Int J Sports Med 2023; 44(06): 397-405
DOI: 10.1055/a-1939-4798
Review

Pelvic Floor Muscle Training In Women Practicing High-impact Sports: A Systematic Review

Fernanda Sayuri Fukuda
1   Physiotherapy, UDESC, Florianopolis, Brazil
,
Eliane Regina Mendoza Arbieto
2   Physiotherapy, Universidade do Estado de Santa Catarina, Florianopolis, Brazil
,
Thuane Da Roza
3   INEGI, Faculty of Engineering, University of Porto, Porto, Portugal
4   Department of Physiotherapy, College of Health and Sport Science, Santa Catarina State University (CEFID/UDESC), Florianópolis, Brazil
,
Soraia Cristina Tonon da Luz
4   Department of Physiotherapy, College of Health and Sport Science, Santa Catarina State University (CEFID/UDESC), Florianópolis, Brazil
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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.

Key words

pelvic floor - pelvic floor disorders - physiotherapy - sports - women


Publication History

Received: 12 July 2022

Accepted: 04 September 2022

Accepted Manuscript online:
08 September 2022

Article published online:
17 February 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Haylen BT, de Ridder D, Freeman RM. et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 2010; 21: 5-26
    CrossrefPubMedGoogle Scholar
  • 2 Alves JO, Luz STD, Brandão S. et al. Urinary incontinence in physically active young women: prevalence and related factors. Int J Sports Med 2017; 38: 937-941
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Teixeira RV, Colla C, Sbruzzi G. et al. Prevalence of urinary incontinence in female athletes: a systematic review with meta-analysis. Int Urogynecol J 2018; 29: 1717-1725
    CrossrefPubMedGoogle Scholar
  • 4 Bø K, Nygaard IE. Is physical activity good or bad for the female pelvic floor? a narrative review. Sports Med 2020; 50: 471-484
    CrossrefPubMedGoogle Scholar
  • 5 de Mattos Lourenco TR, Matsuoka PK, Baracat EC, Haddad JM. Urinary incontinence in female athletes: a systematic review. Int Urogynecol J 2018; 29: 1757-1763
    CrossrefPubMedGoogle Scholar
  • 6 Almousa S, Bandin Van Loon A. The prevalence of urinary incontinence in nulliparous female sportswomen: A systematic review. J Sports Sci 2019; 37: 1663-1672
    CrossrefPubMedGoogle Scholar
  • 7 Cardoso AMB, Lima CROP, Ferreira CWS. Prevalence of urinary incontinence in high-impact sports athletes and their association with knowledge, attitude and practice about this dysfunction. Eur J Sports Sci 2018; 18: 1405-1412
    CrossrefPubMedGoogle Scholar
  • 8 Pires T, Pires P, Moreira H, Viana R. Prevalence of urinary incontinence in high-impact sport athletes: a systematic review and meta-analysis. J Hum Kinet 2020; 73: 279-288
    CrossrefPubMedGoogle Scholar
  • 9 Eliasson K, Edner A, Mattsson E. Urinary incontinence in very young and mostly nulliparous women with a history of regular organised high-impact trampoline training: occurrence and risk factors. Int Urogynecol J Pelvic Floor Dysfunct 2008; 19: 687-696
    CrossrefPubMedGoogle Scholar
  • 10 Da Roza T, Brandão S, Mascarenhas T. et al. Volume of training and the ranking level are associated with the leakage of urine in young female trampolinists. Clin J Sport Med 2015; 25: 270-275
    CrossrefPubMedGoogle Scholar
  • 11 Hagovska M, Švihra J, Buková A. et al. Prevalence and risk of sport types to stress urinary incontinence in sportswomen: A cross-sectional study. Neurourol Urodyn 2018; 37: 1957-1964
    CrossrefPubMedGoogle Scholar
  • 12 Araujo MP, Sartori MGF, Girão MJBC. Athletic Incontinence: Proposal of a New Term for a New Woman. Rev Bras Ginecol Obstet 2017; 39: 441-442
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Bø K. Urinary incontinence, pelvic floor dysfunction, exercise and sport. Sports Med 2004; 34: 451-464
    CrossrefPubMedGoogle Scholar
  • 14 Ree ML, Nygaard I, Bø K. Muscular fatigue in the pelvic floor muscles after strenuous physical activity. Acta Obstet Gynecol Scand 2007; 86: 870-876
    CrossrefPubMedGoogle Scholar
  • 15 Frawley H, Shelly B, Morin M. et al. An International Continence Society (ICS) report on the terminology for pelvic floor muscle assessment. Neurourol Urodyn 2021; 40: 1217-1260
    CrossrefPubMedGoogle Scholar
  • 16 Middlekauff ML, Egger MJ, Nygaard IE, Shaw JM. The impact of acute and chronic strenuous exercise on pelvic floor muscle strength and support in nulliparous healthy women. Am J Obstet Gynecol 2016; 215: 316.e1-316.e7
    CrossrefPubMedGoogle Scholar
  • 17 Thomaz RP, Colla C, Darski C, Paiva LL. Influence of pelvic floor muscle fatigue on stress urinary incontinence: a systematic review. Int Urogynecol J 2018; 29: 197-204
    CrossrefPubMedGoogle Scholar
  • 18 Bø K. Pelvic floor muscle training in treatment of female stress urinary incontinence, pelvic organ prolapse and sexual dysfunction. World J Urol 2012; 30: 437-443
    CrossrefPubMedGoogle Scholar
  • 19 Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev 2018; 10: CD005654
    CrossrefPubMedGoogle Scholar
  • 20 Radzimińska A, Strączyńska A, Weber-Rajek M. et al. The impact of pelvic floor muscle training on the quality of life of women with urinary incontinence: a systematic literature review. Clin Interv Aging 2018; 13: 957-965
    CrossrefPubMedGoogle Scholar
  • 21 Viana R, Viana S, Neto F, Mascarenhas T. Adaptation and validation of the King’s Health Questionnaire in Portuguese women with urinary incontinence. Int Urogynecol J 2015; 26: 1027-1033
    CrossrefPubMedGoogle Scholar
  • 22 Moseley AM, Herbert RD, Sherrington C, Maher CG. Evidence for physiotherapy practice: A survey of the Physiotherapy Evidence Database (PEDro). Aust J Physiother 2002; 48: 43-49
    CrossrefPubMedGoogle Scholar
  • 23 de Morton NA. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother 2009; 55: 129-133
    CrossrefPubMedGoogle Scholar
  • 24 Cashin AG, McAuley JH. Clinimetrics: physiotherapy evidence database (PEDro) scale. J Physiother 2020; 66: 59
    CrossrefPubMedGoogle Scholar
  • 25 Sterne JA, Hernán MA, Reeves BC. et al. ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016; 355: i4919
    CrossrefPubMedGoogle Scholar
  • 26 Slade SC, Dionne CE, Underwood M, Buchbinder R. Consensus on exercise reporting template (CERT): explanation and elaboration statement. Br J Sports Med 2016; 50: 1428-1437
    CrossrefPubMedGoogle Scholar
  • 27 Ferreira S, Ferreira M, Carvalhais A. et al. Reeducation of pelvic floor muscles in volleyball athletes. Rev Assoc Med Bras 2014; 60: 428-433
    CrossrefPubMedGoogle Scholar
  • 28 Pires TF, Pires PM, Moreira MH. et al. Pelvic floor muscle training in female athletes: a randomized controlled pilot study. Int J Sports Med 2020; 41: 264-270
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Sherman RA, Davis GD, Wong MF. Behavioral treatment of exercise-induced urinary incontinence among female soldiers. Mil Med 1997; 162: 690-694
    CrossrefPubMedGoogle Scholar
  • 30 Da Roza T, de Araujo MP, Viana R. et al. Pelvic floor muscle training to improve urinary incontinence in young, nulliparous sport students: A pilot study. Int Urogynecol J 2012; 23: 1069-1073
    CrossrefPubMedGoogle Scholar
  • 31 Sousa M, Viana R, Viana S. et al. Effects of a pelvic floor muscle training in nulliparous athletes with urinary incontinence: biomechanical models protocol. In: Tavares J, Natal Jorge R (Eds). Computational and Experimental Biomedical Sciences: Methods and Applications. Lecture Notes in Computational Vision and Biomechanics. vol 21. Springer, Cham.; 2015; 83-90
    PubMedGoogle Scholar
  • 32 Resende AP, Stüpp L, Bernardes BT. et al. Can hypopressive exercises provide additional benefits to pelvic floor muscle training in women with pelvic organ prolapse?. Neurourol Urodyn 2012; 31: 121-125
    CrossrefPubMedGoogle Scholar
  • 33 Bø K. Pelvic floor muscle strength and response to pelvic floor muscle training for stress urinary incontinence. Neurourol Urodyn 2003; 22: 654-658
    CrossrefPubMedGoogle Scholar
  • 34 Schütze S, Heinloth M, Uhde M. et al. The effect of pelvic floor muscle training on pelvic floor function and sexuality postpartum. A randomized study including 300 primiparous. Arch Gynecol Obstet 2022; 306: 785–793
    PubMed
  • 35 Pires T, Pires P, Moreira H. et al. Leg stiffness and muscle power vs manometer in sportswomen with symptoms of stress urinary incontinence. Clin Biomech (Bristol, Avon) 2021; 90: 105471
    CrossrefPubMedGoogle Scholar
  • 36 Hagovska M, Svihra J, Bukova A. et al. The impact of physical activity measured by the International Physical Activity questionnaire on the prevalence of stress urinary incontinence in young women. Eur J Obstet Gynecol Reprod Biol 2018; 228: 308-312
    CrossrefPubMedGoogle Scholar
  • 37 Hagovska M, Švihra J, Buková A. et al. Prevalence of urinary incontinence in females performing high-impact exercises. Int J Sports Med 2017; 38: 210-216
    Article in Thieme ConnectPubMedGoogle Scholar
  • 38 Pires T, Pires P, Moreira H. et al. Assessment of pelvic floor muscles in sportswomen: Quality of life and related factors. Phys Ther Sport 2020; 43: 151-156
    CrossrefPubMedGoogle Scholar
  • 39 Dakic JG, Cook J, Hay-Smith J. et al. Pelvic floor disorders stop women exercising: A survey of 4556 symptomatic women. J Sci Med Sport 2021; 24: 1211-1217
    CrossrefPubMedGoogle Scholar
  • 40 Carvalhais A, Natal Jorge R, Bø K. Performing high-level sport is strongly associated with urinary incontinence in elite athletes: a comparative study of 372 elite female athletes and 372 controls. Br J Sports Med 2018; 52: 1586-1590
    CrossrefPubMedGoogle Scholar
  • 41 GCMF Pucci, Rech CR, Fermino RC, Reis RS. Association between physical activity and quality of life in adults. Rev. Saúde Pública 2012; 46: 166-179
    PubMedGoogle Scholar
  • 42 García-Sánchez E, Ávila-Gandía V, López-Román J. et al. What pelvic floor muscle training load is optimal in minimizing urine loss in women with stress urinary incontinence? A systematic review and meta-analysis. Int J Environ Res Public Health 2019; 16: 4358
    CrossrefPubMedGoogle Scholar
  • 43 Moher D, Liberati A, Tetzlaff J, Altman DG. The PRISMA group (2009) preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6: e1000097
    CrossrefPubMedGoogle Scholar