Urinary leakage and physical activity in young women

Sammanfattning: The effect of recreational physical activity on urinary leakage/ incontinence (UL/UI) with regard to load on the pelvic floor (PF) in young women has not been studied specifically. The aim of the present work was, to survey the prevalence of UL and UI in young and mostly nulliparous women giving special attention to previous and current physical activity and micturition habits and to study the prevalence of UL and UI in women with low back pain (LBP) within the same age-span. Methods. Study I, II, IV and V included 1230 women (725 primiparous, 305 ex-trampolinists and 200 women with LBP), mean age 28 (range 17-45) years, who answered the same questionnaire with questions regarding physical activity, micturition habits and UL. The primiparous women answered the questionnaire concerning the pre-pregnancy situation and a second questionnaire one year postpartum (n=665). The International Continence Society's definitions of UL and UI from 1988 were used. Physical activity was classified according to high or low impact on the PF. Study III included all elite female trampolinists in Sweden one year (n=35) (mean age 15, range 12-22 years), who answered a questionnaire about UL and training habits. Leakage was verified by a pad-weighing test during trampoline training and strength was measured by perineometry. Results. Most women in Study I, II, IV and V performed physical activity regularly, and of them the ex-trampolinists reported the highest frequencies of high impact activities and women with LBP the lowest. Before pregnancy, primiparous women reported 39% UL and 2% Ul, and one year postpartum 49% UL and 6% Ul. During trampolining, the ex-trampolinists reported 68% UL and 48% UI and 5-10 years afterwards 5 1% UL and 12% Ul. Of women with LBP 78% reported UL and 23% UI. The extrampolinists and the women with LBP reported more UL and UI than the primiparous group (p<0.001). Of the primiparous women with leakage before pregnancy 70% continued to leak one year postpartum, and 76% of the ex-trampolinists with leakage during trampolining reported current leakage. Risk factors associated with UL were: symptoms of dysfunctional PFM i.e. inability to interrupt the urine flow (p<0.001), pelvic load (p<0.001) and dysfunctional micturition habits such as straining during micturition and preventive micturition (p<0.001). High impact activity had a significant influence on current UL (p=0.011) as did high impact activity in the past (p=0.013), while low impact activities in these studies promoted continence (p=0.020). In Study 11180% of the elite trampolinists reported UL and 5 1 % UI during trampoline training. All women above 15 years of age reported UL. The leakage averaged 28g during a jump session. The elite trampolinists showed good strength in the PE muscles. Factors significantly associated with leakage were; duration of training, frequency, years of training after menarche and inability to interrupt the urine flow. Conclusions. Many women in the studies performed physical activity with high impact on the PF and more than one third of healthy young women reported UL before pregnancy. A high prevalence of UL as well as UI was reported for the ex-trampolinists, especially when trampolining after menarche, hence the negative effects of activities loading PFM cannot be ruled out. The highest prevalence of UL/Ul was, except for current trampolining, shown for women with LBP. In all studies the strongest associations with UL were; PF dysfunction (inability to interrupt the urine flow) and dysfunctional micturition habits. Even a small leakage ought to be looked upon as a sign of dysfunction or excessive load on the PE. The benefits of being physically active are overwhelming, but must be balanced against negative effects of high impact load on the PF.