Pelvic Floor Muscle Training in Female Athletes: A Randomized
Controlled Pilot Study

Pires, Telma; Pires, Patrícia; Moreira, Helena; Gabriel, Ronaldo; João, Paulo Vicente; Viana, Sara; Viana, Rui

doi:10.1055/a-1073-7977

Cited by 37 publications

(71 citation statements)

References 25 publications

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“…26 Interestingly, although athletes have stronger PFMs, high-quality research demonstrated that after 16 weeks of PFM training, volleyball athletes showed a significant improvement in maximum voluntary PFM contraction and urinary loss. 27 The present study also revealed that although the athletes had a higher maximum voluntary PFM contraction, they could not maintain the contraction strength for a long time (endurance). This leads us to believe that the occurrence of UI during sports training may be due to the difficulty of maintaining prolonged PFM contractions, fatiguing these muscles and leading to urine loss.…”

Section: Discussionmentioning

confidence: 49%

“…Their findings also revealed that mild‐to‐moderate physical activities, such as walking, decrease the risk of UI; however, female athletes are approximately three times more likely to have UI compared to control participants 26 . Interestingly, although athletes have stronger PFMs, high‐quality research demonstrated that after 16 weeks of PFM training, volleyball athletes showed a significant improvement in maximum voluntary PFM contraction and urinary loss 27 …”

Section: Discussionmentioning

confidence: 98%

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Comparison of urinary incontinence, based on pelvic floor and abdominal muscle strength, between nulliparous female athletes and non‐athletes: A secondary analysis

Arbieto

Santos²,

Luz

et al. 2021

Neurourology and Urodynamics

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Aims To compare the strength of abdominal and pelvic floor muscles (PFM) between nulliparous female athletes (FAs) and non‐athletes (FNAs), to determine the frequency of urinary incontinence (UI) in these groups. Methods This cross‐sectional comparative study of nulliparous women included 39 professional FAs, who competed at the district level or above, and 34 FNAs. Participants underwent pelvic floor and abdominal muscle assessments. PFM function and strength were assessed using the modified Oxford scale and a manometer (PERINA 996‐2 QUARK). Abdominal muscle function and strength were assessed using a 4‐Pro isokinetic dynamometer. The International Consultation on Incontinence Questionnaire‐Short Form was used to assess UI symptoms among the athletes, and the International Physical Activity Questionnaire‐Short Form was used to establish the level of physical activity among the non‐athletes. Results The prevalence of UIs in the FAs was 53.8%, while that for FNAs was 35.3%. There was no association between being an athlete and having UI (p = 0.112). FAs were found to weigh more (p = 0.012) and have increased abdominal muscle strength (p = 0.014) and maximum voluntary PFM contraction as recorded by the manometer (p = 0.035), as well as a decreased PFM contraction endurance time (p = 0.025) than FNAs. Conclusion FAs had stronger abdominal muscles and PFM contraction, as assessed by a manometer, but less PFM endurance when compared to FNAs. Despite these differences, the prevalence of UI was similar between groups.

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Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 98%

Comparison of urinary incontinence, based on pelvic floor and abdominal muscle strength, between nulliparous female athletes and non‐athletes: A secondary analysis

Arbieto

Santos²,

Luz

et al. 2021

Neurourology and Urodynamics

View full text Add to dashboard Cite

show abstract

“…Phasic contraction provides immediate support to the urethra, whereas tonic contraction stabilizes the urethra [27]. An observational study conducted in 2020 demonstrated SUI improvement in athletes that underwent pelvic muscle training compared to those that did not [36]. Furthermore, a pilot study done in 2012 showed an improvement in the vaginal resting pressure and MVC in athletic students who completed an eight-week program of PFM training [37].…”

Section: Non-pharmacological Methodsmentioning

confidence: 99%

Stress Urinary Incontinence Among Young Nulliparous Female Athletes

Joseph

Srivastava

Ochuba

et al. 2021

Cureus

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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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“…The various randomized clinical studies returned by the PubMed searches showed the effectiveness of PF rehabilitation in UI [ 12 , 13 , 14 ]. Symptoms of PF dysfunctions may progress and affect an athlete’s life [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, a series of sports were found, such as gymnastics, basketball, tennis, field hockey, track, swimming, volleyball, softball, golf (transversal study by Nygaard in 1994 [ 30 ]); female soccer (clinical case by Louis in 2019 [ 13 ]); some cases of female volleyball players (randomized trial by Pires in 2020 [ 14 ]); and elite female athletes (transversal studies by Nygaard in 1996 [ 32 ]) and Thyssen [ 24 ]) and meta-analysis by Cerruto in 2019 [ 35 ]) where the risk of urinary incontinence was shown to be higher in athletes than in the control group, and where physiotherapy favored the control group more than the athletes. This finding is especially interesting given the poor prognosis associated with these sports.…”

Section: Discussionmentioning

confidence: 99%

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

Sorrigueta-Hernández

Padilla-Fernández

Márquez-Sánchez

et al. 2020

JCM

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

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Pelvic Floor Muscle Training in Female Athletes: A Randomized Controlled Pilot Study

Cited by 37 publications

References 25 publications

Comparison of urinary incontinence, based on pelvic floor and abdominal muscle strength, between nulliparous female athletes and non‐athletes: A secondary analysis

Comparison of urinary incontinence, based on pelvic floor and abdominal muscle strength, between nulliparous female athletes and non‐athletes: A secondary analysis

Stress Urinary Incontinence Among Young Nulliparous Female Athletes

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

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