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.

Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • 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
    CrossrefPubMedSearch in Google 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
    Thieme ConnectPubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    Thieme ConnectPubMedSearch in Google Scholar
  • 13 Bø K. Urinary incontinence, pelvic floor dysfunction, exercise and sport. Sports Med 2004; 34: 451-464
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    Search in Google 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
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google Scholar
  • 24 Cashin AG, McAuley JH. Clinimetrics: physiotherapy evidence database (PEDro) scale. J Physiother 2020; 66: 59
    CrossrefPubMedSearch in Google 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
    Search in Google 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
    CrossrefPubMedSearch in Google 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
    Search in Google 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
    Thieme ConnectPubMedSearch in Google Scholar
  • 29 Sherman RA, Davis GD, Wong MF. Behavioral treatment of exercise-induced urinary incontinence among female soldiers. Mil Med 1997; 162: 690-694
    CrossrefPubMedSearch in Google 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
    Search in Google 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
    PubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    Thieme ConnectPubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    PubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    Search in Google Scholar