy, Ciudad Real Faculty of Nursing, University of Castilla-La Mancha, Ciudad Real, Spain
| | - Juan Miguel Martínez-Galiano
- Department of Nursing, University of Jaen, Jaen, Spain
- Consortium for Biomedical Research in the Epidemiology and Public Health Network (CIBERESP), Madrid, Spain
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14
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Luo L, Xie H. Review of self-efficacy assessment scales for geriatric patients with urinary incontinence. Int Urol Nephrol 2023; 55:2133-2138. [PMID: 37330933 DOI: 10.1007/s11255-023-03661-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/03/2023] [Indexed: 06/20/2023]
Abstract
Urinary incontinence is a common condition in the elderly, which can be improved with rehabilitation. However, compliance with the rehabilitation regimen is influenced by the level of self-efficacy. Self-efficacy of elderly patients in dealing with urinary incontinence can be clinically assessed and understood by using a suitable scale, to implement specific improvement measures. At present, the tools used for assessing the self-efficacy of elderly patients with urinary incontinence include the General Self-Efficacy Scale (GSES), the Pelvic Floor Muscle Self-efficacy Scale, the Geriatric Self-efficacy Index for Urinary Incontinence, and the Yoga Self-Efficacy Scale. Most of these tools are suitable for female patients with urinary incontinence, but lack relevance to the disease characteristics of geriatric patients. In this study, we reviewed the self-efficacy assessment tools for geriatric patients with urinary incontinence, to provide a reference for related research. It is important to accurately assess the self-efficacy of patients with geriatric UI to effectively enhance their level of self-efficacy, so that patients with geriatric UI can avail early help and quickly reintegrate with family and society.
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Affiliation(s)
- Liumei Luo
- Department of Scientific Research, Hainan General Hospital, Haikou, 570311, China
| | - Huifang Xie
- Department of International Nursing School, Hainan Medical University, No.3 of Xueyuan Road, Longhua District, Haikou, 570100, China.
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15
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Torstveit MK, Ackerman KE, Constantini N, Holtzman B, Koehler K, Mountjoy ML, Sundgot-Borgen J, Melin A. Primary, secondary and tertiary prevention of Relative Energy Deficiency in Sport (REDs): a narrative review by a subgroup of the IOC consensus on REDs. Br J Sports Med 2023; 57:1119-1126. [PMID: 37752004 DOI: 10.1136/bjsports-2023-106932] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2023] [Indexed: 09/28/2023]
Abstract
Relative Energy Deficiency in Sport (REDs) is common among female and male athletes representing various sports at different performance levels, and the underlying cause is problematic low energy availability (LEA). It is essential to prevent problematic LEA to decrease the risk of serious health and performance consequences. This narrative review addresses REDs primary, secondary and tertiary prevention strategies and recommends best practice prevention guidelines targeting the athlete health and performance team, athlete entourage (eg, coaches, parents, managers) and sport organisations. Primary prevention of REDs seeks to minimise exposure to and reduce behaviours associated with problematic LEA. Some of the important strategies are educational initiatives and de-emphasising body weight and leanness, particularly in young and subelite athletes. Secondary prevention encourages the early identification and management of REDs signs or symptoms to facilitate early treatment to prevent development of more serious REDs outcomes. Recommended strategies for identifying athletes at risk are self-reported screening instruments, individual health interviews and/or objective assessment of REDs markers. Tertiary prevention (clinical treatment) seeks to limit short-term and long-term severe health consequences of REDs. The cornerstone of tertiary prevention is identifying the source of and treating problematic LEA. Best practice guidelines to prevent REDs and related consequences include a multipronged approach targeting the athlete health and performance team, the athlete entourage and sport organisations, who all need to ensure a supportive and safe sporting environment, have sufficient REDs knowledge and remain observant for the early signs and symptoms of REDs.
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Affiliation(s)
| | - Kathryn E Ackerman
- Wu Tsai Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Naama Constantini
- Sport Medicine, Shaare Zedek Medical Center, The Hebrew University, Jerusalem, Israel
| | - Bryan Holtzman
- Wu Tsai Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Karsten Koehler
- Department of Sport and Health Sciences, Technical University of Munich, München, Germany
| | - Margo L Mountjoy
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Anna Melin
- Department of Sport Science, Linnaeus University, Vaxjo/Kalmar, Sweden
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16
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Perlow A, Joyce CJ, Bennis S, Mueller ER, Fitzgerald CM. Toileting Behaviors and Lower Urinary Tract Symptoms Among Female Physicians and Medical Students. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023; 29:678-686. [PMID: 37490707 DOI: 10.1097/spv.0000000000001333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
IMPORTANCE A greater understanding of the relationship between toileting behaviors and lower urinary tract symptoms (LUTS) has the potential to generate awareness and improvement of overall bladder health in specific populations. OBJECTIVE The aim of the study was to investigate the prevalence and correlation between maladaptive toileting behaviors and LUTS among female medical trainees and attending physicians. STUDY DESIGN We surveyed female medical students, residents, fellows, and attending physicians at an academic hospital, capturing demographics, voiding behaviors, LUTS, and fluid intake using the Bristol Female Lower Urinary Tract Symptoms Short Form, the Toileting Behavior-Women's Elimination Behaviors, and the Beverage Intake Questionnaire. RESULTS A total of 146 medical students and physicians participated in the study. Eighty-three percent reported at least 1 LUTS, most commonly storage symptoms, particularly incontinence (30%, stress urinary incontinence > urgency urinary incontinence). Altered toileting behaviors included "worrying about public toilet cleanliness" (82%), "emptying the bladder before leaving home" (81%), "delaying emptying their bladder when busy" (87%), and "waiting until they could not hold urine any longer" (57%). Total Toileting Behavior-Women's Elimination Behaviors scores were significantly associated with total Bristol Female Lower Urinary Tract Symptoms scores (β = 0.27; 95% CI, 0.12-0.42; P<0.01). This remained true after adjusting for total fluid intake in medical students (β = 0.41, P<0.01) and resident physicians (β = 0.28, P = 0.03) but was not correlated among attending physicians (β = -0.07, P = 0.77). CONCLUSIONS Female physicians and medical students experience a high prevalence of LUTS. Many engage in maladaptive toileting behaviors, which highly correlate with LUTS (especially among medical students and residents) and may lead to impaired bladder health.
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Affiliation(s)
- Aaron Perlow
- From the Loyola University Stritch School of Medicine, Maywood, IL
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17
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Deinstadt RTM, Sternin S, Reissing ED. Urinary Symptoms and their Impact on Young Women's Sexual Function and Quality of Life. JOURNAL OF SEX & MARITAL THERAPY 2023; 49:917-931. [PMID: 37317557 DOI: 10.1080/0092623x.2023.2222728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Sexuality and urinary function have received scarce research attention in younger women. In this cross-sectional survey study, prevalence, type, severity, and impact of urinary incontinence (UI), and its relationship with sexuality was investigated in 261 nulliparous women aged 18-27 (M = 19.08 years). Modules of the International Consultation on Incontinence Questionnaire and the Female Sexual Function Index assessed UI, sexual function, and quality of life. Thirty percent of the sample experienced UI, and 26% reported sexual function problems. A significant small negative correlation was found between UI and sexual lubrication (p = .017). Forty-three percent of participants in the total sample reported that they were bothered by urinary symptoms, and 13% avoided sexual activity due to urinary symptoms. Of those classified as incontinent, 90% were bothered by their symptoms. Urinary symptoms are impactful on the quality of life and sexual lives of young women, but despite their high prevalence, they remain a largely understudied and undertreated issue in this age group. Further research is crucial for improving awareness and access to treatment for this underserved population.
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Affiliation(s)
| | - Shulamit Sternin
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Elke D Reissing
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
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18
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Niederauer S, Hunt G, Foreman KB, Merryweather A, Hitchcock R. Intrinsic factors contributing to elevated intra-abdominal pressure. Comput Methods Biomech Biomed Engin 2023; 26:941-951. [PMID: 35837994 PMCID: PMC9840719 DOI: 10.1080/10255842.2022.2100220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 05/02/2022] [Accepted: 06/22/2022] [Indexed: 01/18/2023]
Abstract
Pelvic floor disorders affect 24% of US women, and elevated intra-abdominal pressure may cause pelvic injury through musculoskeletal strain. Activity restrictions meant to reduce pelvic strain after traumatic events, such as childbirth, have shown little benefit to patients. Reported high variability in abdominal pressure suggests that technique plays a substantial role in pressure generation. Understanding these techniques could inform evidence-based recommendations for protective pelvic care. We hypothesized use of a motion-capture methodology could identify four major contributors to elevated pressure: gravity, acceleration, abdominal muscle contraction, and respiration. Twelve women completed nineteen activities while instrumented for whole body motion capture, abdominal pressure, hip acceleration, and respiration volume. Correlation and partial least squares regression were utilized to determine primary technique factors that increase abdominal pressure. The partial least squares model identified two principal components that explained 59.63% of relative intra-abdominal pressure variability. The first component was primarily loaded by hip acceleration and relative respiration volume, and the second component was primarily loaded by flexion moments of the abdomen and thorax. While reducing abdominal muscle use has been a primary strategy in protective pelvic floor care, the influence of hip acceleration and breathing patterns should be considered with similar importance in future work.
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Affiliation(s)
- Stefan Niederauer
- Department of Biomedical Engineering, University of Utah, Salt Lake City, United States
| | - Grace Hunt
- Department of Mechanical Engineering, University of Utah, Salt Lake City, United States
| | - K Bo Foreman
- Department of Mechanical Engineering, University of Utah, Salt Lake City, United States
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, United States
| | - Andrew Merryweather
- Department of Mechanical Engineering, University of Utah, Salt Lake City, United States
| | - Robert Hitchcock
- Department of Biomedical Engineering, University of Utah, Salt Lake City, United States
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19
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Lee CL, Park JM, Lee JY, Yang SW, Na HS, Lee J, Jung S, Shin JH. A Novel Incisionless Disposable Vaginal Device for Female Stress Urinary Incontinence: Efficacy and Quality of Life. Int Neurourol J 2023; 27:S40-48. [PMID: 37280759 DOI: 10.5213/inj.2346092.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/14/2023] [Indexed: 06/08/2023] Open
Abstract
PURPOSE This clinical study sought to evaluate the possible clinical effectiveness and practicality of URINO, an innovative, incisionless, and disposable intravaginal device, designed for patients suffering from stress urinary incontinence. METHODS A prospective, multicenter, single-arm clinical trial was carried out, involving women diagnosed with stress urinary incontinence who used a self-inserted, disposable intravaginal pessary device. Comparisons were made between the results of the 20-minute pad-weight gain (PWG) test at baseline and visit 3, where the device was applied. After 1 week of device usage, compliance, satisfaction, the sensation of a foreign body, and adverse events were assessed. RESULTS Out of 45 participants, 39 completed the trial and expressed satisfaction within the modified intention-to-treat group. The average 20-minute PWG of participants was 17.2±33.6 g at baseline and significantly dropped to 5.3±16.2 g at visit 3 with device application. A total of 87.2% of participants exhibited a reduction ratio of PWG by 50% or more, surpassing the clinical trial success benchmark of 76%. The mean compliance was recorded as 76.6%±26.6%, the average visual analogue scale score for patient satisfaction was 6.4±2.6, and the sensation of a foreign body, measured on a 5-point Likert scale, was 3.1±1.2 after 1 week of device use. No serious adverse events were reported; there was 1 instance of microscopic hematuria and 2 cases of pyuria, all of which recovered. CONCLUSION The investigated device demonstrated significant clinical effectiveness and safety for patients with stress urinary incontinence. It was easy to use, showing favorable patient compliance. We propose that these disposable intravaginal pessaries could potentially be an alternative treatment for patients with stress urinary incontinence who are seeking nonsurgical options or are unable to undergo surgery. Trial Registration: The study was registered as a clinical trial (KCT0008369).
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Affiliation(s)
- Chung Lyul Lee
- Department of Urology, Chungnam National University Hospital, Daejeon, Korea
| | - Jong Mok Park
- Department of Urology, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Ji Yong Lee
- Department of Urology, Chungnam National University Hospital, Daejeon, Korea
| | - Seung Woo Yang
- Department of Urology, Chungnam National University Hospital, Daejeon, Korea
| | - Hyun Seok Na
- Department of Urology, Chungnam National University Hospital, Daejeon, Korea
| | - Jaegeun Lee
- Department of Urology, Chungnam National University Hospital, Daejeon, Korea
| | - Sunkyung Jung
- Department of Urology, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Ju Hyun Shin
- Department of Urology, Chungnam National University Hospital, Daejeon, Korea
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20
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Ben Zvi M, Arad Cohen M, Friedman M, Ganer Herman H, Weiner E, Ginath S. Urinary Incontinence in Parous Women Practicing Non-Extreme Competitive Sports Compared to the General Population. J Clin Med 2023; 12:jcm12082803. [PMID: 37109140 PMCID: PMC10141981 DOI: 10.3390/jcm12082803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/11/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION AND OBJECTIVE This cross-sectional study aimed to compare the prevalence of urinary symptoms in physically active females to the general population represented by medical staff. MATERIALS AND METHODS We conducted a survey utilizing the UDI-6 questionnaire on women playing catchball for at least one year and training twice a week or more in an official Israeli competitive league. The control group consisted of women practicing medicine (physicians and nurses). RESULTS The study group consisted of 317 catchball players and the control group consisted of 105 medical staff practitioners. Both groups were similar in most of the demographic characteristics. Urinary symptoms represented by UDI-6 scores were higher in women in the catchball group. Frequency and urgency symptoms were common in women playing catchball. Stress urinary incontinence (SUI) was insignificant between the groups (43.8% in the catchball group and 35.2% in the medical staff group, p = 0.114). However, severe symptoms of SUI were more common in catchball players. CONCLUSIONS The rates of all urinary symptoms were higher in in catchball players. SUI symptoms were common in both groups. However, severe symptoms of SUI were more common in catchball players.
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Affiliation(s)
- Masha Ben Zvi
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Holon 5822012, Israel
| | - Maya Arad Cohen
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Holon 5822012, Israel
| | - Matan Friedman
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Holon 5822012, Israel
| | - Hadas Ganer Herman
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Holon 5822012, Israel
| | - Eran Weiner
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Holon 5822012, Israel
| | - Shimon Ginath
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Holon 5822012, Israel
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21
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Muro S, Akita K. Pelvic floor and perineal muscles: a dynamic coordination between skeletal and smooth muscles on pelvic floor stabilization. Anat Sci Int 2023:10.1007/s12565-023-00717-7. [PMID: 36961619 DOI: 10.1007/s12565-023-00717-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/15/2023] [Indexed: 03/25/2023]
Abstract
The purpose of this review is to present our researches on the pelvic outlet muscles, including the pelvic floor and perineal muscles, which are responsible for urinary function, defecation, sexual function, and core stability, and to discuss the insights into the mechanism of pelvic floor stabilization based on the findings. Our studies are conducted using a combination of macroscopic examination, immunohistological analysis, 3D reconstruction, and imaging. Unlike most previous reports, this article describes not only on skeletal muscle but also on smooth muscle structures in the pelvic floor and perineum to encourage new understanding. The skeletal muscles of the pelvic outlet are continuous, which means that they share muscle bundles. They form three muscle slings that pass anterior and posterior to the anal canal, thus serving as the foundation of pelvic floor support. The smooth muscle of the pelvic outlet, in addition to forming the walls of the viscera, also extends in three dimensions. This continuous smooth muscle occupies the central region of the pelvic floor and perineum, thus revising the conventional understanding of the perineal body. At the interface between the levator ani and pelvic viscera, smooth muscle forms characteristic structures that transfer the lifting power of the levator ani to the pelvic viscera. The findings suggest new concepts of pelvic floor stabilization mechanisms, such as dynamic coordination between skeletal and smooth muscles. These two types of muscles possibly coordinate the direction and force of muscle contraction with each other.
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Affiliation(s)
- Satoru Muro
- Department of Clinical Anatomy, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan.
| | - Keiichi Akita
- Department of Clinical Anatomy, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
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22
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Dominguez-Antuña E, Diz JC, Suárez-Iglesias D, Ayán C. Prevalence of urinary incontinence in female CrossFit athletes: a systematic review with meta-analysis. Int Urogynecol J 2023; 34:621-634. [PMID: 35635565 PMCID: PMC9150382 DOI: 10.1007/s00192-022-05244-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/16/2022] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
| | - José Carlos Diz
- Unidad de Cuidados Intensivos, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
- Departamento de Didácticas Especiais, Universidade de Vigo, Well-Move Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Pontevedra, Spain
| | - David Suárez-Iglesias
- VALFIS Research Group, Institute of Biomedicine (IBIOMED), Faculty of Physical Activity and Sports Sciences, University of León, León, Spain.
| | - Carlos Ayán
- Departamento de Didácticas Especiais, Universidade de Vigo, Well-Move Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Pontevedra, Spain
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Fukuda FS, Arbieto ERM, Da Roza T, Luz SCTD. Pelvic Floor Muscle Training In Women Practicing High-impact Sports: A Systematic Review. Int J Sports Med 2023. [PMID: 36075371 DOI: 10.1055/a-1939-4798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Urinary incontinence (UI) in female athletes can impair their quality-of-life (QoL) and reduce their participation in sports. This review aims to evaluate the effect of pelvic floor muscle training (PFMT) in treating UI in women participating in high-impact sports. Furthermore, to assess the influence of PFMT on pelvic floor muscles (PFM) function and the UI impact on their QoL. For this purpose, a systematic review of randomized controlled trials (RCTs) and non-RCTs was performed. An electronic search was conducted on PubMed, EMBASE, SciELO, and Scopus. The quality of evidence was assessed using the PEDro and ROBINS-I scales. The Consensus on Exercise Reporting Template (CERT) was used to assess the quality of PFMT protocols. All studies were available in full-text including incontinent female participants who are practitioners of high-impact sports, investigating PFMT vs control groups(inactive) or undergoing other treatments. Three RCTs and two non-RCTs (104 participants) were analyzed. PFMT provided a significant improvement in UI symptoms with a reduction in the frequency (n=3) and the amount of UI (n=5). PFM function was assessed in three studies, and two found improvement in maximal contraction and one in vaginal resting pressure in favor of PFMT. None of the two studies that assessed QoL found a difference after PFMT intervention.
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Affiliation(s)
| | | | - Thuane Da Roza
- INEGI, Faculty of Engineering, University of Porto, Porto, Portugal.,Department of Physiotherapy, College of Health and Sport Science, Santa Catarina State University (CEFID/UDESC), Florianópolis, Brazil
| | - Soraia Cristina Tonon da Luz
- Department of Physiotherapy, College of Health and Sport Science, Santa Catarina State University (CEFID/UDESC), Florianópolis, Brazil
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Urinary Incontinence in Elite Female Athletes. Curr Urol Rep 2023; 24:51-58. [PMID: 36418531 DOI: 10.1007/s11934-022-01133-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW To summarize the current understanding on the epidemiology, pathophysiology, and management strategies of urinary incontinence (UI) in female athletes, highlighting findings specific to nulliparous elite athletes. RECENT FINDINGS UI occurs in about 20-50% of female athletes of all ages and parity status, around 40% for younger nulliparous athletes, and is more prevalent in high-impact sports. Possible contributing factors to UI in female elite athletes include pelvic floor laxity and bladder neck descent, pelvic floor muscle fatigue, low energy availability, and hypermobility syndrome. In female elite athletes, urinary symptoms negatively affect quality of life, although the effects of symptoms on exercise participation are not well understood. Current management strategies are primarily conservative and centered on behavioral modifications and pelvic floor muscle physiotherapy. UI in female elite athletes appears to be multifactorial. Clarifying how individual factors influence UI in this population will inform athlete counseling, prevention, and treatment strategies.
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Laino FM, de Araújo MP, Sartori MGF, de Aquino Castro R, Santos JLF, Tamanini JTN. Urinary incontinence in female athletes with inadequate eating behavior: a case-control study. Int Urogynecol J 2023; 34:431-438. [PMID: 36102941 DOI: 10.1007/s00192-022-05349-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/14/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Female athletes can develop symptoms of urinary incontinence (UI) as well as risk behaviors for eating disorders owing to the type of training and sports modality. Such symptoms are intensified by the demands for results and an idealized body composition. Our aim is to investigate the possible association between urinary incontinence and risk behaviors for eating disorders in female athletes. METHODS A case-control study was conducted with 270 female athletes who answered the International Consultation on Incontinence Questionnaire (ICIQ-SF) and the Eating Attitudes Test (EAT-26). Different sports modalities and their respective impact levels were considered in the study. Female athletes were divided into two groups, i.e., athletes with UI (case group) and those without UI (control group). Multiple logistic regression was used to calculate associated factors. RESULTS From all variables included in the study, only abnormal eating behavior was found to be associated with UI according to the multiple logistic regression test. Participants with UI were 2.15-fold more likely to have risk behaviors for eating disorders. CONCLUSIONS Female athletes with UI were more likely to have risk behaviors for eating disorders. Multidisciplinary teams that provide care for these athletes should be attentive to symptoms that may not appear to be associated at first glance but may reflect a condition that needs to be treated.
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Affiliation(s)
- Fernanda Mies Laino
- Sports Gynecology Sector, Department of Gynecology, Federal University of São Paulo, Rua Botucatu, 821, São Paulo, SP, Brazil.
| | - Maíta Poli de Araújo
- Division of Sports Medicine and Physical Activity, Department of Orthopedics and Traumatology, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Marair Gracio Ferreira Sartori
- Sector of Urogynecology and Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Rodrigo de Aquino Castro
- Sector of Urogynecology and Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Jair Lício Ferreira Santos
- Department of Social Medicine, Ribeirão Preto School of Medicine, University of São Paulo, São Paulo, SP, Brazil
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De Marchi T, Ferlito JV, Turra AC, Flamia S, de Bispo Magro F, Pavelecini Donida ML, Dilkin M, da Silva D, Massia Ribas V, Leal Junior ECP. Pilates Method and/or Photobiomodulation Therapy Combined to Static Magnetic Field in Women with Stress Urinary Incontinence: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. J Clin Med 2023; 12:jcm12031104. [PMID: 36769752 PMCID: PMC9917687 DOI: 10.3390/jcm12031104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 02/04/2023] Open
Abstract
This clinical trial aims to provide evidence about the effectiveness of the Pilates method on stress urinary incontinence (SUI), as well as to elucidate the effects of photobiomodulation therapy associated with static magnetic field (PBMT/sMF) alone or associated with the Pilates Method on Pelvic floor muscle (PFM) in women affected by SUI. For that, a three-arm, parallel randomized, double-blinded, placebo-controlled trial was conducted (NCT05096936). We recruited thirty-three women diagnosed with SUI, randomly allocated to three groups: placebo PBMT/sMF plus method Pilates, PBMT/sMF active plus method Pilates and only PBMT/sMF active. The evaluation consisted of anamnesis and physical examination, muscle strength, completion of the ICIQ-SF questionnaire, and urinary loss. The evaluation of muscle strength and filling the ICIQ-SF were performed on the first and last days, while the Pad test was applied in baseline, one month, two months, and three months of intervention. We observed an increase in strength (p < 0.01), tone (p < 0.01), and quality of life (p < 0.01), in addition to a decrease in urinary lost (p < 0.01) for all groups comparing the pre and post-intervention. The PBMT/sMF alone, the Pilates, and the combination of the two therapies proved to be effective in improving the signs and symptoms of women with SUI.
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Affiliation(s)
- Thiago De Marchi
- Laboratory of Phototherapy and Innovative Technologies in Health (LaPIT), Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo 03155-000, SP, Brazil
- Correspondence: or
| | - João Vitor Ferlito
- Oxidative Stress and Antioxidant Laboratory, Postgraduate Program in Biotechnology, University of Caxias do Sul, Caxias do Sul 95070-560, RS, Brazil
- School Clinic of Physical Therapy, University Center CNEC of Bento Gonçalves (UNICNEC), Bento Gonçalves 95700-000, RS, Brazil
| | - Ariane Cristina Turra
- School Clinic of Physical Therapy, University Center CNEC of Bento Gonçalves (UNICNEC), Bento Gonçalves 95700-000, RS, Brazil
| | - Sheila Flamia
- School Clinic of Physical Therapy, University Center CNEC of Bento Gonçalves (UNICNEC), Bento Gonçalves 95700-000, RS, Brazil
| | - Franciele de Bispo Magro
- School Clinic of Physical Therapy, University Center CNEC of Bento Gonçalves (UNICNEC), Bento Gonçalves 95700-000, RS, Brazil
| | - Maribel Luiza Pavelecini Donida
- School Clinic of Physical Therapy, University Center CNEC of Bento Gonçalves (UNICNEC), Bento Gonçalves 95700-000, RS, Brazil
| | - Michele Dilkin
- School Clinic of Physical Therapy, University Center CNEC of Bento Gonçalves (UNICNEC), Bento Gonçalves 95700-000, RS, Brazil
| | - Djéssica da Silva
- School Clinic of Physical Therapy, University Center CNEC of Bento Gonçalves (UNICNEC), Bento Gonçalves 95700-000, RS, Brazil
| | - Vanessa Massia Ribas
- Physiotherapy Department, University Center CNEC of Bento Gonçalves (UNICNEC), Bento Gonçalves 95700-000, RS, Brazil
| | - Ernesto Cesar Pinto Leal Junior
- Laboratory of Phototherapy and Innovative Technologies in Health (LaPIT), Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo 03155-000, SP, Brazil
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Strenuous physical activity, exercise, and pelvic organ prolapse: a narrative scoping review. Int Urogynecol J 2023:10.1007/s00192-023-05450-3. [PMID: 36692525 DOI: 10.1007/s00192-023-05450-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/03/2023] [Indexed: 01/25/2023]
Abstract
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.
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Kuutti MA, Hyvärinen M, Kauppinen M, Sipilä S, Aukee P, Laakkonen EK. Early adulthood and current physical activity and their association with symptoms of pelvic floor disorders in middle-aged women: An observational study with retrospective physical activity assessment. BJOG 2023; 130:664-673. [PMID: 36655435 DOI: 10.1111/1471-0528.17397] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/16/2022] [Accepted: 12/14/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To investigate associations of early and middle adulthood physical activity (PA) with symptoms of pelvic floor disorders (PFDs), i.e. stress urinary incontinence (SUI), urge urinary incontinence (UUI), faecal incontinence (FI), constipation or defecation difficulties (CDDs) and feeling of pelvic organ prolapse (POP) among middle-aged women. DESIGN A cross-sectional, observational study with retrospective PA assessment. SETTING University Research Laboratory. SAMPLE A random population sample of 1098 Finnish women aged 47-55 years. METHODS Early adulthood PA, current PA, and demographic and gynaecological variables were assessed using self-report questionnaires. Logistic regression analyses were applied to study associations of PA variables with symptoms of PFDs. Potential confounding effects of demographic and gynaecological variables were controlled in multiple logistic regression models. MAIN OUTCOME MEASURES Structured questionnaire-assessed retrospective PA assessment at the age of 17-29 years, current PA at middle age, and prevalence of symptoms of CDD, FI, POP, SUI and UUI. RESULTS Current PA was not independently associated with the occurrence of the symptoms of PFDs. Middle-aged women with an early adulthood history of competitive sports were more likely to experience symptoms of UUI (OR 2.16, 95% CI 1.10-4.24, p = 0.025) but not symptoms of SUI, FI, CDD or POP, whereas women with a history of regular PA were more likely to experience symptoms of FI (OR 4.41, 95% CI 1.05-18.49, p = 0.043) but no other symptoms of PFDs. CONCLUSIONS Competitive sports during early adulthood may increase the risk of UUI in middle age. Regular PA during early adulthood may increase the risk of FI.
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Affiliation(s)
- Mari A Kuutti
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Matti Hyvärinen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Markku Kauppinen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Sarianna Sipilä
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | | | - Eija K Laakkonen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Augustina SJ, Suganthirababu P, Rajagopal V, Kumaresan A, Srinivasan V, Ramana K, Kamalakannan M, Alagesan J, Prathap L. Pelvic floor dysfunction and its impact on quality of life among female health care employees. Work 2023; 74:1055-1059. [PMID: 36683523 DOI: 10.3233/wor-211125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND In today's fast-paced world, both men and women have to be equally competent to handle their responsibilities in order to look after their family members and children. In this pace of competency women tend to forget to take care of their own health and face many health issues, including pelvic floor dysfunction. OBJECTIVE This study aimed to analyse the prevalence rate of pelvic floor dysfunction among the working women in regards to their age and body mass index as well as their quality of life. METHODS One hundred sixty one post-partum working female participants from the medical fraternity were involved in this study after their consent was obtained. Pelvic floor muscle strength was assessed and their quality of life measured using King's health questionnaire. RESULTS There was a strong correlation between the pelvic floor muscle dysfunction and its impact on the quality of life among the females with increasing age. Significant statistical significant difference of P(<0.0001) was noted. CONCLUSION Pelvic floor dysfunction among females has a direct impact on their quality of life.
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Affiliation(s)
- S Jenifer Augustina
- Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences, Chennai, India
| | - Prathap Suganthirababu
- Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences, Chennai, India
| | | | - A Kumaresan
- Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences, Chennai, India
| | - Vignesh Srinivasan
- Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences, Chennai, India
| | - K Ramana
- Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences, Chennai, India
| | - M Kamalakannan
- Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences, Chennai, India
| | - Jagatheesan Alagesan
- Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences, Chennai, India
| | - Lavanya Prathap
- Department of Anatomy, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Chennai, India
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Effect of Kegel Exercises on Lower Urinary Tract Symptoms in Young Gymnasts: A Prospective Cohort Study. UROGYNECOLOGY (HAGERSTOWN, MD.) 2023:02273501-990000000-00068. [PMID: 36701297 DOI: 10.1097/spv.0000000000001331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
IMPORTANCE Lower urinary tract symptoms (LUTS) have been shown to exist in young athletes. The use of pelvic floor muscle training as a preventive strategy at an early age may be useful to avoid possible pelvic floor dysfunction in the future. OBJECTIVES The aim of the study was to describe LUTS in underaged gymnasts. We also aimed to evaluate the effects of a 12-week Kegel exercise intervention for LUTS and urinary incontinence (UI) and their relationship to bother. STUDY DESIGN A quasi-experimental (nonrandomized, noncontrolled) pre-post study was conducted. Nineteen gymnasts with a mean age of 13.21 ± 1.84 were selected from a gymnastics club in Madrid, Spain. Outcomes of LUTS and quality of life were measured using the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms validated questionnaire at baseline and at the end of the 12-week intervention. RESULTS The participants presented with certain LUTS such as urgency UI (57.7%) or stress UI (47.4%), which negatively affect their daily lives by feeling annoyed in various aspects (when practicing gymnastics, getting up during the night to urinate or feeling bladder pain among others). No significant differences in LUTS and quality of life variables were observed after the exercise intervention ( P > 0.05). CONCLUSIONS A high prevalence of LUTS was observed in a sample of underaged high-level gymnasts. The 12-week Kegel exercise intervention did not significantly reduce the presence of pelvic floor problems and even intensified some of them, probably because of an increased awareness. Pelvic floor muscle training as a preventive strategy at an early age seems to be necessary to avoid possible pelvic floor dysfunction in the future.
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Giagio S, Salvioli S, Innocenti T, Gava G, Vecchiato M, Pillastrini P, Turolla A. PFD-SENTINEL: Development of a screening tool for pelvic floor dysfunction in female athletes through an international Delphi consensus. Br J Sports Med 2022:bjsports-2022-105985. [DOI: 10.1136/bjsports-2022-105985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 12/15/2022]
Abstract
To develop a screening tool for pelvic floor dysfunction (PFD) in female athletes for use by sports medicine clinicians (eg, musculoskeletal/sports physiotherapists, sports and exercise medicine physicians), which guides referral to a PFD specialist (eg, pelvic floor/women’s health physiotherapist, gynaecologist, urogynaecologist, urologist).Between February and April 2022, an international two-round modified Delphi study was conducted to assess expert opinion on which symptoms, risk factors and clinical and sports-related characteristics (items) should be included in a screening tool. We defined consensus a priori as >67% response agreement to pass each round.41 and 34 experts participated in rounds 1 and 2, respectively. Overall, seven general statements were endorsed as relevant by most participants highlighting the importance of screening for PFD in female athletes. Through consensus, the panel developed the Pelvic Floor Dysfunction-ScrEeNing Tool IN fEmale athLetes (PFD-SENTINEL) and agreed to a cluster of PFD symptoms (n=5) and items (risk factors, clinical and sports-related characteristics; n=28) that should prompt specialist care. A clinical algorithm was also created: a direct referral is recommended when at least one symptom or 14 items are reported. If these thresholds are not reached, continuous monitoring of the athlete’s health is indicated.Despite increasing awareness and clinical relevance, barriers to identify PFD in female athletes are still present. The PFD-SENTINEL is a new resource for sports medicine clinicians who regularly assess female athletes and represents the first step towards early PFD identification and management. Further studies to validate the tool are needed.
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Rodríguez-López ES, Acevedo-Gómez MB, Romero-Franco N, Basas-García Á, Ramírez-Parenteau C, Calvo-Moreno SO, Fernández-Domínguez JC. Urinary Incontinence Among Elite Track and Field Athletes According to Their Event Specialization: A Cross-Sectional Study. SPORTS MEDICINE - OPEN 2022; 8:78. [PMID: 35704136 PMCID: PMC9200916 DOI: 10.1186/s40798-022-00468-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/24/2022] [Indexed: 11/29/2022]
Abstract
Background Physical effort in sports practice is an important trigger for urinary incontinence (UI). Among high-impact sports, all track and field events require continuous ground impacts and/or abdominal contractions that increase intra-abdominal pressure and impact on the pelvic floor musculature. However, studies to date have not taken into account the specific sports tasks that elite track and field athletes perform according to the competitive events for which they are training. Methods This cross-sectional study describes the prevalence, type, and severity of UI among elite track and field athletes considering their event specialization and training characteristics. A total of 211 female and 128 male elite track and field athletes answered an online questionnaire including anthropometric measures, medical history, training characteristics, and UI symptoms. To determine self-reported UI, the International Consultation on Incontinence Questionnaire-UI Short-Form (ICIQ-UI-SF) was used. To determine UI type and severity, the incontinence questionnaire and incontinence severity index were used, respectively. Results The ICIQ-UI-SF showed that 51.7% of female and 18.8% of male athletes had UI, with stress UI (SUI) being the most frequent type (64.4%) for female and urge UI for male athletes (52.9%). Of athletes who were not identified as having UI according to the questionnaires, 24.6% of female and 13.6% of male athletes experienced urine leakage during training, mainly during jumping. Although training characteristics (experience, volume, and resting) were not related to UI, female athletes specializing in vertical jumps showed significantly lower UI prevalence compared to those specializing in horizontal jumps (χ2 [1] = 4.409, p = 0.040), middle-distance running (χ2 [1] = 4.523, p = 0.033), and sprint/hurdles events (χ2 [1] = 4.113, p = 0.043). These female athletes also displayed the lowest training volume. No differences were shown for males (p > 0.05). Conclusions Over half of the elite track and field female athletes have self-reported UI, especially SUI, and prevalence is higher when considering urine leakage events during training. Training characteristics and specialization were not related to UI identified by questionnaires, but female athletes specializing in vertical jump events showed the lowest prevalence and training volume. Males showed significantly lower prevalence, without correlation with their specialization. Sport professionals should increase UI detection among elite athletes and design-specific approaches that consider their physical demands to make visible, prevent, or improve pelvic floor dysfunction in this population. Supplementary Information The online version contains supplementary material available at 10.1186/s40798-022-00468-1.
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Huebner M, Ma W, Harding S. Sport-related risk factors for moderate or severe urinary incontinence in master female weightlifters: A cross-sectional study. PLoS One 2022; 17:e0278376. [PMID: 36449558 PMCID: PMC9710785 DOI: 10.1371/journal.pone.0278376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 11/15/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Urinary incontinence (UI), defined as the involuntary loss of urine, is a common, multifactorial condition. It is unclear whether physical activities, their intensity or frequency, may affect the potential for UI in addition to known risk factors in the general population. Higher prevalence of UI has been observed when engaging in high-impact sports, but research is sparse regarding UI in strength sports. Since the Olympic-style weightlifting has seen an unprecedented increase in women's participation in recent years, this study provides much-needed data to investigate whether weightlifting predisposes women to UI. OBJECTIVES The aim was to conduct a survey of female Master athletes in countries that are members of the International Weightlifting Federation using a validated incontinence severity index and to study (1) whether known risk factors in the general population increase the odds of UI in female competitive weightlifters and (2) whether sport-related factors are associated with UI after adjusting for known risk factors. The outcomes of interest were moderate or more severe UI and incontinence during lifts specific to weightlifting competitions. RESULTS Respondents consisted of 824 female competitive weightlifters from 29 countries, ages 30 to 79, median 41 years. Prevalence of moderate or more severe incontinence was 32%. Higher BMI, prior pregnancies, and depressive mood increased the odds, but age was not associated. Athletes who had engaged in high-impact sports prior to starting weightlifting training were at a higher risk of UI, but participation in prior strength sports was not associated with UI. The predictive probability of moderate or more severe UI increased with more hours per week of weightlifting training. CONCLUSIONS Our findings indicate that while female weightlifters had a higher prevalence of moderate or severe UI than in a general population according to the National Health and Nutrition Examination Survey, and that athletes who had engaged in high-impact sports prior to starting weightlifting were at a higher risk of UI.
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Affiliation(s)
- Marianne Huebner
- Department of Statistics and Probability, Michigan State University, East Lansing, Michigan, United States of America
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, United States of America
- * E-mail:
| | - Wenjuan Ma
- Center for Statistical Training and Consulting, Michigan State University, East Lansing, Michigan, United States of America
| | - Shirley Harding
- Department of Osteopathic Surgical Specialties, Michigan State University, East Lansing, Michigan, United States of America
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Menezes EC, da Silva Pereira F, Porto RM, Fank F, Mazo GZ. Effect of exercise on female pelvic floor morphology and muscle function: a systematic review. Int Urogynecol J 2022; 34:963-977. [PMID: 36205725 DOI: 10.1007/s00192-022-05375-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/20/2022] [Indexed: 10/10/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to synthesize the scientific evidence on the relationship of exercise with morphology and muscle function parameters of the female pelvic floor. The design was a systematic review. METHODS Searches were performed in MEDLINE, PubMed, CINAHL, Web of Science, SCOPUS, SportDiscuss, and Google Scholar up to April 2021. Observational and experimental studies evaluating the morphology and/or function of the pelvic floor muscles (PFMs) in women were eligible. Studies reporting exercise or sports disciplines as exposure/intervention were included. RESULTS Twenty-five studies were included. Compared with the control group, women performing vigorous and high-impact exercises exhibited lower maximum voluntary contraction of the PFM and those performing moderate exercise had better maximum voluntary contraction. Exercise practitioners had a larger hiatal area at rest, during contraction, and during Valsalva, and greater bladder neck descent than the control group. CONCLUSIONS The results of this review demonstrate an inverse relationship of PFM maximum voluntary contraction with exercise intensity. Qualitative synthesis showed that the studies found favorable outcomes for the control group in terms of hiatal area during contraction and Valsalva and bladder neck displacement.
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Affiliation(s)
| | - Franciele da Silva Pereira
- Gerontology Laboratory, State University of Santa Catarina, Street Pascoal Simone, 358, Coqueiros, Florianopolis, SC, CEP: 88080-350, Brazil.
| | - Rafaela Maria Porto
- Gerontology Laboratory, State University of Santa Catarina, Street Pascoal Simone, 358, Coqueiros, Florianopolis, SC, CEP: 88080-350, Brazil
| | - Felipe Fank
- Gerontology Laboratory, State University of Santa Catarina, Street Pascoal Simone, 358, Coqueiros, Florianopolis, SC, CEP: 88080-350, Brazil
| | - Giovana Zarpellon Mazo
- Gerontology Laboratory, State University of Santa Catarina, Street Pascoal Simone, 358, Coqueiros, Florianopolis, SC, CEP: 88080-350, Brazil
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Snyder K, Mollard E, Bargstadt-Wilson K, Peterson J, Branscum C, Richards T. Pelvic floor dysfunction in rural postpartum mothers in the United States: prevalence, severity, and psychosocial correlates. Women Health 2022; 62:775-787. [PMID: 36411292 DOI: 10.1080/03630242.2022.2146831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Pelvic floor dysfunction (PFD) is a common gynecological problem; however, women residing in rural communities may refrain from seeking treatment for PFD. The purpose of this study was to characterize severity of PFD among postpartum women residing in rural communities (<50,000 residents) in the United States and explore the demographic and psychosocial correlates of PFD. METHODS A survey packet comprised of the Pelvic Floor Disability Index (PFDI-20) and Prolapse and Incontinence Knowledge Questionnaire (PIKQ) as well as the Edinburgh Perinatal Depression Screening (EPDS), items from the Canadian Sexual Health Indicator (CSHI) survey, and demographic questions were distributed via electronic link following recruitment using social media. Descriptive statistics were calculated, and multivariate logistic regression was used to assess the factors associated with PFDI-20 score. RESULTS Participants (n = 383) have limited pelvic health knowledge (PIKQ) despite self-reporting moderate symptoms of dysfunction (PFDI-20). Over half of women scored ≥14 on the EPDS, indicating probable depression. Women with high scores on the EPDS had greater odds of reporting moderate/severe PFD. Women that identified as Black and/or having a college degree were more likely to report moderate/severe PFD. CONCLUSION Rural women require further support to improve their physical and psychological health in the postpartum period.
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Affiliation(s)
| | - Elizabeth Mollard
- College of Nursing, University Nebraska Medical Center, Lincoln, Nebraska, USA
| | - Kari Bargstadt-Wilson
- Physical Therapy Department, School of Pharmacy and Health Professions, Creighton University, Omaha, Nebraska, USA
| | | | - Caralin Branscum
- School of Criminology and Criminal Justice, University of Nebraska at Omaha, Omaha, Nebraska, USA
| | - Tara Richards
- School of Criminology and Criminal Justice, University of Nebraska at Omaha, Omaha, Nebraska, USA
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L’Heveder A, Chan M, Mitra A, Kasaven L, Saso S, Prior T, Pollock N, Dooley M, Joash K, Jones BP. Sports Obstetrics: Implications of Pregnancy in Elite Sportswomen, a Narrative Review. J Clin Med 2022; 11:jcm11174977. [PMID: 36078907 PMCID: PMC9456821 DOI: 10.3390/jcm11174977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/01/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
Increasing numbers of females are participating in elite sports, with a record number having competed at the Tokyo Olympic Games. Importantly, the ages of peak performance and fertility are very likely to coincide; as such, it is inevitable that pregnancy will occur during training and competition. Whilst there is considerable evidence to promote regular exercise in pregnancy, with benefits including a reduction in hypertensive disorders, gestational diabetes, and reduced rates of post-natal depression, few studies have been conducted which include elite athletes. Indeed, there are concerns that high-intensity exercise may lead to increased rates of miscarriage and preterm labour, amongst other pregnancy-related complications. There is minimal guidance on the obstetric management of athletes, and consequently, healthcare professionals frequently adopt a very conservative approach to managing such people. This narrative review summarises the evidence on the antenatal, intrapartum, and postpartum outcomes in elite athletes and provides recommendations for healthcare providers, demonstrating that generally, pregnant athletes can continue their training, with a few notable exceptions. It also summarises the physiological changes that occur in pregnancy and reviews the literature base regarding how these changes may impact performance, with benefits arising from pregnancy-associated cardiovascular adaptations at earlier gestations but later changes causing an increased risk of injury and fatigue.
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Affiliation(s)
- Ariadne L’Heveder
- Department of Surgery & Cancer, Imperial College London, London W12 0NN, UK
- Correspondence: ; Tel.: +44-07989356191
| | - Maxine Chan
- Department of Surgery & Cancer, Imperial College London, London W12 0NN, UK
- Queen Charlotte’s and Chelsea Hospital, Imperial College NHS Trust, Du Cane Road, London W12 0HS, UK
| | - Anita Mitra
- Department of Surgery & Cancer, Imperial College London, London W12 0NN, UK
- Queen Charlotte’s and Chelsea Hospital, Imperial College NHS Trust, Du Cane Road, London W12 0HS, UK
| | - Lorraine Kasaven
- Department of Surgery & Cancer, Imperial College London, London W12 0NN, UK
- Queen Charlotte’s and Chelsea Hospital, Imperial College NHS Trust, Du Cane Road, London W12 0HS, UK
| | - Srdjan Saso
- Department of Surgery & Cancer, Imperial College London, London W12 0NN, UK
- Queen Charlotte’s and Chelsea Hospital, Imperial College NHS Trust, Du Cane Road, London W12 0HS, UK
| | - Tomas Prior
- Queen Charlotte’s and Chelsea Hospital, Imperial College NHS Trust, Du Cane Road, London W12 0HS, UK
| | - Noel Pollock
- Institute of Sport, Exercise & Health, University College London, London W1T 7HA, UK
- British Athletics, National Performance Institute, Loughborough, LE11 3TU, UK
| | | | - Karen Joash
- Queen Charlotte’s and Chelsea Hospital, Imperial College NHS Trust, Du Cane Road, London W12 0HS, UK
| | - Benjamin P. Jones
- Department of Surgery & Cancer, Imperial College London, London W12 0NN, UK
- Queen Charlotte’s and Chelsea Hospital, Imperial College NHS Trust, Du Cane Road, London W12 0HS, UK
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Vieira I, Esteves D, Ramos L, Simões V, Franco S. Quality of life of fitness professionals in Portugal: Comparative and correlation study. Front Psychol 2022; 13:958063. [PMID: 36092028 PMCID: PMC9450883 DOI: 10.3389/fpsyg.2022.958063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Fitness has been revealing a positive impact on the quality of life (QoL) of practitioners and fitness professionals (FPs) represent a role model for their customers in the fitness industry, emphasizing the need to know their QoL indices. The purpose of this study is to characterize the QoL of FPs in Portugal, compare it between groups and correlate QoL with sociodemographic and work-related variables. A total of 388 FPs answered an online survey about sociodemographic and work-related variables and the Portuguese version of the World Health Organization Bref QoL Assessment. Descriptive analysis, t-test, ANOVA, Kruskal-Wallis, Pearson and Spearman were used for statistical analysis. The results suggest that FPs in Portugal have different levels of QoL, considering the high standard deviation, with lower average indices than other countries. The lowest scores of QoL were verified in the environment domain. The results of the comparison between groups suggest that being male, married and having a master’s degree or higher were the characteristics with better indices of QoL. Age, professional experience and net salary reveal a positive relation/association with QoL. Body&mind group classes (GC) per week, maximal GC per day, paid and unpaid working hours per week and annual expenses related to the profession reveal a negative relation/association. Maximal GC per day results could be an important finding to help minimize the physical problems among FPs and body&mind GC per week results could be an indicator of the FPs adaptation that allows them to remain on the profession. Unpaid working hours per week has the highest number of significant relations/associations with QoL. These findings could be important to improve the QoL of FPs. Thus, they could result in better work capacity and, therefore, fewer professionals would abandon the profession. It would also have a positive impact on the fitness industry and on the promotion of physical activity for a healthier society. More research is needed regarding the QoL of FPs.
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Affiliation(s)
- Isabel Vieira
- School of Sports of Rio Maior, Polytechnic Institute of Santarém, Rio Maior, Portugal
- Quality of Life Research Center (CIEQV), Santarém, Portugal
- Department of Sport Sciences, Faculty of Social and Human Sciences, University of Beira Interior, Covilhã, Portugal
- *Correspondence: Isabel Vieira,
| | - Dulce Esteves
- Department of Sport Sciences, Faculty of Social and Human Sciences, University of Beira Interior, Covilhã, Portugal
- Research Centre in Sports Sciences, Health Sciences and Human Development (CIDESD), Vila Real, Portugal
| | - Liliana Ramos
- School of Sports of Rio Maior, Polytechnic Institute of Santarém, Rio Maior, Portugal
- Quality of Life Research Center (CIEQV), Santarém, Portugal
| | - Vera Simões
- School of Sports of Rio Maior, Polytechnic Institute of Santarém, Rio Maior, Portugal
- Quality of Life Research Center (CIEQV), Santarém, Portugal
| | - Susana Franco
- School of Sports of Rio Maior, Polytechnic Institute of Santarém, Rio Maior, Portugal
- Quality of Life Research Center (CIEQV), Santarém, Portugal
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Fang J, Ye J, Huang Q, Lin Y, Weng Y, Wang M, Chen Y, Lu Y, Zhang R. Risk factors of pelvic floor muscle strength in south Chinese women: a retrospective study. BMC Pregnancy Childbirth 2022; 22:624. [PMID: 35933360 PMCID: PMC9356495 DOI: 10.1186/s12884-022-04952-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 07/26/2022] [Indexed: 12/31/2022] Open
Abstract
Objectives To evaluate pelvic floor muscle strength using surface electromyography and risk factors for pelvic floor muscle strength in the early postpartum period. Methods This retrospective study included 21,302 participants who visited Fujian
Maternity and Child Health Hospital from September 2019 to February 2022. All participants
were assessed by
medical professionals for general information and surface electromyography. Results Univariate analysis indicated that age was inversely related to tonic and endurance contractions. In contrast, all the other variables, including education level, body mass index, neonatal weight, and number of fetuses, had a positive impact on rapid, tonic, and endurance contractions. Likewise, parity was also positively associated with rapid contractions. In addition, compared with vaginal delivery, cesarean section delivery had a protective effect on the amplitude of the three types of contractions. Stepwise regression analysis showed that both age and neonatal weight had a negative linear relationship with the amplitude of rapid, tonic and endurance contractions. In contrast, the amplitude of rapid, tonic and endurance contractions significantly increased as body mass index, parity (≤ 3), education level and gestational weight gain (endurance contractions only) increased. Participants with cesarean section delivery showed positive effects on rapid, tonic, and endurance contractions compared to participants with vaginal delivery. Conclusions We found that age, neonatal weight, vaginal delivery, episiotomy, and forceps delivery were risk factors for pelvic floor muscle strength; in contrast, body mass index, parity (≤ 3) and gestational weight gain had a positive relationship with pelvic floor muscle strength.
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Affiliation(s)
- Jianqi Fang
- Department of Women's Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, 350000, People's Republic of China.,Department of Rehabilitation Assessment, Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350000, People's Republic of China
| | - Jiajia Ye
- Department of Rehabilitation Assessment, Rehabilitation Hospital, Fujian University of Traditional Chinese Medicine, Fujian, 350000, Fuzhou, People's Republic of China
| | - Qing Huang
- College of Environment and Public Health, Xiamen Huaxia University, Xiamen Fujian, People's Republic of China
| | - Yang Lin
- Department of Women's Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, 350000, People's Republic of China.,Department of Rehabilitation Assessment, Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350000, People's Republic of China
| | - Yilin Weng
- Department of Women's Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, 350000, People's Republic of China.,Department of Rehabilitation Assessment, Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350000, People's Republic of China
| | - Miao Wang
- Department of Women's Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, 350000, People's Republic of China.,Department of Rehabilitation Assessment, Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350000, People's Republic of China
| | - Yi Chen
- Department of Women's Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, 350000, People's Republic of China.,Department of Rehabilitation Assessment, Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350000, People's Republic of China
| | - Yao Lu
- Department of Women's Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, 350000, People's Republic of China.,Department of Rehabilitation Assessment, Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350000, People's Republic of China
| | - Ronghua Zhang
- Department of Women's Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, 350000, People's Republic of China. .,Department of Rehabilitation Assessment, Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350000, People's Republic of China.
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Yang C, Feng Z, Chen Z, Xu D, Li Y, Lai K, Yi F. The risk factors for urinary incontinence in female adults with chronic cough. BMC Pulm Med 2022; 22:276. [PMID: 35850673 PMCID: PMC9295435 DOI: 10.1186/s12890-022-02069-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/07/2022] [Indexed: 12/05/2022] Open
Abstract
Background Female patients with chronic cough are more likely to suffer from urinary incontinence (UI). However, there are few data in regard of risks related with UI in female adults with chronic cough. Method We recruited female adult patients with chronic cough from the cough specialist clinic. Demographic information and clinical characteristics including age, BMI, duration of cough, severity of cough, nature and timing of cough, cough triggers, concomitant symptoms, comorbidities and UI condition were collected. The demographics and clinical features of patients with UI and those without UI were compared. Result A total of 700 female patients with the main symptom of chronic cough were included, of whom 351 (50.1%) presented with UI. As compared with patients without UI, patients with UI showed a longer mean age (years) (49.5 vs. 42.4, p < 0.001), a more severe cough symptom (median of cough Visual Analogue Scale: 65 vs. 50, p < 0.001), a higher prevalence of chronic sinusitis (17.6% vs. 8.6%, p = 0.002), and combined with a higher incidence of abdominal muscle pain due to cough (39.6% vs. 18.7%, p < 0.001).In addition, patients in UI group whose cough were more easily triggered by exercise (28.2% vs. 17.2%, p = 0.048). Multivariate logistic regression analysis indicated the above five variables were risk factors for UI in female adult patients with chronic cough. Conclusion Urinary incontinence is a common complication in female patients with chronic cough. Older age, severe cough, combing with a higher proportion of chronic sinusitis and abdominal muscle pain, a cough easily triggered by exercise are identified as risk factors for urinary incontinence. We should pay more attention to female chronic coughers with these risk factors in clinics. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-02069-w.
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Affiliation(s)
- Cunzhen Yang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 28 middle Qiaozhong Rd, Liwan District, Guangzhou, Guangdong, People's Republic of China
| | - Zien Feng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 28 middle Qiaozhong Rd, Liwan District, Guangzhou, Guangdong, People's Republic of China
| | - Zhiyin Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 28 middle Qiaozhong Rd, Liwan District, Guangzhou, Guangdong, People's Republic of China
| | - Dongting Xu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 28 middle Qiaozhong Rd, Liwan District, Guangzhou, Guangdong, People's Republic of China
| | - Yuling Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 28 middle Qiaozhong Rd, Liwan District, Guangzhou, Guangdong, People's Republic of China
| | - Kefang Lai
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 28 middle Qiaozhong Rd, Liwan District, Guangzhou, Guangdong, People's Republic of China.
| | - Fang Yi
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 28 middle Qiaozhong Rd, Liwan District, Guangzhou, Guangdong, People's Republic of China.
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García-Perdomo HA, Uribe Bayona AJ, Zamora Segura BD. High-Impact Exercises Associated with an Increased Risk of Stress Urinary Incontinence: Systematic Review and Meta-Analysis. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00360-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Management of urinary incontinence in athletic women: the POsITIve feasibility study. Physiotherapy 2022; 114:30-37. [DOI: 10.1016/j.physio.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 11/04/2021] [Accepted: 12/13/2021] [Indexed: 11/24/2022]
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Giagio S, Innocenti T, Pillastrini P, Gava G, Salvioli S. What is known from the existing literature about the available interventions for pelvic floor dysfunction among female athletes? A scoping review. Neurourol Urodyn 2022; 41:573-584. [PMID: 35094428 PMCID: PMC9305779 DOI: 10.1002/nau.24883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/24/2021] [Accepted: 01/02/2022] [Indexed: 12/29/2022]
Abstract
Background Aim Methods Results Conclusions
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Affiliation(s)
- Silvia Giagio
- Division of Occupational Medicine IRCCS Azienda Ospedaliero‐Universitaria di Bologna Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM) Alma Mater Studiorum University of Bologna Bologna Italy
| | - Tiziano Innocenti
- Department of Health Science, Faculty of Science Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Amsterdam The Netherlands
| | - Paolo Pillastrini
- Division of Occupational Medicine IRCCS Azienda Ospedaliero‐Universitaria di Bologna Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM) Alma Mater Studiorum University of Bologna Bologna Italy
| | - Giulia Gava
- Gynecology and Physiopathology of Human Reproduction IRCCS Azienda Ospedaliero ‐Universitaria di Bologna Bologna Italy
- Department of Medical and Surgical Sciences (DIMEC) University of Bologna Bologna Italy
| | - Stefano Salvioli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health Campus of Savona University of Genova Genova Italy
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Corrêa Neto IJF, Oliveira MCD, Robles L, Santos LML, Rolim AS, Souza RFL, Watté HH, Cecchini ARDS. Is There a Precise Correlation between the Lengths of the Peritoneal Reflection and the Middle Rectal Valve? JOURNAL OF COLOPROCTOLOGY 2022. [DOI: 10.1055/s-0041-1739550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Introduction Pelvic anatomy remains a challenge, and thorough knowledge of its intricate landmarks has major clinical and surgical implications in several medical specialties. The peritoneal reflection is an important landmark in intraluminal surgery, rectal trauma, impalement, and rectal adenocarcinoma.
Objectives To investigate the correlation between the lengths of the middle rectal valve and of the peritoneal reflection determined with rigid sigmoidoscopy and to determine whether there are any differences in the location of the peritoneal reflection between the genders and in relation to body mass index (BMI) and parity.
Design We prospectively investigated the location of the middle rectal valve and of the peritoneal reflection via intraoperative rigid sigmoidoscopy in colorectal cancer patients undergoing elective colorectal surgery.
Results We evaluated 38 patients with a mean age of 55.5 years old (57.5% males) who underwent colorectal surgery at the coloproctology service of the Hospital Santa Marcelina, São Paulo, state of São Paulo, Brazil. There was substantial agreement between the lengths of the middle rectal valve and of the peritoneal reflection (Kappa = 0.66). In addition, the peritoneal reflection was significantly lower in overweight patients (p = 0.013 for women and p < 0.005 for men) and in women with > 2 vaginal deliveries (p = 0.009), but there was no significant difference in the length of the peritoneal reflection between genders (p = 0.32).
Conclusion There was substantial agreement between the lengths of the peritoneal reflection and of the middle rectal valve, and the peritoneal reflection was significantly lower in overweight patients and in women with more than two vaginal deliveries.
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Affiliation(s)
| | | | - Laercio Robles
- Department of General Surgery and Coloproctology Service, Faculdade de Medicina Santa Marcelina, São Paulo, SP, Brazil
| | | | - Alexander Sá Rolim
- Coloproctology Assistant Physicians from Faculdade de Medicina Santa Marcelina, São Paulo, SP, Brazil
| | | | - Hugo Henriques Watté
- Coloproctology Assistant Physicians from Faculdade de Medicina Santa Marcelina, São Paulo, SP, Brazil
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Snyder K, Mollard E, Bargstadt-Wilson K, Peterson J. “We don’t talk about it enough”: Perceptions of pelvic health among postpartum women in rural communities. WOMEN'S HEALTH 2022; 18:17455057221122584. [PMID: 36148940 PMCID: PMC9510969 DOI: 10.1177/17455057221122584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: A descriptive qualitative study was conducted to explore perceptions and
experiences related to pelvic health in the postpartum period among a cohort
of women residing in communities with less than 50,000 residents. Methods: A semi-structured interview approach guided by the Theory of Planned Behavior
was used. Postpartum individuals (<6 months since childbirth) were
interviewed in the fall/winter of 2021–2022. Results: Specific to individuals’ attitudes toward pelvic health, women viewed Kegels
as an important component to improving pelvic health but had a negative
attitude toward their own pelvic health, often identifying their pelvic
floor as “weak.” The subjective norms influencing a woman’s perception were
typically, a positive influence by family/friends and the Internet, although
the Internet was viewed as an insufficient resource. Healthcare providers
were noted as an infrequent and ineffective resource for education and
support in the postpartum period. Finally, women’s perceived behavioral
control to manage their pelvic health was influenced by limited knowledge of
pelvic health and time, and a desire for more education from their primary
care provider and geographical barriers. Conclusion: Innovative strategies are needed to support postpartum women’s pelvic health
within rural communities. Primary care providers may benefit from the
development of “quick tips” by specialists, such as women’s health physical
therapists, to optimize pelvic health discussions with their postpartum
patients. Education interventions targeted toward postpartum women in rural
communities should focus on strategies that address the geographic barriers
identified while still providing individualized care. Options, such as
webinars, telehealth, and text message interventions, could be
considered.
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Affiliation(s)
- Kailey Snyder
- Physical Therapy Department, Creighton University, Omaha, NE, USA
| | - Elizabeth Mollard
- College of Nursing-Lincoln Divison, University Nebraska Medical Center, Lincoln, NE, USA
| | | | - Julie Peterson
- Physical Therapy Department, Creighton University, Omaha, NE, USA
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Pisani GK, Sato TDO, de Carvalho DHT, Carvalho C. Impact of urinary incontinence on quality of life in female CrossFit practitioners: A cross-sectional study. Eur J Obstet Gynecol Reprod Biol 2021; 268:56-61. [PMID: 34861594 DOI: 10.1016/j.ejogrb.2021.11.424] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/13/2021] [Accepted: 11/19/2021] [Indexed: 11/04/2022]
Abstract
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.
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Affiliation(s)
- Giulia Keppe Pisani
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
| | | | | | - Cristiano Carvalho
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil.
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Reis BM, da Silva JB, Rocha APR, Liebano RE, Driusso P. Intravaginal electrical stimulation associated with pelvic floor muscle training for women with stress urinary incontinence: study protocol for a randomized controlled trial with economic evaluation. Trials 2021; 22:823. [PMID: 34801063 PMCID: PMC8606065 DOI: 10.1186/s13063-021-05781-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 11/01/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Pelvic floor muscle training (PFMT) exercises and neuromuscular electrical stimulation (NMES) are described as conservative interventions to prevent or treat female stress urinary incontinence (SUI). However, it has not been described yet the effect of PFMT associated to intravaginal NMES which evaluated the cost-effectiveness and cost-utility of treating. AIMS To evaluate the effects of intravaginal NMES associated with the PFMT protocol on urinary loss and quality of life in women with SUI and to evaluate the cost-effectiveness and cost-utility and pelvic floor muscle in women with SUI. METHODS Randomized controlled trial study with economic evaluation. Inclusion criteria are woman (biological), aged ≥ 18 years old and with a report of SUI ≥ once/week. Exclusion criteria are presence of vaginal or urinary infection, virginity, being in the gestational or puerperium period, or neurological disease. Participants will undergo physical therapy assessment and intervention: anamnesis, pelvic floor muscle assessment by vaginal palpation and manometry (PeritronTM), questionnaires (Short-Form 6 Dimensions-Brazil (SF-6D), King's Health Questionnaire (KHQ) and King´s Health Questionnaire for Scoring Algorithm), health costs, and voiding diary. Participants will be randomly allocated into 3 groups: CG (control group), IG 1 (intervention group 1, PFMT), and IG2 (intervention group 2, PFMT + NMES). The statistical analysis will be performed by intention to treat, and multivariate analysis of mixed effects will be used to compare outcomes. Effect size measurements will be calculated and will be provided by Cohen's d test. A significance level of 5% will be adopted. Additionally, the incremental cost-effectiveness and incremental cost-utility ratios will be used. DISCUSSION This protocol can corroborate with the literature in order to identify the effect of techniques, based on the possibility of confirming the hypothesis that the NMES associated with PFMT performed concurrently will be the best treatment option; considering the effectiveness, cost-effectiveness, and cost-utility analysis, it will be used as an option for optimization of the treatment of SUI. TRIAL REGISTRATION Brazilian Registry of Clinical Trials (ReBEC) ID: RBR-6gtzg4 . Registered on September 3, 2019.
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Affiliation(s)
- Bianca Manzan Reis
- Women’s Health Research Laboratory, Physical Therapy Post-Graduate Program, Federal University of São Carlos, Rod. Washington Luis, km 235, CEP, São Carlos, SP 13565-905 Brazil
| | - Jordana Barbosa da Silva
- Women’s Health Research Laboratory, Physical Therapy Post-Graduate Program, Federal University of São Carlos, Rod. Washington Luis, km 235, CEP, São Carlos, SP 13565-905 Brazil
| | - Ana Paula Rodrigues Rocha
- Women’s Health Research Laboratory, Physical Therapy Post-Graduate Program, Federal University of São Carlos, Rod. Washington Luis, km 235, CEP, São Carlos, SP 13565-905 Brazil
| | - Richard Eloin Liebano
- Physioterapeutics Resources Laboratory, Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP Brazil
| | - Patricia Driusso
- Women’s Health Research Laboratory, Physical Therapy Post-Graduate Program, Federal University of São Carlos, Rod. Washington Luis, km 235, CEP, São Carlos, SP 13565-905 Brazil
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Joseph C, Srivastava K, Ochuba O, Ruo SW, Alkayyali T, Sandhu JK, Waqar A, Jain A, Poudel S. Stress Urinary Incontinence Among Young Nulliparous Female Athletes. Cureus 2021; 13:e17986. [PMID: 34660161 PMCID: PMC8516023 DOI: 10.7759/cureus.17986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/15/2021] [Indexed: 11/12/2022] Open
Abstract
Urinary incontinence (UI) is described as unintentional voiding of urine that is usually seen in post-partum and post-menopausal women due to the weakening of pelvic floor muscles (PFM). Recent studies have shown an increase in the prevalence of stress urinary incontinence (SUI) among young nulliparous female athletes. The association between UI and high-impact physical activity is due to increased intra-abdominal pressure during high-impact sports exceeding intra-urethral pressure. Usually, the levator ani muscle (LAM) helps in urethral closure. However, weakening or injury of LAM can reduce the pelvic support and cause UI in young female athletes. This study aims to assess the prevalence of SUI among young nulliparous athletes and also explore the association between SUI and athletic sports in young females. We searched PubMed and Google Scholar as databases to find specific articles about the topic. After the inclusion and exclusion criteria were applied, 52 articles were selected for this review. It is found that there is an increased UI prevalence, mainly SUI, among young nulliparous female athletes, especially in volleyball players and long-distance runners. Nulliparous athletes involved in high-impact exercises were found to have an increased cross-sectional area of LAM and puborectalis muscle width. SUI is usually under-reported and underdiagnosed due to lack of knowledge and unawareness, which can negatively affect the personal and social life of young females. PFM training is considered the first line of therapy among nulliparous athletes. However, it is unclear whether the high-impact effects of sports cause UI through PFM fatigue or PFM damage. More research is needed to better understand this effect.
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Affiliation(s)
- Christine Joseph
- Urology and Obstetrics & Gynecology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Kosha Srivastava
- Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Olive Ochuba
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sheila W Ruo
- General Surgery Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Tasnim Alkayyali
- Pathology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Jasmine K Sandhu
- Obstetrics & Gynecology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ahsan Waqar
- Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ashish Jain
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sujan Poudel
- Psychiatry and Behavioral Sciences, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Haeusler M, Grunstra ND, Martin RD, Krenn VA, Fornai C, Webb NM. The obstetrical dilemma hypothesis: there's life in the old dog yet. Biol Rev Camb Philos Soc 2021; 96:2031-2057. [PMID: 34013651 PMCID: PMC8518115 DOI: 10.1111/brv.12744] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 12/17/2022]
Abstract
The term 'obstetrical dilemma' was coined by Washburn in 1960 to describe the trade-off between selection for a larger birth canal, permitting successful passage of a big-brained human neonate, and the smaller pelvic dimensions required for bipedal locomotion. His suggested solution to these antagonistic pressures was to give birth prematurely, explaining the unusual degree of neurological and physical immaturity, or secondary altriciality, observed in human infants. This proposed trade-off has traditionally been offered as the predominant evolutionary explanation for why human childbirth is so challenging, and inherently risky, compared to that of other primates. This perceived difficulty is likely due to the tight fit of fetal to maternal pelvic dimensions along with the convoluted shape of the birth canal and a comparatively low degree of ligamentous flexibility. Although the ideas combined under the obstetrical dilemma hypothesis originated almost a century ago, they have received renewed attention and empirical scrutiny in the last decade, with some researchers advocating complete rejection of the hypothesis and its assumptions. However, the hypothesis is complex because it presently captures several, mutually non-exclusive ideas: (i) there is an evolutionary trade-off resulting from opposing selection pressures on the pelvis; (ii) selection favouring a narrow pelvis specifically derives from bipedalism; (iii) human neonates are secondarily altricial because they are born relatively immature to ensure that they fit through the maternal bony pelvis; (iv) as a corollary to the asymmetric selection pressure for a spacious birth canal in females, humans evolved pronounced sexual dimorphism of pelvic shape. Recently, the hypothesis has been challenged on both empirical and theoretical grounds. Here, we appraise the original ideas captured under the 'obstetrical dilemma' and their subsequent evolution. We also evaluate complementary and alternative explanations for a tight fetopelvic fit and obstructed labour, including ecological factors related to nutrition and thermoregulation, constraints imposed by the stability of the pelvic floor or by maternal and fetal metabolism, the energetics of bipedalism, and variability in pelvic shape. This reveals that human childbirth is affected by a complex combination of evolutionary, ecological, and biocultural factors, which variably constrain maternal pelvic form and fetal growth. Our review demonstrates that it is unwarranted to reject the obstetrical dilemma hypothesis entirely because several of its fundamental assumptions have not been successfully discounted despite claims to the contrary. As such, the obstetrical dilemma remains a tenable hypothesis that can be used productively to guide evolutionary research.
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Affiliation(s)
- Martin Haeusler
- Institute of Evolutionary MedicineUniversity of ZurichWinterthurerstrasse 190Zürich8057Switzerland
| | - Nicole D.S. Grunstra
- Konrad Lorenz Institute (KLI) for Evolution and Cognition ResearchMartinstrasse 12Klosterneuburg3400Austria
- Department of Evolutionary BiologyUniversity of ViennaUniversity Biology Building (UBB), Carl Djerassi Platz 1Vienna1030Austria
- Mammal CollectionNatural History Museum ViennaBurgring 7Vienna1010Austria
| | - Robert D. Martin
- Institute of Evolutionary MedicineUniversity of ZurichWinterthurerstrasse 190Zürich8057Switzerland
- The Field Museum1400 S Lake Shore DrChicagoIL60605U.S.A.
| | - Viktoria A. Krenn
- Institute of Evolutionary MedicineUniversity of ZurichWinterthurerstrasse 190Zürich8057Switzerland
- Department of Evolutionary AnthropologyUniversity of ViennaUniversity Biology Building (UBB), Carl Djerassi Platz 1Vienna1030Austria
| | - Cinzia Fornai
- Institute of Evolutionary MedicineUniversity of ZurichWinterthurerstrasse 190Zürich8057Switzerland
- Department of Evolutionary AnthropologyUniversity of ViennaUniversity Biology Building (UBB), Carl Djerassi Platz 1Vienna1030Austria
| | - Nicole M. Webb
- Institute of Evolutionary MedicineUniversity of ZurichWinterthurerstrasse 190Zürich8057Switzerland
- Senckenberg Research Institute and Natural History Museum FrankfurtSenckenberganlage 25Frankfurt am Main60325Germany
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49
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Wolpern AE, de Gennaro JD, Brusseau TA, Byun W, Egger MJ, Hitchcock RW, Nygaard IE, Sheng X, Shaw JM. Relationship of heart rate, perceived exertion, and intra-abdominal pressure in women. ACTA ACUST UNITED AC 2021; 9:97-103. [PMID: 34532155 DOI: 10.31189/2165-6193-9.3.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Exercise increases intra-abdominal pressure (IAP) acutely, which may impact the pelvic floor of women. IAP during exercise demonstrates high variability among women but is not routinely assessed. Assessing less invasive measures related to IAP during exercise may facilitate study of how IAP impacts the pelvic floor. Methods The objective of this study was to investigate the relationship of heart rate and rating of perceived exertion (RPE) with IAP during a standard treadmill test. We describe the trend of IAP by predicted aerobic fitness during incremental exercise. IAP was measured using a validated transducer placed in the upper vagina. Heart rate and RPE were collected during the first 3 stages of the standard Bruce treadmill protocol. Relationships of heart rate and RPE with IAP were determined by Pearson correlation coefficients. Predicted aerobic fitness values for each participant were ranked in tertiles with IAP by treadmill stage. Results Twenty-four women participated in this study (mean age: 24.7 (5.4) years; body mass index: 22.5 (2.2) kg/m2). There were significant relationships between heart rate and IAP (r= 0.67, p < 0.001) and RPE and IAP (r= 0.60, p < 0.001) across treadmill stages. Tertiles of predicted aerobic fitness and IAP displayed similar trends as other exercise measures during incremental exercise, such as, heart rate and ventilation. Conclusion Heart rate and RPE could be used as proxy measures of IAP during incremental exercise. Aerobic fitness may help explain IAP variability in women and provide context for future research on IAP and pelvic floor health.
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Affiliation(s)
- Ali E Wolpern
- Department of Health, Kinesiology, and Recreation, University of Utah College of Health, Salt Lake City, United States
| | - Johanna D de Gennaro
- Department of Biomedical Engineering, University of Utah College of Engineering, Salt Lake City, United States
| | - Timothy A Brusseau
- Department of Health, Kinesiology, and Recreation, University of Utah College of Health, Salt Lake City, United States
| | - Wonwoo Byun
- Department of Health, Kinesiology, and Recreation, University of Utah College of Health, Salt Lake City, United States
| | - Marlene J Egger
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, United States
| | - Robert W Hitchcock
- Department of Biomedical Engineering, University of Utah College of Engineering, Salt Lake City, United States
| | - Ingrid E Nygaard
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, United States
| | - Xiaoming Sheng
- University of Utah College of Nursing, Salt Lake City, United States
| | - Janet M Shaw
- Department of Health, Kinesiology, and Recreation, University of Utah College of Health, Salt Lake City, United States
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50
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Moore IS, James ML, Brockwell E, Perkins J, Jones AL, Donnelly GM. Multidisciplinary, biopsychosocial factors contributing to return to running and running related stress urinary incontinence in postpartum women. Br J Sports Med 2021; 55:1286-1292. [PMID: 34144950 DOI: 10.1136/bjsports-2021-104168] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To examine contributory factors behind postpartum return-to-running and return to pre-pregnancy running level, in addition to risk factors for postpartum running-related stress urinary incontinence (SUI). METHODS 881 postpartum women completed an online questionnaire. Clinically and empirically derived questions were created relating to running experiences and multidisciplinary, biopsychosocial contributory factors. Logistic regression was used to determine predictors for return-to-running, returning to pre-pregnancy level of running and running-related SUI. RESULTS Median time to first postpartum run was 12 weeks. Running during pregnancy (OR: 2.81 (1.90 to 4.15)), a high weekly running volume (OR: 1.79 (1.22 to 2.63)), lower fear of movement (OR: 0.53 (0.43 to 0.64)) and not suffering vaginal heaviness (OR: 0.52 (0.35-0.76)) increased the odds of return-to-running. Factors that increased the odds of returning to pre-pregnancy running level were a low weekly running volume (OR: 0.38 (0.26 to 0.56)), having more than one child (OR: 2.09 (1.43 to 3.05)), lower fear of movement (OR: 0.78 (0.65 to 0.94)), being younger (OR: 0.79 (0.65 to 0.96)) and shorter time to running after childbirth (OR: 0.74 (0.60 to 0.90)). Risk factors for running-related SUI were having returned to running (OR: 2.70 (1.51 to 4.76)) and suffering running-related SUI pre-pregnancy (OR: 4.01 (2.05 to 7.82)) and during pregnancy (OR: 4.49 (2.86 to 7.06)); having a caesarean delivery decreased the odds (OR: 0.39 (0.23 to 0.65)). CONCLUSION Running during pregnancy may assist women safely return-to-running postpartum. Fear of movement, the sensation of vaginal heaviness and running-related SUI before or during pregnancy should be addressed early by healthcare providers.
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Affiliation(s)
- Isabel S Moore
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Megan L James
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Emma Brockwell
- Private practice, Oxted, UK.,Perinatal Physical Activity Research Group, Canterbury Christchurch University, Canterbury, UK
| | | | - Alex L Jones
- Department of Psychology, Swansea University, Swansea, UK
| | - Gráinne M Donnelly
- Perinatal Physical Activity Research Group, Canterbury Christchurch University, Canterbury, UK.,Private practice, ABSOLUTE.PHYSIO, Maguiresbridge, UK.,University of Ulster, Coleraine, Londonderry, UK
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