Urinary incontinence in women

Physical activity and the pelvic floor

The prevalence of urinary incontinence in nulliparous adolescent and middle-aged women and the associated risk factors: A systematic review.

People are increasingly aware of healthy lifestyles. Extenuating practice can injure the pelvic floor. Urinary incontinence (UI) is a prevalent condition in women whether they exercise professionally or not. The most common symptom is stress UI. It is reported in a large variety of sports and may interfere with everyday life or training, leading athletes to change or compromise their performance or risk compromising it. We aimed to assess the prevalence of UI in female athletes and to determine whether the type of sport might also influence UI. A systematic review of the literature was performed by searching PubMed, the Cochrane Library, and LILACS up to 23 January 2017. The search strategy included the keywords pelvic floor disorders, urinary incontinence, athletes, and sports. The inclusion criterion was studies of women who performed any kind of sport with a prevalence of UI. The subjects were female, with no restriction for age, sport modality, or frequency of training. The outcome was prevalence of UI. The search identified 385 studies, 22 of which met the methodologic criteria for complete analysis. In this review, 7507 women aged 12 to 69 years were included. Only five studies compared physically active women to controls. Every study included high or moderate impact activities involving jumping, fast running, and rotational movements. In total, 17 sport modalities were analyzed. The prevalence of UI varied from 5.56% in low-impact activity to 80% in trampolining. In athletes, the prevalence of incontinence ranged from 10.88% to 80%, showing that the amount of training influences UI symptoms. High-impact activities showed a 1.9-fold prevalence over medium-impact activities and 4,59-fold prevalence over impact activities. Factors such as hormone use, smoking, or menopausal status could not be assessed since they were not detailed in most of the studies. These data suggest that sports practice increases the prevalence of UI and that the type of activity performed by women also has a bearing on the disorder.

Urinary incontinence in female athletes: a systematic review

Objective To determine whether women engaged in strenuous, provocative exercise are more likely to be incontinent in future life than similarly fit women who participated in less provocative exercise. Methods In this retrospective cohort study, female American Olympians who competed in swimming (low-impact group) and in gymnastics and track and field (high-impact group) between 1960 and 1976 completed a structured questionnaire. Primary outcome measures included the prevalence of the symptoms of stress and urge incontinence. Statistical analyses of results included χ 2 , Fisher exact test, two-tailed t tests, Wilcoxon rank sum test, and stepwise multiple logistic regression. P Results One hundred four women responded (response rate 51.2%). High-impact athletes were older (46.2 compared with 42.4 years) and were more likely to report incontinence when they were doing their sport as Olympians (35.8% compared with 4.5%) than low-impact athletes; low-impact athletes were more likely to be parous (83.3% compared with 60.7%). There was no difference in the prevalence of the symptom of stress incontinence between the highversus low-impact groups: any incontinence, 41.1% compared with 50%; daily or weekly incontinence, 10.7% compared with 8.3%; and incontinence that bothered them moderately or greatly, 10.7% compared with 4.2%. With our sample size, this study had 80% power to detect a fourfold difference in daily or weekly incontinence between groups, but only a 30% power to detect a twofold difference, given a baseline prevalence of 10%. When age, body mass index (BMI), parity, Olympic sport group, and incontinence during Olympic sport were entered into stepwise logistic regression analyses, only BMI was significantly associated with regular stress or urge incontinence symptoms. Conclusion Participation in regular, strenuous, highimpact activity when younger did not predispose women to a markedly higher rate of clinically significant urinary incontinence in later life.

Does prolonged high-impact activity contribute to later urinary incontinence? A retrospective cohort study of female olympians

Stress urinary incontinence is a frequent complaint in medical offices and studies have shown that women who practice high impact sports develop its symptoms. To evaluate the prevalence of stress urinary incontinence in women who attend gyms and perform high impact exercises and correlate it with women who do not attend gyms. Prospective comparative study in which 488 nulliparous women of normal weight were divided into a Study Group, composed of women who attended gyms, and a Comparative Group, composed of women who did not attend gyms. Three questionnaires were used for the evaluation of stress urinary incontinence and the results of the ICIQ-SF questionnaire were used to compare the groups. There was a significant difference between groups on the ICIQ-SF. The average in the Study Group was 1.68 (+ 3.46) and in the Comparative Group the average was 1.02 (+ 2.69) (p = 0.006). Women who attend gym and perform high impact exercises have a higher prevalence of urinary incontinence symptoms, independent of the exercise modality, than women who do not perform any high impact exercise.

Prevalence study of stress urinary incontinence in women who perform high-impact exercises

Introduction: Urinary continence depends on a complex coordination between bladder, urethra, pelvic floor muscles and ligaments, mainly during exercises, when the abdominal pressure rises (1). Intensity and frequency of high impact and repetitive exercises might determine pelvic floor muscles fatigue and as a consequence, urinary incontinence. Objective: Evaluate the prevalence of stress urinary incontinence among women on high impact regular exercises and woman with no physical activity or low impact exercises. Material and Methods: 488 healthy nulliparous women 19 to 45 years old were interviewed in Campinas, São Paulo. The study group (SG) included 244 women on high impact regular exercises for at least 4 weeks. Control Group (CG) included 244 women with no physical activity or low impact exercises. All women responded the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) for the evaluation of the prevalence of stress urinary incontinence and a specific questionnaire to register the type and frequency of the exercises. All women signed a consent term and data was confidential. For statistical analysis a SPSS program version 17.0 was used. Results: Mean age was 25, 68 years old (± 5,32) on SG and 24,45 years old (± 4,97) on CG. BMI was 22,03 (±3,21) on SG and 21,87 (±2,85) on CG. The groups were similar in relation to race and number of years at school. ICIQ-SF demonstrated significant difference among the groups (p=0,009). In the SG 24.6% referred urine loss, while in CG only 14.8% suffered from stress urinary in continence (p=0,006). When asked about urine loss during exercise 5.7% of women in the SG and 0,4% of women on CG referred the symptom (p= 0,001). The questionnaire on physical exercises showed that women in SG practiced the exercises for 39,65 months (±47,08) with a frequency of 3,74 days per week (±1,36). Regarding the type of exercise 40,6% walked, 17,8% were runners, 67,6% did exercises for muscular strength, 29,9% did localized exercises, 35,7 % abdominal exercises, 32,8% “jump”, 17,6% “step”, 36,5% “bike”, 27,9% elongating exercises, 15,2% Pilates, 2,9% exercised on the water, 5,7% swimming and 13,5% other exercises. Among those women 14,3% referred urine loss during exercise and 57,4% urinate before exercise to prevent leakage. Comparing women on the SG who declared no urine loss on ICIQ-SF with those who declared at least one leakage episode, no statistical difference was observed among them regarding the length or frequency of physical activity. Regarding the type of exercise, those who exercised “capoeira”, dancing, fights or tennis presented a significantly higher prevalence of urinary leakage (p<0.001). Comments –These study included Young, healthy and nulliparous women, consequently not at risk for urinary incontinence. The inclusion of a control group supports better the results, with few studies in the literature doing so. In a study of elite athletes at the same age (2), the prevalence of urinary incontinence was higher in the elite group. Our study demonstrated a higher prevalence of urinary incontinence among women who were on high impact exercises when compared to those with no exercises or on low impact activities, as walking, swimming or exercising in the water. Fisher (1999) correlating BMI with stress urinary incontinence states that the effect of weight occurs only when superior to 30. Our study excluded women with BMI above 30. Among women on physical exercises, 14,3 % referred urinary leakage during exercise. A study observes that 54% of elite athletes leaked urine during exercises. Thyssen (3) found that 4% of the athletes leaked urine during exercises stating that “jumping” is the activity more prone to determine leakage. In our study, exercises like “capoeira”, dancing, fights or tennis demonstrated o high prevalence of urinary incontinence. The situation of incontinence during exercises leads to preventive urination before exercises, as mentioned by Thyssen. Among the women interviewed in our study, 57.4% used this practice. Conclusion – This study demonstrated that women who exercise regularly with high impact exercises have a higher prevalence of urinary incontinence, independently of the exrcise performed. Low impact exercises seem to offer less risk for stress urinary incontinence. More studies are necessary the study the correlation between high impact exercises and SUI and which mechanism could explain the effect on pelvic structures that lead to urinary incontinence. By doing so, exercises should be oriented adequately to protect pelvic floor muscles. References 1. Norton P, Brubaker L. Urinary incontinence in women. Lancet 2006; 367:57-67 2. Bo K, Sundgot Borgen J. Prevalence of stress and urge incontinence in elite athletes controls. Med Sci Sports 2001, 33:1798-1802 3. Thyssen HH, Clevin L, Olesen S, Lose G. Urinary incontinence in elite female athletes and dancers. Int Urogynecol J. 2002; 13:15-7

Luiza R. Marques

Papers

Prevalence study of stress urinary incontinence in women who perform high-impact exercises

Prevalence study of stress urinary incontinence among women on high impact regular exercises