Prevalence and Normalization of Stress Urinary Incontinence in Female Strength Athletes

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.

Athletes' Knowledge of Pelvic Floor Dysfunction and Their Knowledge of and Engagement with Pelvic Floor Muscle Training: A Scoping Review

INTRODUCTION

Pelvic floor dysfunction (PFD) is prevalent among athletes. Investigating whether athletes are practicing pelvic floor muscle training (PFMT) will assist in delineating the factors underlying the burden of PFD in this population. Additionally, investigating athletes' knowledge of PFD and knowledge of and attitudes toward PFMT may inform interventions to improve the practice of PFMT.

AIMS

This scoping review aimed to collate the available evidence regarding athletes' knowledge of PFD and their knowledge of and engagement with PFMT. Furthermore, this review aimed to determine the types of athletes (sports and competition levels) research had been conducted on and the definitions of PFD and PFMT most used.

METHODS

Six databases were searched up to January 2024. No study design or publication types were restricted; however, non-English articles were excluded due to resource constraints. Additional publications were identified through the reference lists of included articles. Data were synthesized and presented under subheadings relevant to the aims of this review.

RESULTS

Thirty-five publications were included for data extraction. Athletes had low practice of PFMT, poor knowledge of PFD and PFMT, but positive attitudes toward PFMT. One publication reported that higher levels of knowledge were associated with a lower prevalence of PFD. The athletic population was heterogeneous in sport type and competition level, and the definitions of PFD and PFMT were ill-defined.

CONCLUSIONS

Athletes have a low practice of PFMT and poor knowledge of PFD and PFMT. The education of athletes may have a role in supporting pelvic floor health.

Urinary Incontinence in Female Athletes: A Systematic Review on Prevalence and Physical Therapy Approaches

Urinary incontinence (UI) is an involuntary leakage of urine and is classified as stress, mixed, or urge. It is more common in females due to anatomical and physiological body differences. Moreover, the literature remarks an evident presence of UI with high-intensity physical activities. Therefore, the present integrative systematic review focused on the studies aimed at investigating the prevalence of UI in nulliparous sportswomen, studies illustrating sport-specific prevalence of UI, and studies demonstrating the impact of physical therapy intervention on UI. A literature search was carried out systematically on electronic databases consisting of Cochrane and Google Scholar databases from 2018 to December 2023. The keywords utilized to perform the literature search and include relevant articles consisted of "urinary incontinence," AND "nulliparous," AND "sportswomen," OR "female athletes," AND "physical therapy". A total of nine studies were included in the present systematic review. The quality assessment of the studies was performed by using a measurement tool to assess systematic reviews (AMSTAR 2) scale, and the Mixed Methods Appraisal Tool was used for cross-sectional and randomized controlled trial studies. The data extracted included first author and year of publication, study design, sample or number of individuals involved in the study, age range of the participants, type of UI, type of sports involved, purpose of the study, methodological part, outcome measures derived, conclusion, and quality assessment of the studies. The review concluded that nulliparous athletes, especially those participating in high-impact activities, have a significant prevalence of UI. In addition, the physical therapy intervention consisting of pelvic floor muscle training (PFMT) along with education about pertinent pelvic anatomy was mostly performed on female athletes for the prevention and management of UI.

Clinical and exercise professional opinion of return-to-running readiness after childbirth: an international Delphi study and consensus statement

Female athletes have identified a lack of guidance as a barrier to successfully returning to running postpartum, and existing guidelines are vague. Our aim was to define the current practice of determining postpartum run-readiness through a consensus survey of international clinicians and exercise professionals in postpartum exercise to assist clinicians and inform sport policy changes.A three-round Delphi approach was used to gain international consensus from clinicians and exercise professionals on run-readiness postpartum. Professionals who work with postpartum runners participated in an online survey to answer open-ended questions about the following postpartum return-to-running topics: definitions (runner and postpartum), key biopsychosocial milestones that runners need to meet, recommended screening, timeline to initiate running, support items, education topics and factors that contribute to advising against running. Consensus was defined as ≥75% participant agreement.One hundred and eighteen professionals participated in round I, 107 participated in round II (response rate 90.6%) and 95 participated in round III (response rate 80.5%). Responses indicated that, following a minimum 3-week period of rest and recovery, an individualised timeline and gradual return to running progression can be considered. Screening for medical and psychological concerns, current physical capacity, and prior training history is recommended prior to a return to running.This study proposes recommendations for the initial guidance on return-to-running postpartum, framed in the context of current research and consensus from professionals. Future research is needed to strengthen and validate specific recommendations and develop guidelines for best practice when returning-to-running after childbirth.

Women's preferences for pelvic floor screening in sport and exercise: a mixed-methods study integrating survey and interview data in Australian women

OBJECTIVES

One in two women experiencing pelvic floor (PF) symptoms stop playing sport or exercising. The study examines the perspective of women with PF symptoms to inform acceptable screening practices within sport and exercise settings.

METHODS

Explanatory, sequential, mixed-methods design. Phase 1: survey of 18-65 years, symptomatic, Australian women (n=4556). Phase 2: semistructured interviews with a subset of survey participants (n=23). Integration occurred through connection of phases (study design, sampling) and joint display of data.

RESULTS

Findings are represented in three threads: (1) 'women (not) telling'; a majority of women had told no-one within a sport or exercise setting about their PF symptoms due to shame/embarrassment, lack of pelvic health knowledge and not wanting to initiate the conversation, (2) 'asking women (screening for PF symptoms)'; women endorsed including PF symptom questions within existing sport and exercise screening practices but only when conducted in a respectful and considered manner and (3) 'creating safety'; professionals can assist women to disclose by demonstrating expertise, trustworthiness and competency. If health and exercise professionals are provided with appropriate training, they could raise pelvic health awareness and promote a supportive and safe sport and exercise culture.

CONCLUSION

Women with PF symptoms support health and exercise professionals initiating conversations about PF health to normalise the topic, and include PF symptoms among other pre-exercise screening questions. However, women should be informed on the relevance and potential benefits of PF screening prior to commencing. Safe screening practices require building trust by providing information, gaining consent, displaying comfort and genuine interest, and being knowledgeable within one's scope of practice to the provision of advice, exercise modifications and referral as appropriate.