Regular exercisers have stronger pelvic floor muscles than nonregular exercisers at midpregnancy

Bø, Kari; Engh, Marie Ellstrøm; Hilde, Gunvor

doi:10.1016/j.ajog.2017.12.220

Cited by 20 publications

(23 citation statements)

References 22 publications

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“…While exercising women at 37 weeks' gestation had stronger PFM than non-exercising women, the UI prevalence was not different between groups, after adjusting for PFM training, age, pre-pregnancy body mass index, education and smoking [38]. An adjusted linear regression model showed that PFM strength, rather than being a regular exerciser, was associated with continence.…”

Section: Ui and Pfm Strength In Exercisersmentioning

confidence: 82%

“…In a group of 41 women, PFM strength correlated with aerobic capacity and also with habitual physical activity measured by questionnaire [37]. Controlling for PFM training and other factors, primigravid women performing general exercise at 21 week gestation ≥ times per week had stronger and more enduring PFM than non-exercisers [38].…”

Section: Evidence In Support Of Stronger Pfmmentioning

confidence: 91%

“…Another study found no difference in vaginal support between 35 women habitually engaged in CrossFit and controls [35]. In primiparas, there was no difference in levator hiatus area at 21 weeks gestation between women who reported exercising for 30 or more minutes at least three times per week and non-exercisers, but at 37 weeks, exercisers had significantly larger levator hiatus area both at rest and during Valsalva [38]. The proportion of women that reported also doing PFM training three or more times per week was similar between groups, about 15%.…”

Section: What Is the Effect Of Exercise On Pelvic Floormentioning

confidence: 96%

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Is Physical Activity Good or Bad for the Female Pelvic Floor? A Narrative Review

2019

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More women participate in sports than ever before and the proportion of women athletes at the Olympic Games is nearly 50%. The pelvic floor in women may be the only area of the body where the positive effect of physical activity has been questioned. The aim of this narrative review is to present two widely held opposing hypotheses on the effect of general exercise on the pelvic floor and to discuss the evidence for each. Hypothesis 1: by strengthening the pelvic floor muscles (PFM) and decreasing the levator hiatus, exercise decreases the risk of urinary incontinence, anal incontinence and pelvic organ prolapse, but negatively affects the ease and safety of childbirth. Hypothesis 2: by overloading and stretching the PFM, exercise not only increases the risk of these disorders, but also makes labor and childbirth easier, as the PFM do not obstruct the exit of the fetus. Key findings of this review endorse aspects of both hypotheses. Exercising women generally have similar or stronger PFM strength and larger levator ani muscles than non-exercising women, but this does not seem to have a greater risk of obstructed labor or childbirth. Additionally, women that specifically train their PFM while pregnant are not more likely to have outcomes associated with obstructed labor. Mild-to-moderate physical activity, such as walking, decreases the risk of urinary incontinence but female athletes are about three times more likely to have urinary incontinence compared to controls. There is some evidence that strenuous exercise may cause and worsen pelvic organ prolapse, but data are inconsistent. Both intra-abdominal pressure associated with exercise and PFM strength vary between activities and between women; thus the threshold for optimal or negative effects on the pelvic floor almost certainly differs from person to person. Our review highlights many knowledge gaps that need to be understood to understand the full effects of strenuous and non-strenuous activities on pelvic floor health.

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Section: Ui and Pfm Strength In Exercisersmentioning

confidence: 82%

Section: Evidence In Support Of Stronger Pfmmentioning

confidence: 91%

Section: What Is the Effect Of Exercise On Pelvic Floormentioning

confidence: 96%

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Is Physical Activity Good or Bad for the Female Pelvic Floor? A Narrative Review

2019

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“…As for pregnant athletes, physical exercise, outside professional and high-performance fields, may be beneficial in maintaining pelvic floor fitness. Women who exercise regularly in the mid-gestation weeks of pregnancy were found to have more endurance and muscle strength in the PF and 31.2% presented with UI in contrast with 38.4% of nonathlete pregnant women [ 27 ]. However, engaging in high-performance sports does not prevent the multiple pathologies triggered by childbirth, such as low back pain, UI, or fecal incontinence, but neither does it aggravate those symptoms [ 28 ].…”

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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“…More than one method has been adopted to obtain a comprehensive understanding of PFM function [22][23] . However, it is difficult to evaluate PFM function and there is no gold standard for such evaluation [24] . Digital vaginal palpation and sEMG evaluation are two common methods to evaluate the strength of PFM.…”

Section: Discussionmentioning

confidence: 99%

A non-randomized chlinical trial The effect of pelvic floor exercises at home and electrical stimulation plus biofeedback in hospital in management of stress urinary incontinence of primiparas in short-term postpartum period

Tang¹,

Zhao²,

Sun³

et al. 2019

Preprint

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Background To investigate the effect of pelvic floor exercises at home and electrical stimulation plus biofeedback in hospital in management of stress urinary incontinence (SUI) primiparas in short-term postpartum period. Methods A total of 150 SUI primiparas at postpartum 6-8 weeks were interviewed. According to participants’ willingness and necessary coordination, the subjects were divided into 2 groups including the treatment group (n=69) and the control group (n=81). The treatment group received at-home pelvic floor muscle training(PFMT) every day and in-hospital electrical stimulation plus biofeedback therapy twice a week for consecutive 5 weeks (from 6-8 postpartum weeks to 11-13 postpartum weeks). The control group was not given pelvic floor exercise at home or in hospital. The PFM strength in the two groups was measured by specially trained personnel using digital palpation (Modified Oxford scale:0-5 grade) and surface electromyography(sEMG) in 6-8 postpartum weeks and in 11-13 postpartum weeks. For statistical analysis, t -test,Chi-square analysis and Wilcoxon test were carried out. Results The recovery rate of SUI in the treatment group was 63.8% (44/69), which was higher than that in the control group (12.3%,10/81) ( p <0.05). In the treatment group, the PFM strength was higher after PFMT than that before PFMT no matter measured by digital palpation or by sEMG ( p <0.05); but in the control group, it had no change at postpartum 6-8 weeks and at postpartum about 12 weeks ( p >0.05). Conclusion: The combination treatment of at-home PFM training and in-hospital electrical stimulation plus biofeedback PFM therapy is an effective method to manage SUI and improve PFM strength in short-time postpartum.

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Regular exercisers have stronger pelvic floor muscles than nonregular exercisers at midpregnancy

Cited by 20 publications

References 22 publications

Is Physical Activity Good or Bad for the Female Pelvic Floor? A Narrative Review

Is Physical Activity Good or Bad for the Female Pelvic Floor? A Narrative Review

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

A non-randomized chlinical trial The effect of pelvic floor exercises at home and electrical stimulation plus biofeedback in hospital in management of stress urinary incontinence of primiparas in short-term postpartum period

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