SPORTS, PHYSICAL ACTIVITY AND PELVIC FLOOR MUSCLE DISORDERS
DOI:
https://doi.org/10.24193/subbeag.64(4).27Keywords:
physical activity, sport, manual labour, pelvic floor muscle dysfunction.Abstract
Introduction: Physical activity is essential to leading a healthy lifestyle; however, in some cases (when not adequate to one’s individual needs, both quantitatively and qualitatively), it might lead to unforeseen outcomes. One such consequence is pelvic floor muscle dysfunction, nowadays a major public health problem, mainly because of its impact on the quality of life of the general population and the associated high health costs, respectively. Material and Methods: The articles used for the study were available via online databases. Our research is based solely on studies written in English, out of which 65 represent the main frame of this paper. Results: Participating in high-intensity physical activities (competitive sports, challenging manual labour) can increase the load on pelvic floor muscles. What is more, overloading the pelvic floor muscles might lead to disorders such as incontinence or pelvic organs prolapse. Some studies showed a 41% prevalence of urinary incontinence in elite athletes. This prompted us to review the circumstances leading to the pelvic floor disorders, more specifically, the relationship between physical activity and pelvic floor muscle dysfunctions. The analysis was based on the available published literature. Physical activity (PA) refers not only to recreational and regular physical training, but also to household tasks and other work-related and transport-related undertakings. Women engaged in hard manual labour can be 9.6 times more likely to have stage 2-4 grade uterine prolapse. Conclusions: Women suffering from urinary stress incontinence should be encouraged to participate in regular leisure and fitness activities and women engaged in vigorous physical activity have to be forewarned. Specific perinea muscle reinforcement may be needed in order to maximize the pelvic floor muscle strength.
REZUMAT. Sportul, activitatea fizică și disfuncțiile musculaturii planșeului pelvian. Introducere: Activitatea fizică este esențială pentru a avea un stil de viață sănătos; cu toate acestea, atunci când nu este adaptată nevoilor individuale, atât din punct de vedere calitativ, cât și din punct de vedere cantitativ, ea poate avea urmări nedorite. Una dintre aceste consecințe nedorite este afectarea musculaturii planșeului pelvian, considerată în prezent o problemă majoră de sănătate publică, datorită atât impactului negativ asupra calității vieții, cât și costurilor mari pe care le generează. Material și Metode: Articolele introduse în acest studiu au fost selectate din bazele de date disponibile online. Au fost căutate doar articole în limba engleză, fiind selectate 65 dintre acestea. Rezultate: Practicarea activităților fizice de mare intensitate (sport, muncă fizică solicitantă) poate crește solicitarea musculaturii planșeului pelvian. Suprasolicitarea musculaturii planșeului pelvian poate duce la incontinență urinară sau la prolapsul organelor pelviene. Unele studii indică o prevalență de 41% a incontinenței urinare în rândul sportivelor de performanță. Drept urmare, am decis să investigăm condițiile în care apare afectarea musculaturii planșeului pelvian, precum și legătura dintre activitatea fizică și afectarea musculaturii planșeului pelvian, bazându-ne pe literatura de specialitate disponibilă online. Prin activitate fizică se înțelege nu doar activitatea fizică practicată în mod regulat sau recreațional, ci și munca fizică sau căratul. Femeile care prestează muncă fizică grea au un risc de 9.6 ori mai mare de a prezenta prolaps uterin de gradul 2-4. Concluzii: Femeile care suferă de incontinență urinară de efort trebuie încurajate să practice în mod regulat activități fizice recreaționale, iar femeile care practică activități fizice de mare intensitate trebuie să fie prevenita asupra riscurilor. Exercițiile specifice pentru planșeul pelvian pot fi utile pentru a crește rezistența musculaturii de la acest nivel.
Cuvinte cheie: activitate fizică, sport, muncă fizică, disfuncțiile musculaturii planșeului pelvian.
References
Almousa, S., Moser, H., Kitsoulis, G., Almousa, N., Tzovaras, H., Kastani, D. (2015). The prevalence of urine incontinence in nulliparous female athletes: a systematic review. Physiotherapy. 2015; 101:e58.
Ashton-Miller, J., Howard, D., DeLancey, J. (2001). The functional anatomy of the female pelvic floor and stress continence control system. Scand. J. Urol. Nephrol. (Suppl. 207), 1–7.
Bauer, S.T., Vasquez, E., Cendron, M., Wakamatsu, M.M., Chow, J.S. (2018). Pelvic floor laxity: A not so rare but unrecognized form of daytime urinary incontinence in peripubertal and adolescent girls. Journal of Pediatric Urology, 2018; 14 544.e1-544.e7; https://doi.org/10.1016/j.jpurol.2018.04.030
Bo, K. (2004). Urinary incontinence, pelvic floor dysfunction, exercise and sport. Sports Med, 34, 451-464.
Bo, K., Borgen, J.S. (2001). Prevalence of stress and urge urinary incontinence in elite athletes and controls. Med Sci Sports Exerc, 33(11):1797–1802.
Borin, L.C.M.S., Nunes, F.R., Guirro, E.C.O.G. (2013). Assessment of pelvic floor muscle pressure in female athletes. Phys. Med. Rehabil, 5, 189–193.
Bortolini, M.A., Drutz, H.P., Lovatsis, D., Alarab, M. (2010). Vaginal delivery and pelvic flor dysfunction: current evidence and implications for future research. Int. Urogynecol J. Pelvic Floor Dysfunct, 21: 1025–1030.
Brækken, I.H., Maijida, M., Engh, M.E., Bo, K. (2010). Morphological changes after pelvic floor muscle training measured by 3-dimensional ultrasonography. A randomized controlled trial. Obstet. Gynecol, 115 (2), 317–324.
Caspersen, C.J., Powell, K.E., Christenson, G.M. (1985). Physical activity, exercise, and physical fitness: Definitions and distinctions for health-related research. Public Health Rep, 100: 126–131
Caylet, N., Fabbro-Peray, P., Mares, P., Dauzat, M., Prat-Pradal, D., Corcos, J. (2006). Prevalence and occurrence of stress urinary incontinence in elite women athletes. Can. J. Urol, 13 (4), 3174–3179.
Coyne, K.S., Sexton, C.C., Clemens, J.Q., et al. (2013.) The impact of OAB on physical activity in the United States: results from OAB-POLL. Urology, 82 (4): 799–806. [PubMed: 23953610]
Da Roza, T., Brandão, S., Mascarenhas, T., Jorge, R.N., Duarte, J.A. (2015a). Volume of Training and the Ranking Level Are Associated with the Leakage of Urine in Young Female Trampolinists. Clin J Sport Med, 25 (3): 270-5.
Da Roza, T., Brandão, S., Mascarenhas, T., Jorge, R.N., Duarte, J.A. (2015b). Urinary Incontinence and Levels of Regular Physical Exercise in Young Women. Int J Sports Med, 36 (9): 776-80.
DeLancey, J.O. (1994.). Structural support of the urethra as it relates to stress urinary incontinence: the hammock hypothesis. American Journal of Obstetrics and Gynecology, 170 (6): 1713–1723.
DeLancey, J.O. (2002). Fascial and muscular abnormalities in women with urethral hypermobility and anterior vaginal wall prolapse. American Journal of Obstetrics and Gynecology, 187 (1): 93–98.
Dias, N., Peng, Y., Khavari, R., Nakib, N.A., Sweet, R.M., Timm, G.W., Erdman, A.G., Boone, T.B., Zhang, Y. (2017). Pelvic floor dynamics during high-impact athletic activities: A computational modeling study. Clinical Biomechanics, 41: 20–27.
Dietz, H.P., Shek, C., (2008). Levator avulsion and grading of pelvic floor muscle strength. Int. Urogynecol. J. Pelvic Floor Dysfunct, 19, 633–636.
Dos Santos, K.M., Da Roza, T.H., Da Luz, S.C.T., Hort, J.P., Kruger, J.M., Schevchenco B. (2018). Quantification of Urinary Loss in Nulliparous Athletes During 1 Hour of Sports Training. PM&R, 1-8.
Eliasson, K., Larsson, T., Mattsson, E. (2002). Prevalence of stress incontinence in nulliparous elite trampolinists. Scand J Med Sci Sports, 12 (2): 106–110.
Fernandes, A., Fitz, F., Silva, A.,Filoni, E., Filho, J.M. (2014). Evaluation of the Prevalence of Urinary Incontinence Symptoms in Adolescent Female Soccer Players and their Impact on Quality of Life. Occup Environ Med, 71 (Suppl 1): A59–60.
Glavind, K. (1997). Use of a vaginal sponge during aerobic exercises in patients with stress urinary incontinence. Int. Urogynecol. J. Pelvic Floor Dysfunct, 8, 351–353.
Goldstick, O., Constantini, N. (2014). Urinary incontinence in physically active women and female athletes. British journal of sports medicine, 48 (4): 296–298.
Good, M.M., Solomon, E.R. (2019). Pelvic Floor Disorders, Obstet.Gynecol Clin N. Am. 46, 527–540, https://doi.org/10.1016/j.ogc.2019.04.010
Haderer, J., Pannu, H., Genadry, R., Hutchins, G.M. (2002). Controversies in female urethral anatomy and their significance for understanding urinary continence: observations and literature review. Int. Urogynecol. J. Pelvic Floor Dysfunct, 13, 236–252.
Hagovska, M., Švihra, J., Buková, A., Dračková, D., Švihrová, V. (2018). Prevalence and risk of sport types to stress urinary incontinence in sportswomen: A cross-sectional study. Neurourology and Urodynamics, 37:1957 –1964.
Hägglund, D., Wadensten, B. (2007). Fear of humiliation inhibits women’s care-seeking behaviour for longterm urinary incontinence. Scandinavian journal of caring sciences, 21 (3): 305–312. [PubMed:17727542]
Hannestad, Y.S., Rortveit, G., Daltveit, A.K., Hunskaar, S. (2003). Are smoking and other lifestyle factors associated with female urinary incontinence? The Norwegian EPINCONT Study. BJOG, 110 (3): 247–254. [PubMed: 12628262]
Hock, M., Ambrus, E., Tóvári, A., Tardi, P., Szilágyi, B., Leidecker, N., Molics, B., Járomi, M., Ács, P. (2019). Az anális inkontinencia diagnosztikája és kezelési lehetőségei. Fizioterápia, 28 (3): 3-9.
Hock, M., Farkas, N., Tiringer, I., Gitta, S., Németh, Z., Farkas, B. (2019). Validation and translation of the Hungarian version of the Female Sexual Function Index (FSFI-H) International Urogynecology Journal, 30 (12): 2109–2120.
Hock, M., Domány, B., Bódis, J., Garai, J. (2014). Does Surgery Benefit Postmenopausal Overweight Women with Pelvic Floor Dysfunction? Open Journal of Therapy and Rehabilitation, 2 (3): 114-119.
Hock, M., Tóth, Sz., Hartmann, G., Hartmann, T., Bódis, J., Garai J. (2015). Quality of Life, Sexual Functions and Urinary Incontinence After Hysterectomy in Hungarian Women. American Journal of Health Research, 3 (6): 393-398.
Hock, M., Tardi, P., Ambrus, E., Tóvári, A., Hajnal, B., Szilágyi, B., Leidecker, E., Molics, B., Járomi, M., Kránicz, J., Bódis, J. (2019). Changes of pelvic floor muscle function during pregnancy. Studia UBB Educatio Artis Gymn., 64: (2) 57-68.
Hock, M., Kránicz, J., Bódis, J. (2006). A gátizomerőváltozásáról. Magyar Nőorvosok Lapja 69: (4) 347-350.
Islam, R.M., Oldroyd, J., Karim, M.N., Hossain, S.M., EmdadulHoque, D., Romero, L., et al. (2017). Systematic review and meta-analysis of prevalence of, and risk factors for, pelvic floor disorders in community-dwelling women in low and middle-income countries: a protocol study. BMJ Open, 7 (6): 01–7.
Jiang, K., Novi, J.M., Darnell, S., Arya, L.A. (2004). Exercise and urinary incontinence in women. Obstet Gynecol Surv, 59 (10): 717–721. quiz 745–716.
Lovegrove Jones, R., Peng, Q., Humphrey, V., Stokes, M., Payne, C. and Constantinou, C.E. (2009). Effect of the knack on the pelvic floor: evaluated by 2d real time ultrasound and image processing methods. International Continence Society Annual Meeting. 29 Sep - 03 Oct 2009. pp. 662-663.
Krause, C., Wells, T., Hughes, S., Brink, C., Mayer, R. (2003). Incontinence in women: effect of expectancy to regain control and severity of symptoms on treatment outcomes. Urol Nurs, 23(1):54
Kruger, J.A., Murphy, B.A., Heap, S.W. (2005). Alterations in levatorani morphology in elite nulliparous athletes: a pilot study. Aust N Z J Obstet Gynaecol, 45 (1): 42–47.
Kruger, J.A., Dietz, H.P., Murphy, B.A. (2007). Pelvic floor function in elite nulliparous athletes. Ultrasound Obstet Gynecol, 30 (1): 81–85.
Larsen, W.I., Yavorek, T. (2007). Pelvic prolapse and urinary incontinence in nulliparous college women in relation to paratrooper training. Int Urogynecol J Pelvic Floor Dysfunct, 18 (7): 769–771.
Leitner, M., Moser, H., Taeymans, J., Kuhn, A., Radlinger, L. (2015). Pelvic floor muscle displacement during voluntary and involuntary activation in continent and incontinent women: a systematic review. Int Urogynecol J, 26: 1587–1598.
Leitner, M., Moser, H., Eichelberger, P., Kuhn, A., Radlinger, L. (2017). Evaluation of pelvic floor muscle activity during running in continent and incontinent women: An exploratory study. Neurourology and Urodynamics, 36: 1570 –1576.
Liu, B., Wang, L., Huang, S.S., Wu, Q., Wu, D.L. (2014). Prevalence and risk factors of urinary incontinence among Chinese women in Shanghai. Int J ClinExp Med, 7 (3): 686–696.
Manonai, J., Poowapirom, A., Kittipiboon, S., Patrachai, S., Udomsubpayakul, U., Chittacharoen, A. (2006). Female urinary incontinence: a cross-sectional study from a Thai rural area. Int Urogynecol J Pelvic Floor Dysfunct, 17 (4): 321–325.
Masenga, G.G., Shayo, B.C., Rasch, V. (2018). Prevalence and risk factors for pelvic organ prolapse in Kilimanjaro, Tanzania: A population based study in Tanzanian rural community. PLOS ONE, 13 (4): e0195910.
Middlekauff, M.L., Egger, M.J., Nygaard, I.E., Shaw, J. (2016). The impact of acute and chronic strenuous exercise on pelvic floor muscle strength and support in nulliparous healthy women. Am J Obstet Gynecol, 215: 316.e1-7.
Monz, B., Pons, M.E., Hampel, C., Hunskaar, S., Quail, D., Samsioe, G., Sykes, D., Wagg, A., Papanicolaou, S. (2005). Patient-reported impact of urinary incontinence—results from treatment seeking women in 14 European countries. Maturitas, 52 [Suppl 2]: S24–S34. doi:10.1016/j.maturitas.2005.09.005
Moore, K., Dumoulin, C., Bradley, C., (2013). Committee 12: adult conservative management. In: Abrams, P., Cardozo, L., Khoury, S., et al. (Eds.). Incontinence: Fifth International Consultation on Incontinence. European Association of Urology, Arnhem, pp. 1101–1227.
Nygaard, I., DeLancey, J.O., Arnsdorf, L., Murphy, E. (1990). Exercise and incontinence. Obstet Gynecol, 75 (5): 848–851.
Nygaard, I., Thompson, F.L., Svengalis, S.L., Albright, J.P. (1994). Urinary incontinence in elite nulliparous athletes. Obstet. Gynecol, 84, 183–187.
Nygaard, I., Girts, T., Fultz, N.H., Kinchen, K., Pohl, G., Sternfeld, B. (2005). Is urinary incontinence a barrier to exercise in women? Obstet Gynecol, 106 (2): 307–314. [PubMed: 16055580]
Nygaard, I.E., Shaw, J.M., Bardsley, T., Egger, M.J. (2015). Lifetime physical activity and female stress urinary incontinence. Am J Obstet Gynecol, Jul; 213(1): 40.e1-40.e10. doi: 10.1016/j.ajog.2015.01.044. Epub 2015 Jan 29.
Nygaard, I.E., Shaw, J.M. (2016). Physical activity and the pelvic floor. Am J Obstet Gynecol, 214: 164–171.
Palancsa, M., Damásdi, M., Tardi, P., Gitta, S., Járomi, M., Ács, P., Simon-Ugron, Á., Hock, M. (2018). Pelvic floor muscle exercises for the improvement of male sexual functions Studia UBB Educatio Artis Gymn., 63:(2) 5-9.
Papanicolaou, S., Hunskaar, S., Lose, G., Sykes, D. (2005.) Assessment of bothersomeness and impact on quality of life of urinary incontinence in women in France, Germany, Spain and the UK. BJU Int, 96 (6): 831–838.
Raizada, V., Bhargava, V., Jung, S.A., Karstens, A., Pretorius, D., Krysl, P., Mittal, R.K. (2010). Dynamic assessment of the vaginal high-pressure zone using high-definition manometery, 3-dimensional ultrasound, and magnetic resonance imaging of the pelvic floor muscles. Am J Obste tGynecol 203 (2): 172.e1–172.e8. doi:10.1016/j.ajog.2010.02.028
Randolph, J.T., Burleson, L.K., Sheffield, A., Hannan, J.L. (2019). Exercise, Sports, and Men’s Health. Effects of Lifestyle on Men’s Health. Elsevier https://doi.org/10.1016/B978-0-12-816665-9.00019-6
Rosen, R., Brown, C., Heiman, J., et al. (2000). The female sexual function index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther, 26: 191–208.
Schaal, M.L., Lee, W., Egger, M.J., Nygaard, I.E.,Shaw, J.M. (2016). Physical activity patterns in healthy middle-aged women. J Women Aging, 28 (6):4 69-476. Epub 2016 Jul 11.
Stephen, K., van Woerden, H., MacRury, S. (2019). Assessing prevalence of urinary incontinence in Scottish fitness instructors and experience of teaching pelvic floor muscle exercises: an online survey. Journal of Public Health | pp. 1–7 | doi:10.1093/pubmed/
fdy102 J Public Health (Oxf). Mar; 41(1): e44–e50.
Sultan, A.H., Monga, A., Lee, J., Emmanuel, A., Norton, C., Santoro, G., et al. (2017). An international Urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for female anorectal dysfunction. Int Urogynecol J, 28:5–31.
Thyssen, H.H., Clevin, L., Olesen, S., Lose, G. (2002). Urinary incontinence in elite female athletes and dancers. Int. Urogynecol. J. Pelvic Floor Dysfunct, 13, 15–17.
Vitton, V., Baumstarck-Barrau, K., Brardjanian, S., Caballe, I., Bouvier, M., Grimaud, J.C. (2011). Impact of high-level sport practice on anal incontinence in a healthy young female population. J. Womens Health, 20 (5): 757–763.
Wiegel, M., Meston, C., Rosen, R. (2005). The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther, 31:1–20.
Zhu, L., Lang, J., Wang, H., Han, S., Huang, J. (2008). The prevalence of and potential risk factors for female urinary incontinence in Beijing, China. Menopause, 15 (3): 566–569. [PubMed: 18467955]
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2019 Studia Universitatis Babeș-Bolyai Educatio Artis Gymnasticae
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
