Urinary leakage during exercise: problematic activities, adaptive behaviors, and interest in treatment for physically active Canadian women

Knowledge, Attitude, and Practice Toward Urinary Incontinence Among Physically Active Women

INTRODUCTION AND HYPOTHESIS

Urinary incontinence (UI) is a prevalent condition that can impact the quality of life of physically active women. This study aimed to evaluate knowledge, attitudes, and practices (KAP) related to UI among women who exercise in gyms.

METHODS

A cross-sectional observational study was carried out from March to July 2022, in gyms located in the city of Parnaíba, in northeastern Brazil with physically active women. For data collection, the International Physical Activity Questionnaire (IPAQ), the International Incontinence Consultation Questionnaire-Short Form (ICIQ-SF), a specific KAP-UI questionnaire and a standardized form for sociodemographic, gynecological and obstetric data were used. The Mann-Whitney test, Fisher's exact test and chi-square tests were performed to analyze differences between subgroups formed on the basis of the presence or absence of urinary incontinence.

RESULTS

The research included 256 female participants with a median age of 33 (18-67) years, good education (≥ 12 years of studies) (97%), majority single (60%), and monthly income greater than US$ 235.51 (68%). The prevalence of UI was 43% (n = 110) with a moderate impact on quality of life. Among the participants, 51.8% had adequate knowledge and 98.7% demonstrated positive attitudes toward UI. However, only 29.5% adopted treatment practices, while preventive practices were carried out by only 16.4%. Factors significantly associated with inadequate knowledge included lower levels of education (p = 0.030), single marital status (p = 0.031), monthly income below US$235.51 (p = 0.019), and bodybuilding as the main physical activity (p = 0.039). Conversely, women who were highly physically active were more likely to have adequate knowledge. Significant associations were found between adequate knowledge and preventive and therapeutic practices (p = 0.003), as well as between inadequate knowledge and inadequate practices.

CONCLUSIONS

Although only half of the participants had adequate knowledge about UI, the majority demonstrated a positive attitude toward the health problem. However, preventive practices were low among women without UI, as was the search for treatment among those with UI. Factors such as age, education, marital status, income, type and level of physical activity were linked to knowledge and preventive and treatment practices. Adequate knowledge was associated with effective preventive and therapeutic practices for IU by physically active women.

Influence of High-Impact Physical Activity on Pelvic Floor and Lumbar Muscle Mechanical Properties in Asymptomatic Nulliparous Women

INTRODUCTION AND HYPOTHESIS

High-impact physical activity is a known risk factor for the development of pelvic floor disorders (PFDs) in women, affecting the pelvic floor muscles (PFMs). However, there is insufficient information to determine whether alterations in PFMs, or even in the lumbar muscles, can be detected before the onset of symptoms. The aim of the study was to identify whether high-impact physical activity influences the muscle mechanical properties (MMPs) of the lumbopelvic region in continent nulliparous women.

METHODS

An observational cross-sectional study with a nonprobabilistic sampling of consecutive cases was designed. Fifty women who had practiced high-impact physical activity at least three times per week for more than 2 years were included in the high-impact group, and 50 women who did not practice high-impact activity were included in the control group. Data collection for both groups included sociodemographic data and MMPs (frequency, characterizing muscle tone; stiffness; logarithmic decrement, characterizing the inverse of the elasticity; relaxation time of stress; creep, characterizing fluidity) of PFMs and lumbar muscles, externally assessed using a hand-held tonometer device. Between-group comparison of the MMPs were calculated, together with intragroup correlations between the outcomes.

RESULTS

The MMPs of PFMs showed statistically significant lower tone (0.76 Hz, 95% CI 0.04, 1.48) and stiffness (23.76 N/m, 95% CI 1.10, 46.42) and were more viscoelastic (relaxation: -1.04 ms, 95% CI -1.98, -0.11; creep: -0.04 De, 95% CI -0.07, -0.02) in women who practiced high-impact physical activity. No lumbar MMPs showed statistically significant between-group differences.

CONCLUSIONS

High-impact physical activity alters the MMPs of PFMs in nulliparous women, although not lumbar spinal MMPs, even before the appearance of signs.

Sport practice and hemorrhoidal disease: results from a self-assessment questionnaire among athletes

BACKGROUND

Hemorrhoidal disease (HD) is a common proctologic disease. Dietary and lifestyle play a role in the genesis of the disease or in its progression to more severe forms, although the exact mechanism is still not fully understood. We performed a pilot observational cross-sectional analytical association study to evaluate the possible association between sport activities and HD.

METHODS

We included subjects aged 18 years old or more, competitive and non-competitive, practicing at least one sport activity, at least twice a week. Data were collected using an online questionnaire, developed on the Microsoft Teams communication platform.

RESULTS

Out of the 312 study participants, 34% reported HD. Among subjects who practiced cycling or horseback riding, 57% reported suffering from HD; among those practicing bodybuilding, 48% complained of HD. In the multivariate logistic regression analysis, age and bodybuilding practice showed a statistically significant association with HD.

CONCLUSIONS

Some sport activities could play a role in the onset or worsening of HD. Our results showed a positive association between cycling, horseback riding, bodybuilding, and HD occurrence. Given the numerous health benefits of physical activity, patients should be provided with correct information regarding the practice of sports in relation to their pathology.

Reducing Falls in Older Women with Urinary Incontinence

Urinary incontinence is common in older women and doubles the risk of falls in this population. The association between urinary incontinence, especially urgency urinary incontinence, and falls is multifactorial and likely the result of a complex interaction between physical, mental, social, and environmental factors. As a result of this multifactorial etiology and based on existing evidence, the integration of different fall prevention strategies including strength and resistance exercises, bladder training, and home hazard reduction have the potential to decrease the risk of falls in older women with urinary incontinence. Given the prevalence of urinary incontinence and the significant morbidity associated with falls, effective interventions to reduce fall risk in older women with urinary incontinence is of high public health significance.

Association Between Obstetric History and Urinary Incontinence in a Cohort of Resistance-Trained Women

Purpose

Urinary incontinence has the potential to reduce participation in sport and exercise and diminish athletic performance. The purpose of this study was to explore the association between obstetric history and urinary incontinence in a cohort of resistance-trained women.

Patients and Methods

This international, cross-sectional survey was completed by 1252 women competing in either powerlifting, weightlifting or CrossFit. The Incontinence Severity Index determined the severity of urinary incontinence.

Results

Almost 43% of the participants experienced urinary incontinence in the threemonths prior to the study. The prevalence of urinary incontinence in this cohort according to mode of birth were: caesarean 42.6%, unassisted vaginal 59.3%, vacuum extraction 58.8%, forceps 60.3%, vaginal and caesarean births 66.2%, forceps and vacuum extraction 73.1%. The prevalence of urinary incontinence in the subgroup of women who had undergone urogenital surgery was 63.6%. Kendall’s tau-b indicated that the correlation between ISI score and the number of births was strong and positive (τ = 0.25, p < 0.001).

Conclusion

Our results suggest that both the number of births and mode of birth influenced the likelihood of urinary incontinence in resistance-trained women. Women who had experienced only caesarean births had the lowest likelihood of urinary incontinence, while women who had experienced both vaginal and caesarean births had the most severe and second highest likelihood of urinary incontinence. Women who had undergone urogenital surgery continued to experience a high likelihood of urinary incontinence.

Urinary Incontinence in Competitive Women Powerlifters: A Cross-Sectional Survey

Background

Urinary incontinence (UI) can negatively affect a woman’s quality of life, participation in sport and athletic performance. The objectives of this study were to determine the prevalence of UI in competitive women powerlifters; identify possible risk factors and activities likely to provoke UI; and establish self-care practices.

Methods

This international cross-sectional study was conducted using an online survey completed by 480 competitive women powerlifters aged between 20 and 71 years. The Incontinence Severity Index (ISI) was used to determine the severity of UI.

Results

We found that 43.9% of women had experienced UI within the three months prior to this study. The deadlift was the most likely, and the bench-press the least likely exercise to provoke UI. ISI scores were positively correlated with parity (τ = 0.227, p < 0.001), age (τ = 0.179, p < 0.001), competition total (τ = 0.105, p = 0.002) and body mass index score (τ = 0.089, p = 0.009). There was no significant correlation between ISI and years strength training (τ = − 0.052, p = 0.147) or years powerlifting (τ = 0.041, p = 0.275). There was a negative correlation between ISI score with having a pelvic floor assessment (η = 0.197), and the ability to correctly perform pelvic floor exercises (η = 0.172).

Conclusion

The prevalence of UI in this cohort was at the upper limit experienced by women in the general population. Women who had undergone a pelvic floor examination or were confident in correctly performing pelvic floor exercises experienced less severe UI.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40798-021-00387-7.

Physiotherapy and pelvic floor health within a contemporary biopsychosocial model of care: From research to education and clinical practice

Background

Pelvic floor dysfunction (PFD) is a common problem in both men and women. Despite the high prevalence and negative effects on quality of life, there is still a lack of research in this area which translates into clinical practice and education.

Objectives

My study discusses how gaps and controversies in current research and evidence on PFD might be addressed by positioning PFD within a contemporary biopsychosocial model of care (BPSM).

Method

Various databases were searched for relevant studies published between 2010 and 2020 to support hypotheses and statements.

Results

My study focuses on the available evidence of PFD in both men and women as related to the themes and sub-themes of the BPSM, and how this available evidence might translate into education and clinical practice. It highlights areas of research, education and clinical practice that need to be explored and how the different components of healthcare may influence one another.

Conclusion

Biomedical aspects regarding pelvic health are mostly investigated and taught, whilst psychological, cognitive, behavioural, social and occupational factors, individualised care, communication and therapeutic alliances are still under-investigated and not integrated or translated at a sufficient level into research, education and clinical practice.

Clinical implications

Incorporating the integration of all factors of the BPSM into research is important for effective knowledge translation and enhancement of a de-compartmentalised approach to management. The interaction between the different components of the BPSM should be investigated especially in a South African population.

Does regular strength training cause urinary incontinence in overweight inactive women? A randomized controlled trial

Introduction and hypothesis

Urinary incontinence (UI) is common in women who exercise. We aimed to investigate new onset UI in formerly inactive, overweight or obese women (BMI > 25) participating in three different strength training modalities compared with a non-exercising control group.

Methods

This was a secondary analysis of an assessor blinded randomized controlled trial investigating the effect of 12 weeks of three strength training concepts for women on muscle strength and body composition. None of the programs included pelvic floor muscle training. International Consensus on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI-SF) was used to investigate primary outcome; new onset UI, and secondary outcome; ICIQ-UI-SF sum score. Suissa and Shuster’s exact unconditional test was used to analyze difference in new onset UI. Difference in ICIQ-UI-SF sum score is presented as mean with 95% CI.

Results

At baseline 40 out of 128 (31.2%) participants reported UI. Three out of 27, 2 out of 17, 2 out of 23, and 0 out of 21 women in the three training and control groups respectively had new onset UI. There were no statistically significant differences in new onset UI across the groups or when collapsing new onset UI in the intervention groups compared with the controls (7 out of 67 vs 0 out of 21), p = 0.124. After the intervention the control group reported worse ICIQ-UI-SF sum score than any of the training groups; mean difference − 6.6 (95% CI: −11.9, −1.27), p = 0.012, but there was no difference in change from baseline to 12 weeks between the groups p = 0.145).

Conclusions

There was no statistically significant change in UI after strength training.

Urinary Incontinence and Women CrossFit Competitors

Purpose

Urinary incontinence is a common condition that potentially discourages women from participating in physical activity. This study aimed to determine the prevalence of urinary and athletic incontinence and establish which activities and contexts were most likely to provoke urine leakage in women CrossFit competitors.

Patients and Methods

This research was an international, cross-sectional, survey-based study. The online survey was completed by 452 women CrossFit competitors. The Incontinence Severity Index was used to determine the frequency and severity of urinary incontinence.

Results

Urinary incontinence was experienced by 41.8% of participants in the three months prior to the study and 17.7% experienced athletic incontinence. Women came to experience athletic incontinence through two different pathways. Some women were continent before commencing CrossFit (9.7%), remain continent during everyday activities but now experience urinary incontinence during exercise. Alternatively, 8% of women were incontinent before commencing CrossFit, are now continent during everyday activities but remain incontinent during exercise. High impact CrossFit activities were most likely to provoke urinary incontinence.

Conclusion

This study highlighted the importance of distinguishing between urinary incontinence that develops after commencing an exercise program in otherwise continent women and urinary incontinence that persists only during exercise in previously incontinent women.

Rug-pee study: the prevalence of urinary incontinence among female university rugby players

INTRODUCTION AND HYPOTHESIS

The goal of this study was to determine the prevalence of urinary incontinence among female university varsity rugby players. Secondary objectives were to understand when the incontinence occurred and to assess the degree of bother experienced. It is postulated that female rugby players may have higher rates of urinary incontinence due to the high-impact activities involved in training and competitions.

METHODS

Data was collected via a self-administered, anonymous questionnaire.

RESULTS

A total of 95 athletes were included in the survey results. Urinary incontinence was experienced by 51 of the 95 (54%) players. Of the 51 athletes who reported leaking urine, 90% leaked urine when competing in a rugby game and 88% of players leaked when being tackled or hit. Despite the high prevalence of urinary incontinence, most players reported they were not bothered or only slightly bothered by their urinary leaking. Several of the players (18%) were interested in receiving treatment for their urinary incontinence.

CONCLUSION

The prevalence of urinary incontinence among varsity female rugby players is 54%, which is consistent with rates among other high-impact sports. Surprisingly, the majority of these women are not bothered by their incontinence and most are not interested in treatment for this condition at this time.

Physical Activity and Stress Incontinence in Women

Purpose of Review

This review aims to discuss the current literature addressing associations between physical activity and stress urinary incontinence in women.

Recent Findings

Multiple cross-sectional studies utilize survey questionnaires to determine prevalence of stress urinary incontinence, impact of various types and intensities of physical activity on stress urinary incontinence, and explain differences in urinary symptoms among active women.

Summary

Although there is evidence for increased rates of stress incontinence among women who are physically active, pathophysiology is not fully understood and there is a need for additional research exploring changes to the pelvic floor during exercise. Future research focusing on the mechanism in which physical activity contributes to urinary symptoms can guide development of primary preventions for stress urinary incontinence.

Prevalence of urinary incontinence in women powerlifters: a pilot study

INTRODUCTION AND HYPOTHESIS

Increased intra-abdominal pressure is associated with urinary incontinence (UI) as is increasing age, obesity, and participating in sport at an elite level. We aimed to determine the prevalence of UI in competitive women powerlifters and establish if commonly cited risk factors affect the incidence of UI.

METHODS

The authors developed a 17-item questionnaire to investigate the prevalence of UI and the relationship of UI with age, body mass, resistance training experience, and competition grade in competitive women powerlifters. The questionnaire was distributed through three major powerlifting federations in Australia for 16 months. The data of 134 competitive women powerlifters were collected anonymously using Qualtrics, and were analysed using multivariate analysis.

RESULTS

In combination, the age of lifters, resistance training experience, body weight categories, and competition grade accounted for a significant 28% of the variability in the Incontinence Severity Index (ISI) (p < 0.01). However, the ISI was not significantly different among age groups, body weight categories, or competition grade. Approximately, 41% of women powerlifters had experienced UI at some stage in life, and 37% of women powerlifters currently experienced UI during training, competition, or maximum effort lifts. However, the rate of UI experienced during daily life activities was approximately 11%.

CONCLUSIONS

This study showed that competitive women powerlifters experience a higher rate of UI during lifting-related activities than in daily life and that the rate of UI correlates positively with age, body weight categories, resistance training experience, and competition grade.