How to balance the treatment of stress urinary incontinence among female athletes?

Abstract

Urinary incontinence in the general population occurs in 7% of non-pregnant women under 39 years old, 17% of those 40 to 59 years old, and 23–32% of those over 60 years old. In athletes the prevalence is higher, especially in high-impact training and gravity sports. Pelvic floor muscles (PFM) have two important roles; they serve as the support for abdominal organs and are crucial for closure of the urethra, vagina and rectum. We present the proper mechanisms of PFM caudal contractions with proper abdominal muscle control to avoid excessive intra-abdominal pressure. Pelvic floor sonography is discussed as the only objective method for pelvic floor examination among sportswomen and a tool which should be used routinely by urophysiotherapists and urogynecologists. A multidisciplinary individualized approach to stress urinary incontinence among athletes is presented including: physiotherapy, diagnostic imaging, use of a pessary, tampons, pharmacologic and surgical treatment. We present guidelines for stress urinary incontinence treatment in sportswomen of different age.

Stress Urinary Incontinence Among Young Nulliparous Female Athletes

“…Urinary continence is generally formed by the balance between intravesical and intraurethral pressure [27]. Intravesical pressure is determined by the intraabdominal pressure, whereas intraurethral pressure is influenced by the sphincter and "hammock" muscle (levator ani, anterior vagina wall) [27].…”

“…Urinary continence is generally formed by the balance between intravesical and intraurethral pressure [27]. Intravesical pressure is determined by the intraabdominal pressure, whereas intraurethral pressure is influenced by the sphincter and "hammock" muscle (levator ani, anterior vagina wall) [27]. In case of increased intra-abdominal pressure, the mechanism modulating urethral closure involves shortening the sub-urethral part of the vaginal wall and levator ani, with sacrouterine ligaments pulling in the posterior direction [27].…”

“…In case of increased intra-abdominal pressure, the mechanism modulating urethral closure involves shortening the sub-urethral part of the vaginal wall and levator ani, with sacrouterine ligaments pulling in the posterior direction [27]. Dysregulation of this delicate balance can lead to UI in young women [27]. SUI is more prevalent in high-impact exercises as compared to low-impact ones.…”

“…Therefore, management begins with conservative measures and changes in lifestyle such as voiding before workouts, avoiding fluids just before physical activity, wearing dark-shaded garments, followed by physiotherapy of the PFM and pharmaceutical treatments. Surgery is reserved for refractory or severe cases [27].…”

Abdominal complex muscle in women with stress urinary incontinence – prospective case-control study

“…The abdominal muscles which generate intra-abdominal pressure, thereby leading to leakage of urine in the case of women with SUI stress urinary incontinence have therefore become a target of study for many specialists [4][5][6][7][8][9]. Information concerning the co-contractions of the pelvic floor muscles with different abdominal muscles can be found in the literature [4][5][6][10][11][12][13]. The Our experience of the authors of the present study in working with patients suffering from different pelvic area disorders confirms that such cocontractions do indeed occur but However, the dependency existing between the working of the abdominal muscles and the pelvic floor muscles is not fully understood.…”