Pelvic Floor Therapy for Athletes with Urinary Incontinence: A Critically Appraised Topic

Abstract

Exercise and sports put a strain on the pelvic floor muscles, causing many women to experience Urinary Incontinence (UI) or pain during activity. It has been reported that up to 75% of athletes experience urine loss while participating in sport and it is purported that pelvic floor therapy may decrease incidence of UI. Clinical questions: “In female athletes with UI, does pelvic floor therapy decrease incidence of urinary leakage?”Pubmed, Cochrane, and Google Scholar were searched in June of 2021 using the Boolean phrases: Pelvic floor therapy AND athletes, Pelvic Floor OR urinary incontinence AND athletes, stress incontinence AND athletes, Pelvic floor muscle training AND athletes, Pelvic floor AND physically active, Pelvic Floor therapy, Pelvic floor muscle training. Internal and external validity were assessed using the STROBE checklist for cohort studies and the Center for Evidence Based Management (CEBM) critical appraisal of randomized control trials and the CASP for case control studies.Study Titles were reviewed for relevance, then abstract, and full text. Articles were included based on their ability to answer the research question and matching clinical outcome measure. Only studies from the past 7 years were considered. The search initially resulted in 1,460 articles, all but 15 were excluded based on title and study type. Of the 15 screened, 2 were included for analysis. In both studies, UI was assessed using the Pad test to measure urinary leakage.  In one study using the pad test (Ferreira et al), female athletes were randomly assigned to control or experimental (pelvic floor muscle rehabilitation program) group.  UI decreased by 45.5% in the experimental group vs 4.9% in the control.  In another study using the pad test (Pires et al), athletes were randomly assigned to an at-home pelvic floor muscle training group or control group. There was a significant reduction in the mean leakage for the experimental group between initial (1.83 ± 2.40) and funal phases (2.00 0 ± 1.67). The percentage of urine loss decreased in EG to 42.9% (n = 3) and increased in CG to 83.3% (n = 5). One study scored 9/10 on the CASP and one scored 3/3 on CEBM.There is consistent evidence that pelvic floor therapy is beneficial in decreasing urinary incontinence in athletes. This is reliant on the ability to target the correct muscles to build awareness of proper muscle contraction and adherence to the exercise protocol. UI is common in athletes, particularly females participating in high impact sports.  Pelvic floor therapy protocols should be developed and available for high impact sport athletes to mitigate the occurrence of urinary incontinence during sport.  SORT B.