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.