Pelvic Floor Dysfunction in the Female Athlete

Cross-Cultural Adaptation and Measurement Properties Analysis of the Brazilian Portuguese Version of the ICIQ-VS

INTRODUCTION AND HYPOTHESIS

The high prevalence of pelvic floor disorders in women requires assessments using validated instruments. We aimed to translate, cross-culturally adapt to Brazilian Portuguese, and analyze the measurement properties of the International Consultation on Incontinence Questionnaire Vaginal Symptoms Module (ICIQ-VS-Br).

METHODS

Participants were Brazilian women older than 18 years presenting vulvovaginal symptoms according to the Vulvovaginal Symptoms Questionnaire (VSQ-Br). The development of the ICIQ-VS-Br included the steps of translation, synthesis, back-translation, expert meeting, and pre-test. We analyzed construct validity by correlating the ICIQ-VS-Br and VSQ-Br. The participants answered the ICIQ-VS-Br the second time 7 to 10 days after the first response. We measured test-retest reliability using intraclass correlation coefficient (ICC), internal consistency using Cronbach's alpha, and construct validity using Pearson's correlation coefficient.

RESULTS

The study included 313 women. Reproducibility was analyzed for the three subscales of the ICIQ-VS-Br, resulting in an ICC of 0.92 (95% CI 0.89 to 0.94) for "vaginal symptoms," 0.85 (95% CI 0.78 to 0.89) for "sexual matters," and 0.87 (95% CI 0.81 to 0.91) for "quality of life." Construct validity showed a moderate correlation between ICIQ-VS-Br and VSQ-Br, confirming our hypotheses.

CONCLUSIONS

The ICIQ-VS-Br demonstrated validity and reproducibility, indicating that the instrument can be used in scientific research and clinical practice.

Comparative study of female pelvic floor among undeformed high-resolution thin-sectional anatomical (visible human) images and MRI and ultrasound images

PURPOSE

Using visible human, MRI and ultrasound images, we aim to provide an anatomical basis for the identification and diagnosis of pelvic floor structure and disease by ultrasound imaging.

METHODS

One Chinese visible human (CVH) image, one American visible human image, 9 MRI images of normal volunteers, and 40 ultrasound images of normal volunteers or pelvic organ prolapse patients were used. Pelvic organs, pelvic floor muscles, and the connective tissue in CVH, VHP, MRI, and ultrasound images were selected for comparative study.

RESULTS

We successfully identified the boundary of the anal sphincter complex, including the subcutaneous, superficial, and deep parts of the external anal sphincter, conjoined longitudinal muscles and internal anal sphincter; the levator ani muscle (LAM), including the internal and external parts of the pubovisceral muscle and the superficial and deep parts of the puborectal muscle; the urethral sphincter complex, including the urethral sphincter proper and the urethral compressor; and the perineal body, the rectoperineal muscle and superficial transverse perineal muscle.

CONCLUSIONS

We successfully recognized and studied the location, subdivisions, 2D morphology and spatial relationships of the LAM, anal sphincter complex, urethral sphincter complex and perineal body in ultrasound images, thereby helping sonologists or clinicians accurately identify pelvic floor muscles and supporting structures in ultrasound images.

Acute Effect of Heavy Weightlifting on the Pelvic Floor Muscles in Strength-Trained Women: An Experimental Crossover Study

INTRODUCTION/PURPOSE

Heavy lifting may produce strain on the pelvic floor muscles (PFM) due to high increases in intra-abdominal pressure, but knowledge of the impact of weightlifting on the PFM is lacking. Therefore, this study aimed to investigate acute effects of heavy weightlifting on the PFM in strength-trained women and whether general strength in whole-body exercises correlated to PFM strength.

METHODS

Forty-seven nulliparous women between 18 and 35 yr who regularly performed weightlifting and were able to lift their own body weight × 1.2 in back squat and 1.5 in deadlift were included in this experimental crossover study. They participated in baseline evaluations (questionnaire/measurements of background characteristics and pelvic floor disorders, one-repetition maximum (1RM) tests in back squat and deadlift) and one test day where they were randomized to start with 60 min of weightlifting (four sets of four repetitions at 75%-85% of 1RM in back squat and deadlift) or seated rest of 60 min. Vaginal pressure measurements of PFM resting pressure, strength, and endurance and surface electromyography measurements of PFM resting activity were performed before/after weightlifting and rest.

RESULTS

No statistically significant differences were found when comparing the change in PFM resting pressure, strength, endurance, and resting activity after heavy weightlifting and rest. There were no statistically significant correlations between PFM strength and maximum (1RM) or relative strength (1RM/bodyweight) in either back squat or deadlift.

CONCLUSIONS

Our results imply that heavy weightlifting is well tolerated by the PFM in short term among young, nulliparous, and strength-trained women. Strength in whole-body exercises was not correlated to PFM strength.

The Persistency Index: a novel screening tool for identifying myofascial pelvic floor dysfunction in patients seeking care for lower urinary tract symptoms

BACKGROUND

Patients with myofascial pelvic floor dysfunction often present with lower urinary tract symptoms, such as urinary frequency, urgency, and bladder pressure. Often confused with other lower urinary tract disorders, this constellation of symptoms, recently termed myofascial urinary frequency syndrome, is distinct from other lower urinary tract symptoms and optimally responds to pelvic floor physical therapy. A detailed pelvic floor myofascial examination performed by a skilled provider is currently the only method to identify myofascial urinary frequency syndrome. Despite a high influence on quality of life, low awareness of this condition combined with no objective diagnostic testing leads to the frequent misdiagnosis or underdiagnosis of myofascial urinary frequency syndrome.

OBJECTIVE

This study aimed to develop a screening measure to identify patients with myofascial urinary frequency syndrome (bothersome lower urinary tract symptoms secondary to myofascial pelvic floor dysfunction) from patient-reported symptoms.

STUDY DESIGN

A population of patients with isolated myofascial urinary frequency syndrome was identified by provider diagnosis from a tertiary urology practice and verified by standardized pelvic floor myofascial examination and perineal surface pelvic floor electromyography. Least Angle Shrinkage and Selection Operator was used to identify candidate features from the Overactive Bladder Questionnaire, Female Genitourinary Pain Index, and Pelvic Floor Distress Index predictive of myofascial urinary frequency syndrome in a pooled population also containing subjects with overactive bladder (n=42), interstitial cystitis/bladder pain syndrome (n=51), and asymptomatic controls (n=54) (derivation cohort). A simple, summated score of the most discriminatory questions using the original scaling of the Pelvic Floor Distress Index 5 (0-4) and Genitourinary Pain Index 5 (0-5) and modified scaling of Female Genitourinary Pain Index 2b (0-3) had an area under the curve of 0.75. As myofascial urinary frequency syndrome was more prevalent in younger subjects, the inclusion of an age penalty (3 points added if under the age of 50 years) improved the area under the curve to 0.8. This score was defined as the Persistency Index (possible score of 0-15). The Youden Index was used to identify the optimal cut point Persistency Index score for maximizing sensitivity and specificity.

RESULTS

Using a development cohort of 215 subjects, the severity (Pelvic Floor Distress Index 5) and persistent nature (Female Genitourinary Pain Index 5) of the sensation of incomplete bladder emptying and dyspareunia (Female Genitourinary Pain Index 2b) were the most discriminatory characteristics of the myofascial urinary frequency syndrome group, which were combined with age to create the Persistency Index. The Persistency Index performed well in a validation cohort of 719 patients with various lower urinary tract symptoms, including overactive bladder (n=285), interstitial cystitis/bladder pain syndrome (n=53), myofascial urinary frequency syndrome (n=111), controls (n=209), and unknown diagnoses (n=61), exhibiting an area under the curve of 0.74. A Persistency Index score ≥7 accurately identified patients with myofascial urinary frequency syndrome from an unselected population of individuals with lower urinary tract symptoms with 80% sensitivity and 61% specificity. A combination of the Persistency Index with the previously defined Bladder Pain Composite Index and Urge Incontinence Composite Index separated a population of women seeking care for lower urinary tract symptoms into groups consistent with overactive bladder, interstitial cystitis/bladder pain syndrome, and myofascial urinary frequency syndrome phenotypes with an overall diagnostic accuracy of 82%.

CONCLUSION

Our study recommends a novel screening method for patients presenting with lower urinary tract symptoms to identify patients with myofascial urinary frequency syndrome. As telemedicine becomes more common, this index provides a way of screening for myofascial urinary frequency syndrome and initiating pelvic floor physical therapy even before a confirmatory pelvic examination.

Spanish Cross-Cultural Adaptation of the Australian Pelvic Floor Questionnaire

The main objectives of this study were to carry out the translation and cross-cultural adaptation of the Australian Pelvic Floor Questionnaire (APFQ) into Spanish and the evaluation of its psychometric properties of validity and reliability in the Spanish population. The APFQ was translated into Spanish and back-translated into its original language by native speakers; it was verified that there was a semantic similarity. A pilot test was carried out on a group of 10 women. The study sample was made up of 104 subjects. They were asked to fill in the APFQ twice, 15 days apart. Codes were assigned so they could link to the test and retest. The Questionnaire on Pelvic Floor Dysfunctions-short version (PFDI-20) and the Women's Sexual Function Questionnaire (FSM) were also completed. The reliability, criterion and construct validity, and stability were studied. A Cronbach's alpha of 0.795 was obtained from the complete questionnaire. For each dimension, Cronbach's alpha was 0.864 for bladder function; 0.796 for bowel function; 0.851 for prolapse; and 0.418 for sexual function (0.67 with the suppression of item 37). The APFQ shows a significant correlation with PFDI-20 in urinary function (rho: 0.704, p = 0.000), intestinal function (rho: 0.462, p = 0.000), and prolapse symptoms (rho: 0.337, p = 0.000). The test-retest analysis showed high reproducibility. The Spanish version of the APFQ is a reliable and valid tool to assess symptoms and impacts on quality of life due to pelvic floor dysfunctions in the Spanish population. However, a review of some of its items could increase its reliability.

Integration of nutrigenomics, melatonin, serotonin and inflammatory cytokines in the pathophysiology of pregnancy-specific urinary incontinence in women with gestational diabetes mellitus

Gestational diabetes mellitus is an important public health problem and has been associated with the development of pregnancy-specific urinary incontinence. The interaction is related to hyperglycemia, and inflammatory and hormonal patterns, which favor functional alterations in different organs and systems. Several genes associated with human diseases have been identified and partially characterized. Most of these genes are known to cause monogenic diseases. However, about 3 % of diseases do not fit the monogenic theory due to the complex interactions between multiple genes and environmental factors, as in chronic metabolic diseases such as diabetes. The nutritional, immunological, and hormonal patterns associated with changes in maternal metabolism may influence and contribute to greater susceptibility to urinary tract disorders. However, early systematic reviews have not yielded consistent findings for these associations. This literature review summarizes important new findings from integrating nutrigenomics, hormones, and cytokines in women with Gestational diabetes mellitus and pregnancy-specific urinary incontinence. Changes in maternal metabolism due to hyperglycemia can generate an inflammatory environment with increased inflammatory cytokines. This environment modulated by inflammation can alter tryptophan uptake through food and thus influence the production of serotonin and melatonin. As these hormones seem to have protective effects against smooth muscle dysfunction and to restore the impaired contractility of the detrusor muscle, it is assumed that these changes may favor the onset of urinary incontinence specific to pregnancy.

Sports Medicine and the Pelvic Floor

ABSTRACT

The female athlete is seen as a specialist population meaning female considerations, such as pelvic floor dysfunction, are not widely taught within sports medicine. Females have unique anatomical characteristics compared with males including a wider pelvic diameter and an additional orifice in the form of the vagina. Furthermore, symptoms of pelvic floor dysfunction are prevalent among female athletes and transitional periods in their lifespan. They also are a barrier to training and performance. Therefore, it is essential that sports medicine practitioners understand how to identify and manage pelvic floor dysfunction. This report aims to describe the anatomy and function of the pelvic floor, outline the types and rates of pelvic floor dysfunction, discuss evidence-based management, and raise awareness of perinatal bodily changes. Practical recommendations are made to aid sports organizations and sports medicine practitioners in supporting the female athlete and in using a proactive approach to manage the perinatal athlete.

Effect of Kegel Exercises on Lower Urinary Tract Symptoms in Young Gymnasts: A Prospective Cohort Study

IMPORTANCE

Lower urinary tract symptoms (LUTS) have been shown to exist in young athletes. The use of pelvic floor muscle training as a preventive strategy at an early age may be useful to avoid possible pelvic floor dysfunction in the future.

OBJECTIVES

The aim of the study was to describe LUTS in underaged gymnasts. We also aimed to evaluate the effects of a 12-week Kegel exercise intervention for LUTS and urinary incontinence (UI) and their relationship to bother.

STUDY DESIGN

A quasi-experimental (nonrandomized, noncontrolled) pre-post study was conducted. Nineteen gymnasts with a mean age of 13.21 ± 1.84 were selected from a gymnastics club in Madrid, Spain. Outcomes of LUTS and quality of life were measured using the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms validated questionnaire at baseline and at the end of the 12-week intervention.

RESULTS

The participants presented with certain LUTS such as urgency UI (57.7%) or stress UI (47.4%), which negatively affect their daily lives by feeling annoyed in various aspects (when practicing gymnastics, getting up during the night to urinate or feeling bladder pain among others). No significant differences in LUTS and quality of life variables were observed after the exercise intervention ( P > 0.05).

CONCLUSIONS

A high prevalence of LUTS was observed in a sample of underaged high-level gymnasts. The 12-week Kegel exercise intervention did not significantly reduce the presence of pelvic floor problems and even intensified some of them, probably because of an increased awareness. Pelvic floor muscle training as a preventive strategy at an early age seems to be necessary to avoid possible pelvic floor dysfunction in the future.

INFLUENCE OF PROGRESSIVE UPPER LIMB STRENGTH TRAINING ON TABLE TENNIS ATHLETES

ABSTRACT Introduction Progressive strength training can help athletes improve their strength levels quickly and safely. By controlling the frequency and amplitude of vibrations, muscles can produce unconscious and voluntary contractions that help prevent diseases such as osteoporosis. Objective To explore the change in sports performance caused by progressive upper limb muscle strength training in table tennis players. Methods 12 table tennis players with a minimum experience of 5 years were randomly divided into experimental and control groups. The control performed traditional strength training methods while the experimental group used the progressive directed strength training method developed by the research team for nine weeks. Tests were performed on ISOMED 2000 equipment at the conditions of 60°/s and 450°/s. Results Circumference, muscle strength, and relative upper limb strength increased. In addition, a difference in the rate of the maximum elbow flexion moment of the athletes in the experimental group in the 60°/s test conditions was observed. At 450°/s, the maximum flexion and extension elbow moment showed a significant difference (P<0.05). Conclusion The progressive strength training method significantly affects the athletes’ maximum elbow flexion moment and maximum elbow extension moment than traditional strength training methods. Muscle strength progress was noted mainly in the elbow and wrist joints, with less intensity in the shoulders. Evidence Level II; Therapeutic Studies – Investigating the results.

Effect of exercise on female pelvic floor morphology and muscle function: a systematic review

INTRODUCTION AND HYPOTHESIS

The objective was to synthesize the scientific evidence on the relationship of exercise with morphology and muscle function parameters of the female pelvic floor. The design was a systematic review.

METHODS

Searches were performed in MEDLINE, PubMed, CINAHL, Web of Science, SCOPUS, SportDiscuss, and Google Scholar up to April 2021. Observational and experimental studies evaluating the morphology and/or function of the pelvic floor muscles (PFMs) in women were eligible. Studies reporting exercise or sports disciplines as exposure/intervention were included.

RESULTS

Twenty-five studies were included. Compared with the control group, women performing vigorous and high-impact exercises exhibited lower maximum voluntary contraction of the PFM and those performing moderate exercise had better maximum voluntary contraction. Exercise practitioners had a larger hiatal area at rest, during contraction, and during Valsalva, and greater bladder neck descent than the control group.

CONCLUSIONS

The results of this review demonstrate an inverse relationship of PFM maximum voluntary contraction with exercise intensity. Qualitative synthesis showed that the studies found favorable outcomes for the control group in terms of hiatal area during contraction and Valsalva and bladder neck displacement.

Ultrasound Evaluation of Pelvic Floor Function after Transumbilical Laparoscopic Single-Site Total Hysterectomy Using Deep Learning Algorithm

This study was aimed at investigating the ultrasound based on deep learning algorithm to evaluate the rehabilitation effect of transumbilical laparoscopic single-site total hysterectomy on pelvic floor function in patients. The bilinear convolutional neural network (BCNN) structure was constructed in the ultrasound imaging system. The spatial transformer network (STN) was used to preserve image information. Two algorithms, BCNN-R and BCNN-S, were proposed to remove sensitive information after ultrasonic image processing, and then, subtle features of the image were identified and classified. 80 patients undergoing transumbilical laparoscopic single-site total hysterectomy in hospital were randomly divided into a control group and a treatment group, with 40 cases in each group. In the control group, conventional ultrasound was used to assess the image of pelvic floor function in patients undergoing laparoendoscopic single-site surgery (LESS); in the observation group, ultrasound based on deep learning algorithm was used. The postoperative incision pain score, average postoperative anus exhaust time, average hospital stay, and postoperative satisfaction of the two groups were evaluated, respectively. The highest accuracy of constructed network BCNN-S was 88.98%; the highest recall rate of BCNN-R was 88.51%; the highest accuracy rate of BCNN-R was 97.34%. The operation time, intraoperative blood loss, and exhaust time were similar between the two groups, and the difference had no statistical significance ( $P>0.05$ ). The numerical rating scale (NRS) scores were compared, the observation group had less pain, the difference between the two groups had statistical significance ( $P<0.05$ ), and the postoperative recovery was good. The BCNN based on deep learning can realize the imaging of the uterus by ultrasound and realize the evaluation of pelvic floor function, and the probability of pelvic floor dysfunction is small, which is worthy of clinical promotion.

Evaluation of Nursing Effect of Pelvic Floor Rehabilitation Training on Pelvic Organ Prolapse in Postpartum Pregnant Women under Ultrasound Imaging with Artificial Intelligence Algorithm

This study was aimed at exploring the application value of ultrasound technology and rehabilitation training based on artificial intelligence algorithm in postpartum recovery of pelvic organ prolapse. Sixty patients diagnosed as mild and moderate pelvic organ prolapse by pelvic organ prolapse quantification evaluation were selected as the research objects. The patients were randomly divided into experimental group (30 cases) and control group (30 cases). The patients in the control group were given routine guidance and postpartum health education 42 days after delivery and given no pelvic floor rehabilitation training, waiting for natural recovery. 42 days after delivery, the patients in the experimental group received pelvic floor rehabilitation training based on the patients in the control group. All patients underwent ultrasonography, the convolution neural network (CNN) algorithm was used for image denoising and edge feature extraction, and the performance of the algorithm was evaluated by the Dice coefficient, positive predictive value, sensitivity, and Hausdorff distance. The thickness of levator ani muscle, anterior and posterior diameter of perineal hiatus, pelvic floor muscle strength, and imaging data were compared between the two groups. The results revealed that the thickness of levator ani muscle in the experimental group was significantly greater than that in the control group after one month and three months of treatment (0.633 ± 0.26 cm vs. 0.519 ± 0.234 cm, 0.7 ± 0.214 cm vs. 0.507 ± 0.168 cm, P < 0.05). After one month and three months of treatment, the anterior and posterior diameter of perineal fissure in the experimental group was obviously smaller than that in the control group (4.76 ± 0.513 cm vs. 5.002 ± 0.763 cm, 4.735 ± 0.614 cm vs. 4.987 ± 0.581 cm, P < 0.05). The pelvic floor muscle strength of the experimental group was remarkably higher than that of the control group after one month and three months of treatment (3.183 ± 1.47 vs. 2.41 ± 1.57, 3.365 ± 1.53 vs. 2.865 ± 1.69, P < 0.05). The ultrasonic image was clearer, the focus was more prominent, and the image quality was significantly improved after being processed by artificial intelligence algorithm. The Dice coefficient, positive predictive value, sensitivity, and Hausdorff distance of the proposed algorithm were better than those of the traditional algorithm. Thus, artificial intelligence algorithm had a good effect in ultrasonic image processing. Pelvic floor rehabilitation training had a good effect on postpartum nursing of patients with pelvic organ prolapse.

The Influence of Obstetric Factors on the Occurrence of Pelvic Floor Dysfunction in Women in the Early Postpartum Period

Background

This study aimed to analyze the effect of obstetric factors on the development of pelvic floor dysfunction (PFD) in women in the early postpartum period.

Methods

Clinical data of 300 women who were reviewed in our outpatient clinic from July 2016 to December 2019 in the postpartum period were retrospectively analyzed. The occurrence of pelvic organ prolapse (POP) and stress urinary incontinence (SUI) was assessed using the Pelvic Organ Prolapse Quantification System and International Consultation on Incontinence Questionnaire Short Form. Factors affecting the occurrence of PFD in women in the early postpartum period were analyzed using univariate and multifactorial logistic regression models.

Results

A total of 46 cases of POP (15.33%) and 82 of SUI (27.33%) occurred in 300 women at 6–8 weeks after birth. Unconditional logistic regression confirmed that age ≥35 years, vaginal delivery, BMI before delivery ≥ 25 kg/m², perineal tear, protracted or prolonged second stage of labor, and fetal macrosomia were risk factors influencing the occurrence of POP (OR > 1, P < 0.05), whereas age ≥ 35 years, vaginal delivery, perineal tear, protracted or prolonged second stage of labor, fetal macrosomia, and SUI during pregnancy were risk factors influencing the occurrence of SUI (OR> 1, P< 0.05).

Conclusion

Obstetric factors such as age, mode of delivery, perineal tear, protracted or prolonged second stage of labor, and fetal macrosomia may increase the risk of developing PFD in women in the early postpartum period; hence, these risk factors should be correctly identified and promptly addressed to prevent the development of PFD.

Risk factors for postoperative pelvic floor dysfunction in patients with cervical cancer: evidences for management strategies

Background

It’s necessary to evaluate the potential risk factors for postoperative pelvic floor dysfunction (PFD) in patients with cervical cancer, to provide insights into the treatment and nursing care of cervical cancer.

Methods

Our study was a case-control study design. Patients who underwent radical cervical cancer surgery in our hospital from January 2018 to January 2020 were included. We selected the patients with benign uterine lesions after hysterectomy at the same time as the control group. The patient characteristics of two groups were retrospectively compared and analyzed. Multiple logistic regression analyses were conducted to identify the potential risk factors.

Results

A total of 247 patients were included. The duration of surgery, estimated blood loss, duration of urinary catheter, and length of hospital stay in cervical cancer group were significantly more than that of control group (all P<0.05). The incidence of postoperative PFD was 63.93%. There were significant differences in the age, postoperative constipation, number of deliveries, duration of urinary catheter between PFD and no PFD patients (all P<0.05). Age ≥45y (OR 4.39, 1.05–9.83), duration of urinary catheter ≥7d (OR 4.31, 1.22–8.05), postoperative constipation (OR 3.17, 1.07–5.89) and number of deliveries ≥2 (OR 2.75, 1.22–5.43) were the risk factors for postoperative PFD in patients with cervical cancer.

Conclusions

Early measures targeted on those risk factors should be implemented for the prophylaxis of PFD.

What is known from the existing literature about the available interventions for pelvic floor dysfunction among female athletes? A scoping review

Background

Aim

Methods

Results

Conclusions

Quality of Life of Physically Active and Inactive Women Who Are Older after Surgery for Stress Urinary Incontinence Using a Transobturator Tape (TOT)

Urinary incontinence is a major health problem. According to various authors, it concerns 30–40% of the population and grows with age, affecting approximately 50% of women aged over 70. According to the recommendations of the International Continence Society, the treatment of urinary incontinence should commence with conservative treatment and, above all, with physiotherapy. If the conservative treatment fails or the level of urinary incontinence is too high, surgery is recommended. With regard to female patients examined at work, the TOT method was applied. The aim of this study was to assess the relationship between regular physical activity and the quality of life of women aged 65–87 who underwent surgical treatment for stress urinary incontinence (SUI) using the TOT method. The study group involved 60 postmenopausal women, patients of the Department of Gynaecology of the Hospital of Ministry of the Interior and Administration in Wroclaw, with SUI diagnosed during ultrasonography. The female patients were surveyed before and 12 months after the surgery using standardised IPAQ and WHOQOL-BREF.FL questionnaires. Significant positive relationships between quality of life and physical activity before and 12 months after the surgery were demonstrated in the somatic and social domains. Physically active postmenopausal women presented higher values in all domains and total quality of life according to the WHOQOL-BREF compared with physically inactive women, both before and 12 months after the procedure using the TOT method.

Musculoskeletal Considerations for Exercise and Sport: Before, During, and After Pregnancy

There is little written in the orthopaedic literature regarding common musculoskeletal problems that women encounter in relation to pregnancy and their clinical and surgical management. Exercise and other physical activity are generally recommended for most women before, during, and after pregnancy. Unfortunately, a variety of musculoskeletal issues may keep women from starting, continuing, or resuming a healthy exercise regimen throughout a notable portion of their reproductive years. Untreated and undertreated orthopaedic conditions in female athletes may therefore have further unintended negative effects on maternal and fetal health. This article reviews the existing literature on musculoskeletal health considerations before, during, and after pregnancy to provide practical information to orthopaedic surgeons who treat women of all ages and athletic abilities.

Urinary and anal incontinence among female gymnasts and cheerleaders-bother and associated factors. A cross-sectional study

Introduction and hypothesis

Artistic gymnastics, team gymnastics and cheerleading are sports including high-impact activities. It is presumed that the athletes’ pelvic floor must be functioning well to prevent urinary (UI) and anal incontinence (AI) during sports. The aim of this study was to investigate the prevalence and risk factors for UI and AI in female artistic gymnasts, team gymnasts and cheerleaders; the influence of UI and AI on daily living and sport performance; and the athletes’ knowledge about the pelvic floor muscles (PFM).

Methods

All female athletes ≥ 12 years of age competing in ≥ 1 National Championship in artistic gymnastics, team gymnastics or cheerleading in 2018/2019 were invited. International Consensus on Incontinence Questionnaires were used to assess the prevalence/bother of UI and AI.

Results

Among the 319 gymnasts and cheerleaders who participated, the prevalence of UI and AI was 67% and 84%, respectively. Age, training ≥ 4 days/week and straining to void were significantly associated with stress urinary incontinence (SUI) and years of training with AI. Eighty-three percent of athletes with SUI reported a negative effect on sports performance, 22% would occasionally avoid training or specific exercises because of leakage, and 28% used pads for protection. Forty-one percent of the athletes had never heard about the PFM, and 74% reported an interest in PFM training to prevent/treat UI or AI.

Conclusions

UI and AI were prevalent in female gymnasts and cheerleaders, and SUI negatively influenced sport performance. The athletes’ knowledge about the PFM was limited.

MicroRNA-124-3p affects myogenic differentiation of adipose-derived stem cells by targeting Caveolin-1 during pelvic floor dysfunction in Sprague Dawley rats

Background

The aim of this study was to investigate using myogenic differentiation of adipose stem cells for the treatment of female pelvic floor dysfunction (PFD) and aimed to further study the influences of microRNA-124-3p (miR-124-3p) in the process of myogenic differentiation of adipose-derived stem cells (ADSCs) through targeting Caveolin-1 (Cav1) during PFD in Sprague Dawley (SD) rats.

Methods

The ADSCs were separated from 6–8-week-old female SD rats (n=25) and were cultivated. Then, we observed the cell status and conducted fat and osteogenic experiments. We then constructed an ADSC-green fluorescent protein (GFP) stable transfer strain. Flow cytometry was used to identify the positive rates of CD44, CD90, and CD45 in ADSCs and ADSC-GFP. Real-time quantitative polymerase chain reaction (qRT-PCR) and western blotting were used to mRNA and protein expression levels. Myogenic differentiation of ADSCs was measured with immunofluorescence methods. A dual-luciferase reporter assay was executed to affirm whether Cav1 was a target of miR-124-3p.

Results

The isolated ADSCs cells were in good condition under the microscope. The results of flow cytometry showed that the positive rate of CD44 and CD90 was high, and the positive rate of CD45 was low in ADSCs and ADSC-GFP. Under normal culture conditions, ADSCs-GFP cells can be massively adipated and osteogenic. After 5-Aza induced ADSC-GFP myogenic differentiation, the level of miR-124-3p was significantly increased. We found that MiR-124-3p mimics promoted the myogenic differentiation of ADSCs. Moreover, we discovered that Cav1 was a target gene of miR-124-3p and was negatively regulated by miR-124-3p. The results of leak point pressure (LPP), hematoxylin and eosin (HE), and Masson showed that the collagen fiber content of the PFD group was lower than that of the control group; the collagen fiber content of ADSC-GFP, 5-Aza, or miR-124-3p mimics were increased after intervention. Furthermore, the outcomes qRT-PCR, western blotting, and immunofluorescence suggested that miR-124-3p facilitated the survival ADSC-GFP fat transplantation by regulating many key factors in vivo.

Conclusions

These results proofed that miR-124-3p could accelerate myogenic differentiation of ADSCs by down-regulating Cav1 to improve PFD in SD rats, which will pave the way for therapeutic delivery of miRNA targeting PFD disease.

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

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.

Urinary incontinence in women: biofeedback as an innovative treatment method

Urinary incontinence is an involuntary urination (leakage of urine). About 200 million people suffer from this condition, and 60% of cases are concealed and untreated because of shame. It is estimated that an increasing number of young women and women of menopausal age will suffer from urinary incontinence. This disease occurs during the perinatal, perimenopausal period, as a result of brain damage or an unhealthy lifestyle. There are four main types of urinary incontinence: stress, urge, overflow and mixed form. Treatment is adapted to the severity of disease, its type and includes physiotherapeutic treatment (kinesiotherapy, physiotherapy, massage), pharmacological, psychological and surgical treatment. In recent years, growing interest has been observed in the noninvasive biofeedback method. The patient learns to contract the weakened pelvic floor muscles, constantly monitoring progress in treatment. She is also motivated by visual and auditory stimuli. Growing evidence confirms the effectiveness of this method, which to a large extent eliminates urinary incontinence. Nevertheless, attention should also be paid to prevention, which reduces the risk of involuntary leakage of urine.

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.