Strenuous physical activity, exercise, and pelvic organ prolapse: a narrative scoping review

Abstract

Introduction and hypothesis High-intensity physical activity and exercise have been listed as possible risk factors for pelvic organ prolapse (POP). The aim of the present study is to conduct a literature review on the prevalence and incidence of POP in women who engage in regular physical activity. In addition, we review the effects of a single exercise or a single session of exercise on pelvic floor support. Finally, the effect of exercises on POP in the early postpartum period is reviewed. Methods This is a narrative scoping review. We searched PubMed and Ovid Medline, the Physiotherapy Evidence Database (PEDro), and the Cochrane Database of Systematic Reviews up to May 2022 with the following MeSH terms: “physical activity” AND “exercise” AND “pelvic floor” AND “pelvic organ prolapse”. Results Eight prevalence studies were retrieved. Prevalence rates of symptomatic POP varied between 0 (small study within different sports) and 23% (Olympic weightlifters and power lifters). Parity was the only factor associated with POP in most studies. Three studies evaluated the pelvic floor after a single exercise or one session of exercise and found increased vaginal descent or increased POP symptoms. One prospective cohort study reported the development of POP after 6 weeks of military parashot training, and one randomized trial reported increased POP symptoms after transverse abdominal training. There is scant knowledge on exercise and POP in the postpartum period. Conclusions Prevalence of POP in sports varies widely. Experimental and prospective studies indicate that strenuous exercise increased POP symptoms and reduced pelvic floor support.

Symptomatology and knowledge regarding pelvic floor dysfunctions and influence of gender stereotypes in female athletes

“…Regarding knowledge about UI, it is the most known PFD among athletes. This result is consistent with the volume of scientific literature and educational interventions focusing on UI compared to the rest of PFD, according to authors of recent reviews 15 , 28 , 38 . Once again, although level of knowledge was not associated with occurrence of urinary leakage, dissemination of information would motivate athletes to ask for professional healthcare and avoid normalizing loss of urine during training 39 .…”

Nuances of the Valsalva manoeuvre and bracing with regard to resistance training performance and its effects on the pelvic floor

“…There are two opposing theories relating to repetitive exposure of the pelvic floor to the VM and the risk of PFD. One postulates that a training effect will occur, and the pelvic system will adapt to the pressures to which it is exposed (Bø et al 2023). The other is that RT and repetitive exposure to the VM will weaken the structures around the pelvis, making individuals more likely to experience issues such as POP (Bø & Nygaard 2020).…”

“…Indeed, PFM thickness is greater in women who are regular exercisers than those who are not, but this does not translate into an increase in the strength of these muscles (Menezes et al 2022). The impact of regular RT on static support around the pelvis and the subsequent risk of POP is unclear (Bø et al 2023). Occupational heavy lifting is a known risk factor for the development of POP, which has led to recommendations to avoid high-load RT and the VM in order to mitigate this possibility (Currier et al 2023).…”

“…An intentional bear-down, as seen in POP assessment, should not be a component of the VM while bracing during RT. However, while describing unique manoeuvres, this overlapping of terminology creates confusion in the research and clinical spaces (Bø et al 2023). Pelvic floor physiotherapists and obstetrical providers may discourage the use of the VM during RT out of fear of exacerbation, or the development, of POP or other PFDs such as urinary incontinence (UI) (Bø et al 2023).…”

“…However, while describing unique manoeuvres, this overlapping of terminology creates confusion in the research and clinical spaces (Bø et al 2023). Pelvic floor physiotherapists and obstetrical providers may discourage the use of the VM during RT out of fear of exacerbation, or the development, of POP or other PFDs such as urinary incontinence (UI) (Bø et al 2023). Figure 1 highlights differences in the direction of pressure between these two manoeuvres.…”