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

Abstract

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.

The Prevalence of Urinary Incontinence among Adolescent Female Athletes: A Systematic Review

“…Given the high prevalence of UI in young female athletes and the lack of awareness of evidence-based preventative neuromuscular strategies such as PFMT and pelvic floor therapy [18,20,27], more studies are warranted. Pelvic physiotherapy has been found to be more effective in achieving continence in elite female athletes and pregnant athletes engaged in aerobic exercise compared to non-athletes [27]. For all these reasons, we suggest early screening with specific evaluation tools such as the pre-participation gynecological evaluation of female athletes proposed by Parmiagiano et al [19] as well as the incorporation of specific neuromuscular training programs for the pelvic floor [13].…”

“…There is a lack of data targeting adolescent females investigating preventative, educational, and treatment modalities for UI. Given the high prevalence of UI in young female athletes and the lack of awareness of evidence-based preventative neuromuscular strategies such as PFMT and pelvic floor therapy [ 18 , 20 , 27 ], more studies are warranted. Pelvic physiotherapy has been found to be more effective in achieving continence in elite female athletes and pregnant athletes engaged in aerobic exercise compared to non-athletes [ 27 ].…”

“…The continence mechanism during sports practice has been hypothesized to be affected by a variety of kinematic and sport-related factors such as pelvic floor displacement during jumps and running [ 22 , 23 ], neuromuscular fatigue of the pelvic floor muscles during strenuous physical activity [ 24 ], and morphological changes of the pelvic floor muscles [ 25 ]. Moreover, low energy availability, low body mass index (BMI), estrogen changes, and hypermobility joint syndrome have also been suggested as possible contributing factors for developing UI in female athletes [ 26 , 27 ].…”

The Specificities of Elite Female Athletes: A Multidisciplinary Approach

“…Recent reviews [ 321 , 322 , 323 , 324 , 325 ] have highlighted that female athletes show a three-fold higher risk of developing urinary incontinence (UI) than male athletes or female non-athletes. The UI is mainly explained by the imbalance of forces between the abdomen and pelvis [ 324 ], with increased intra-abdominal pressure generated during high-impact exercise, which overloads the pelvic organs and creates a pelvic floor dysfunction in high-performance athletes [ 321 , 324 ]. The risk of UI appears dependent on the amount of training and the type of sport, with a prevalence varying from 10% in low-impact to 80% in high-impact sports [ 323 , 325 , 326 , 327 , 328 , 329 ].…”

Resistance Exercise in Prostate Cancer Patients: a Short Review

“…Although general exercise may have a positive effect on the strength of PFM [61], the high prevalence of UI in female powerlifters [62] suggests that RE in isolation might not be sufficient to prevent UI. Although female athletes profit more from PFM training than non-athletic women [63], the question, whether RE and PFM training have a synergistic effect, especially in relation to PCaP, remains to be answered.…”