Interpretation
Due to the hormonal changes and natural aging, middle-aged women are at
high risk for developing pelvic floor disorders. The prevalence rates of
urinary incontinence increase steadily with
age.29,30,31 Previous studies31,31reveal a 30–40% prevalence among middle-aged women, which is in line
with the present study, since symptoms of stress urinary incontinence
were reported by 40% of women. In previous
studies25,32,13 current leisure activity was
associated with lower odds of stress urinary incontinence; whereas the
lack of exercise increases these odds. Similarly, in the current study,
we found an association between current physical activity and stress
urinary incontinence, nevertheless, the association did not remain after
controlling for past physical activity as well as demographical and
gynaecological variables. Competitive sport in early adulthood was
associated with urge urinary incontinence, and association remained
after controlling for confounding factors. Previously, Townsend at
al.33 found that long-term moderate physical activity
is inversely associated with urge urinary incontinence in 37–54 years
old women, instead, according to Danford at al.34long-term total physical activity is not related to incidence of urge
urinary incontinence in older women.
Fecal incontinence is estimated to affect 7–15% of community-dwelling
women, and its prevalence rises with age.35 Deviating
from previous estimates, the prevalence of the symptoms of fecal
incontinence was only 3% in our sample. Physical activity has an effect
on colonic motor function,36,37 and changes in
function may be proportional to the amount of
activity.38 Lower physical activity has been
associated with fecal incontinence in women ages 62–87
years.39 Similarly, in the National Health and
Nutrition Examination Study, adults with greater perceived severity of
fecal incontinence engaged in less moderate-to-vigorous physical
activity.40 In contrary, there is some evidence to
suggest that brisk physical activity, running in particular, may
predispose to gastrointestinal disturbance.41,42According to Vitton et al.43 18–40 years old women
who engaged in high-intensity sport for over 8 hours a week had
significantly higher risk of fecal incontinence than less active women.
Interestingly, we did not find an association on physical activity with
fecal incontinence in simple logistic regression analyses, however,
after adding current physical activity, and demographical and
gynaecological variables in the model, we found that women with history
of regular physical activity were more likely to experience fecal
incontinence. Competitive sports or inactivity in young adulthood or
current physical activity in middle-age were not associated with these
symptoms. It is noteworthy, that the small prevalence of fecal
incontinence may affect the results and, in addition, women reporting
the symptoms were older, had higher BMI and lower education compared to
women who had some other type of pelvic floor disorder.
The global prevalence of constipation is reported to be 14% in adult
population.44 The risk of constipation is higher in
women than in men and increases with age.44,45 In
addition, menopausal transition is associated with gastrointestinal
symptoms, such as constipation.46 In our study
symptoms of constipation or defecation difficulties were reported by
19% of middle-aged women. As stated before, physical activity affects
colonic motor function, therefore, the effect of physical activity on
constipation seems likely. However, study results are inconsistent: In
National Health and Nutrition Examination Survey47recreational physical activity was not strongly associated with
constipation on a population level. Meshkinpour et
al.48 implemented an exercise intervention and
concluded that regular exercise does not play a role in the management
of constipation. Neither did we found an association on previous or
current physical activity with constipation or defecation difficulties.
In contrary, Dukas et al.49 conclude that moderate
physical activity is associated with substantial reduction in the
prevalence of constipation in women, and Tack et al.50state that physical inactivity is one of the many causes contributing to
constipation.
Higher age and postmenopausal status are risk factors for pelvic organ
prolapse.27,51,52 In epidemiological surveys, reported
prevalences varies widely between 1–31% for self-reported symptoms and
up to 65% for clinically confirmed prolapse.53Explanations for the discrepancies between clinical signs of pelvic
organ prolapse and experienced symptoms might lie in the personal sphere
or in the social circumstances.24 In our sample, 5%
of women reported symptoms. We did not find association between previous
or current physical activity and pelvic organ prolapse, which is in line
with some previous studies.27,54,55,56 However,
association of physical activity and pelvic organ prolapse is somewhat
controversial subject, since Braekken et al.56concluded that postmenopausal women with pelvic organ prolapse had
participated less in exercise when they were younger, and, according to
Nygaard et al.,54 strenuous physical activity during
teenage years may result higher odds of pelvic organ prolapse in
middle-age.