Abstract
Objective To investigate associations of early and middle adulthood physical activity (PA) with symptoms of pelvic floor disorders (PFD), i.e. stress urinary incontinence (SUI), urge urinary incontinence (UUI), fecal incontinence (FI), constipation or defecation difficulties (CDD), and feeling of pelvic organ prolapse (POP) among middle-aged women.
Design A cross-sectional, observational study with retrospective physical activity assessment.
Setting University Research Laboratory.
Sample A random population sample of 1098 47-to-55-year-old Finnish women.
Methods PA history, current PA, and demographical and gynaecological variables were assessed using self-report questionnaires. Logistic regression analyses were applied to study associations of past and current PA with PFDs. Associations of demographical and gynaecological variables with PFDs were studied and their potential confounding effect was controlled in multiple logistic regression models.
Main outcome measures Structured questionnaire-assessed retrospective physical activity history at the age of 17–29, current physical activity at middle age, and prevalence of SUI, UUI, FI, CDD and POP.
Results Current PA was not independently associated with the occurrence of the PFDs. Middle-aged women with early adulthood history of competitive sports were more likely to experience UUI (OR 2.161, 95% CI 1.102–4.237, p=0.025) but not SUI, FI or POP, while women with history of regular PA were more likely to experience FI (OR 4.405, 95% CI 1.049–18.493, p=0.043) but not other PFDs.
Conclusions Competitive sports during early adulthood may increase the risk of UUI at middle age. The history of regular PA may increase the risk of FI.
Keywords Pelvic floor function, exercise, menopausal women
Tweetable abstract Early adulthood competitive or other regular sports may increase the middle age risk of incontinences.
INTRODUCTION
In women, aging-related changes in sex hormones accelerate during middle-age, leading to the permanent cessation of ovarian function.1 Menopausal decline in serum estrogen concentration may lead to changes in the pelvic floor tissue and potentially to disorders,2 such as urinary and fecal incontinences, constipation or defecation difficulties, and pelvic organ prolapse3,4,5,6. In addition to hormonal changes, several factors contribute to the pelvic floor disorders including natural aging of the connective tissue, reproductive history, lifestyle, as well as factors increasing the pressure in abdominal cavity.7,8
The significance of physical activity is broadly studied and due to its numerous health benefits it can be recommended for treating wide range of diseases and conditions.9 However, the pelvic floor in women is the rare area of the body where the positive influence of physical activity has been challenged,10,11 since pelvic floor disorders are associated with not only reduced12 but also notably increased13 physical activity. It is debated that while exercise may decrease the risk of incontinences and pelvic organ prolapse by strengthening pelvic floor muscles, it also overloads and stretches the muscles, thus increasing the risk of pelvic floor disorders.11 Large number of girls and women engage in physical activity, and being a potentially modifiable risk factor, its association with pelvic floor disorders needs to be studied.
Several studies have been conducted on the associations of pelvic floor disorders and competitive sports participation in early adulthood,14,15,16 but studies on the consequences of strenuous activities during early adulthood to the condition of pelvic floor later in life are scarce. The purpose of the current study is to investigate associations of early and middle adulthood physical activity with stress urinary incontinence, urge urinary incontinence, fecal incontinence, constipation or defecation difficulties, and feeling of pelvic organ prolapse. We hypothesized that high intensity physical activity, such as early adulthood competitive level sport participation, may be a risk-enhancing factor for midlife pelvic floor disorders. In contrast, being in general physically active at midlife may associate with lower risk of having pelvic floor disorders.