The Acute Effects of Running on Pelvic Floor Morphology and Function in Runners with and Without Running-induced Stress Urinary Incontinence

Overview

Journal Int Urogynecol J

Publisher Springer

Specialties Gynecology & Obstetrics
Urology

Date 2023 Nov 22

PMID 37991566

Authors

Marie-Eve Berube

Linda McLean

Affiliations

Soon will be listed here.

Abstract

Introduction And Hypothesis: The aim of this study was to examine the impact of a single running session on pelvic floor morphology and function in female runners, and to compare those with and without running-induced stress urinary incontinence (RI-SUI).

Methods: This cross-sectional, observational study involved two groups: female runners who regularly experienced RI-SUI (n = 19) and runners who did not (n = 20). Pelvic floor muscle (PFM) properties were assessed using intravaginal dynamometry during maximal voluntary contractions (MVC) and during passive tissue elongation. The morphology of the pelvic floor was assessed at rest, during MVC and during maximal Valsalva maneuver (MVM) using 2D and 3D transperineal ultrasound imaging before and after a running protocol. Mixed-effects ANOVA models were used to compare all outcomes between groups and within-groups, including the interaction between group and time. Effect sizes were calculated.

Results: No changes in PFM function assessed using intravaginal dynamometry were observed in either group after the run. Significant and large within-group differences were observed on ultrasound imaging. Specifically, the area and antero-posterior diameter of the levator hiatus were larger after the run, the bladder neck height was lower after the run, and the levator plate length was longer after the run (p ≤ 0.05). At the peak MVM and MVC, the bladder neck height was lower after the run than before the run (p ≤ 0.05). No between-group differences were observed for any outcomes.

Conclusions: Running appears to cause transient strain of the passive tissues of the female pelvic floor in runners both with and without RI-SUI, whereas no concurrent changes are observed in PFM contractile function.

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References

Abrams P, Avery K, Gardener N, Donovan J . The International Consultation on Incontinence Modular Questionnaire: www.iciq.net. J Urol. 2006; 175(3 Pt 1):1063-6. DOI: 10.1016/S0022-5347(05)00348-4. View

Cotterill N, Norton C, Avery K, Abrams P, Donovan J . Psychometric evaluation of a new patient-completed questionnaire for evaluating anal incontinence symptoms and impact on quality of life: the ICIQ-B. Dis Colon Rectum. 2011; 54(10):1235-50. DOI: 10.1097/DCR.0b013e3182272128. View

Dietz H, Bernardo M, Kirby A, Shek K . Minimal criteria for the diagnosis of avulsion of the puborectalis muscle by tomographic ultrasound. Int Urogynecol J. 2010; 22(6):699-704. DOI: 10.1007/s00192-010-1329-4. View

Brooks K, Varette K, Harvey M, Robert M, Brison R, Day A . A model identifying characteristics predictive of successful pelvic floor muscle training outcomes among women with stress urinary incontinence. Int Urogynecol J. 2020; 32(3):719-728. PMC: 7902568. DOI: 10.1007/s00192-020-04583-z. View

Czyrnyj C, Berube M, Lanteigne E, Brennan A, Bader Y, Lomovtsev D . Design and validation of an automated dual-arm instrumented intravaginal dynamometer. Neurourol Urodyn. 2021; 40(2):604-615. DOI: 10.1002/nau.24600. View

Gan Z, Smith A . Urinary Incontinence in Elite Female Athletes. Curr Urol Rep. 2022; 24(2):51-58. DOI: 10.1007/s11934-022-01133-6. View

Kruger J . High impact exercise may cause pelvic floor dysfunction: AGAINST: Is high-impact exercise really bad for your pelvic floor?. BJOG. 2018; 125(5):615. DOI: 10.1111/1471-0528.15024. View

Berube M, Czyrnyj C, McLean L . An automated intravaginal dynamometer: Reliability metrics and the impact of testing protocol on active and passive forces measured from the pelvic floor muscles. Neurourol Urodyn. 2018; 37(6):1875-1888. DOI: 10.1002/nau.23575. View

Majida M, Braekken I, Bo K, Benth J, Engh M . Validation of three-dimensional perineal ultrasound and magnetic resonance imaging measurements of the pubovisceral muscle at rest. Ultrasound Obstet Gynecol. 2010; 35(6):715-22. DOI: 10.1002/uog.7587. View

10.

Middlekauff M, Egger M, Nygaard I, Shaw J . The impact of acute and chronic strenuous exercise on pelvic floor muscle strength and support in nulliparous healthy women. Am J Obstet Gynecol. 2016; 215(3):316.e1-7. DOI: 10.1016/j.ajog.2016.02.031. View

11.

Falah-Hassani K, Reeves J, Shiri R, Hickling D, McLean L . The pathophysiology of stress urinary incontinence: a systematic review and meta-analysis. Int Urogynecol J. 2021; 32(3):501-552. PMC: 8053188. DOI: 10.1007/s00192-020-04622-9. View

12.

Price N, Jackson S, Avery K, Brookes S, Abrams P . Development and psychometric evaluation of the ICIQ Vaginal Symptoms Questionnaire: the ICIQ-VS. BJOG. 2006; 113(6):700-12. DOI: 10.1111/j.1471-0528.2006.00938.x. View

13.

Teixeira R, Colla C, Sbruzzi G, Mallmann A, Laureano Paiva L . Prevalence of urinary incontinence in female athletes: a systematic review with meta-analysis. Int Urogynecol J. 2018; 29(12):1717-1725. DOI: 10.1007/s00192-018-3651-1. View

14.

Leitner M, Moser H, Eichelberger P, Kuhn A, Baeyens J, Radlinger L . Evaluation of pelvic floor kinematics in continent and incontinent women during running: An exploratory study. Neurourol Urodyn. 2017; 37(2):609-618. DOI: 10.1002/nau.23340. View

15.

Melin A, Tornberg A, Skouby S, Faber J, Ritz C, Sjodin A . The LEAF questionnaire: a screening tool for the identification of female athletes at risk for the female athlete triad. Br J Sports Med. 2014; 48(7):540-5. DOI: 10.1136/bjsports-2013-093240. View

16.

Dietz H . Ultrasound imaging of the pelvic floor. Part I: two-dimensional aspects. Ultrasound Obstet Gynecol. 2004; 23(1):80-92. DOI: 10.1002/uog.939. View

17.

Ree M, Nygaard I, Bo K . Muscular fatigue in the pelvic floor muscles after strenuous physical activity. Acta Obstet Gynecol Scand. 2007; 86(7):870-6. DOI: 10.1080/00016340701417281. View

18.

Lee D . Alternatives to P value: confidence interval and effect size. Korean J Anesthesiol. 2016; 69(6):555-562. PMC: 5133225. DOI: 10.4097/kjae.2016.69.6.555. View

19.

McLean L, Thibault-Gagnon S, Brooks K, Goldfinger C, Pukall C, Chamberlain S . Differences in Pelvic Morphology Between Women With and Without Provoked Vestibulodynia. J Sex Med. 2016; 13(6):963-71. DOI: 10.1016/j.jsxm.2016.04.066. View

20.

Dietz H, Abbu A, Shek K . The levator-urethra gap measurement: a more objective means of determining levator avulsion?. Ultrasound Obstet Gynecol. 2008; 32(7):941-5. DOI: 10.1002/uog.6268. View