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Exercising and pelvic floor health in women

Summary of a review article on the influence of physical activity on pelvic floor health, this includes the effect of exercises on urinary and anal incontinence and labor.

Who

Exercising women versus non-exercising controls.

Design

Systematic review of studies.

Outcome measures

  • pelvic muscle strength
  • urinary incontinence
  • anal incontinence
  • labor outcomes

Main results

  • Mixed results of the influence of exercise on pelvic floor muscles’ strength.
  • Exercising and non-exercising women have been shown to have similar pelvic and urogenital hiatus morphology in some studies but different in others. Levator ani muscle was usually bigger in athletes.
  • Mild to moderate physical activity is likely to decrease the risk of urinary incontinence. However, urinary incontinence is more prevalent in women participating in sport. Especially in high-impact athletes i.e. trampolinists, gymnasts, volleyball players, and long-distance runners.
  • The influence of exercise on anal incontinence was poorly researched. No studies reported less anal incontinence, two studies reported more anal incontinence in athletes, and one study reported no difference.
  • Pelvic organ prolapse research showed either no difference between exercises and non-exercises or marginally higher prevalence in women who did >21h/week of strenuous activity as teens.
  • Elite athletes experienced stress urinary incontinence more often if they had an eating disorder.
  • For athletes in general, urinary incontinence prevalence increased with age and long training hours.
  • Exercising women seem to have a shorter first stage of labor and lower risk of cesarean section.
  • Prenatal pelvic floor exercises shortened labor without increasing risk for episiotomy, perineal lacerations or instrumental vaginal delivery.

Take home message

For a clinician
High-impact sports have higher urinary incontinence rates, as do elite athletes with eating disorders. In general, the longer athletes train and the older they get, the risk increases. Exercisers labor shorter without increasing risks for mother or baby.
For a parent
High-impact sports' athletes (e.g. gymnastics) and athletes with an eating disorder, have higher rates of urinary incontinence. Exercising women labor shorter without increasing risks for mother or baby.
For an athlete
If you are a high-impact sport athlete (e.g. gymnast, volleyball player, long-distance runner) and/or you have an eating disorder, you are at a higher risk of urinary incontinence. Exercising seems to have a positive impact on labor.

Original article

Bø K, Nygaard IE. Is Physical Activity Good or Bad for the Female Pelvic Floor? A Narrative Review. Sports Medicine. 2020 50:471-484.

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