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.