Dynamic changes of the pelvic floor in elite athletes of different sports
DOI:
https://doi.org/10.29352/mill0213.09.00334Keywords:
Levator ani, Maximal voluntary contraction, Pelvic floor function, Translabial ultrasoundAbstract
Introduction: One of the functions of the pelvic floor muscles (PFM) is to support the pelvic organs and continence. This continence mechanism tends to change when PFM are exposed to high-impact exercises.
Objetives: To describe the dynamic changes in the pelvic floor (PF) in elite nulliparous athletes.
Methods: Translabial two and three-dimensional ultrasound was used to assess PF anatomy and function in athletes (n=8). This ultrasonography was performed after voiding and in the supine position, using a vaginal probe. The descent of the pelvic organs was assessed on a maximum Valsalva maneuver, whilst the volume datasets were acquired at rest, during maximum voluntary contraction (MVC) and during a Valsalva maneuver. The athletes performed each maneuver at least 3 times, with the most effective being used for evaluation.
Results: The bladder neck descent was 14 mm for the javelin thrower, being the highest value when compared to the remaining participants. Three athletes featured the rectocele (swimming, gymnastics and javelin throw) and 4 participants presented a paravaginal defect (volleyball, horsemanship, javelin throw and printer). The volleyball athlete had the highest value of the levator hiatal area in MVC value.
Conclusions: The athletes present minimal differences in the evaluated parameters. The sample is small to generalize the results, but there is a tendency for athletes of high-impact exercises to have a lower CMV value. Further studies are needed to corroborate these results.
Downloads
References
Bø, K., & Borgen, J. S. (2001). Prevalence of stress and urge urinary incontinence in elite athletes and controls. Medicine and Science in Sports and Exercise, 33(11), 1797–1802. https://doi.org/10.1097/00005768-200111000-00001
Bø, Kari. (2004a). Urinary incontinence, pelvic floor dysfunction, exercise and sport. Sports Medicine (Auckland, N.Z.), 34(7), 451–464. https://doi.org/10.2165/00007256-200434070-00004
Bø, Kari. (2004b). Pelvic floor muscle training is effective in treatment of female stress urinary incontinence, but how does it work? International Urogynecology Journal and Pelvic Floor Dysfunction, 15(2), 76–84. https://doi.org/10.1007/s00192-004-1125-0
Brandão, S., Parente, M., Silva, A. R., Roza, T. D., Mascarenhas, T., Ramos, I., & Jorge, R. M. N. (2015). The Impairment of Female Pelvic Ligaments and Its Relation With Pelvic Floor Dysfunction: Biomechanical Analysis. Computational and Experimental Biomedical Sciences: Methods and Applications, 63–73. https://doi.org/10.1007/978-3-319-15799-3_4
Cardoso, A. M. B., Lima, C. R. O. de P., & Ferreira, C. W. S. (2018). Prevalence of urinary incontinence in high-impact sports athletes and their association with knowledge, attitude and practice about this dysfunction. European Journal of Sport Science, 18(10), 1405–1412. https://doi.org/10.1080/17461391.2018.1496146
Carvalhais, A., Roza, T. D., & Sacomori, C. (2018). Pelvic Floor in Female Athletes: From Function to Dysfunction. Women’s Health and Biomechanics, 145–153. https://doi.org/10.1007/978-3-319-71574-2_12
Carvalho, C., da Silva Serrão, P. R. M., Beleza, A. C. S., & Driusso, P. (2020). Pelvic floor dysfunctions in female cheerleaders: A cross-sectional study. International Urogynecology Journal, 31(5), 999–1006. https://doi.org/10.1007/s00192-019-04074-w
Casey, E. K., & Temme, K. (2017). Pelvic floor muscle function and urinary incontinence in the female athlete. The Physician and Sportsmedicine, 45(4), 399–407. https://doi.org/10.1080/00913847.2017.1372677
Dietz, H. P. (2004a). Ultrasound imaging of the pelvic floor. Part I: Two-dimensional aspects. Ultrasound in Obstetrics & Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology, 23(1), 80–92. https://doi.org/10.1002/uog.939
Dietz, H. P. (2004b). Ultrasound imaging of the pelvic floor. Part II: Three-dimensional or volume imaging. Ultrasound in Obstetrics & Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology, 23(6), 615–625. https://doi.org/10.1002/uog.1072
Dietz, H. P., & Bennett, M. J. (2003). The effect of childbirth on pelvic organ mobility. Obstetrics and Gynecology, 102(2), 223–228. https://doi.org/10.1016/s0029-7844(03)00476-9
Dietz, H. P., Eldridge, A., Grace, M., & Clarke, B. (2004). Pelvic organ descent in young nulligravid women. American Journal of Obstetrics and Gynecology, 191(1), 95–99. https://doi.org/10.1016/j.ajog.2004.01.025
Dietz, H. P., Shek, C., & Clarke, B. (2005). Biometry of the pubovisceral muscle and levator hiatus by three-dimensional pelvic floor ultrasound. Ultrasound in Obstetrics & Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology, 25(6), 580–585. https://doi.org/10.1002/uog.1899
Dietz, Hans Peter. (2011). Pelvic floor ultrasound in prolapse: What’s in it for the surgeon? International Urogynecology Journal, 22(10), 1221–1232. https://doi.org/10.1007/s00192-011-1459-3
Dietz, Hans Peter. (2017). Pelvic Floor Ultrasound: A Review. Clinical Obstetrics and Gynecology, 60(1), 58–81. https://doi.org/10.1097/GRF.0000000000000264
Dietz, Hans Peter. (2019). Pelvic floor ultrasound: Essentials. Ultrasound in Medicine and Biology, 45, S60. https://doi.org/10.1016/j.ultrasmedbio.2019.07.610
Eliasson, K., Larsson, T., & Mattsson, E. (2002). Prevalence of stress incontinence in nulliparous elite trampolinists. Scandinavian Journal of Medicine & Science in Sports, 12(2), 106–110. https://doi.org/10.1034/j.1600-0838.2002.120207.x
Gao, Y., Zhao, Z., Yang, Y., Zhang, M., Wu, J., & Miao, Y. (2020). Diagnostic value of pelvic floor ultrasonography for diagnosis of pelvic organ prolapse: A systematic review. International Urogynecology Journal, 31(1), 15–33. https://doi.org/10.1007/s00192-019-04066-w
Gram, M. C. D., & Bø, K. (2020). High level rhythmic gymnasts and urinary incontinence: Prevalence, risk factors, and influence on performance. Scandinavian Journal of Medicine & Science in Sports, 30(1), 159–165. https://doi.org/10.1111/sms.13548
Gray, T. G., & Radley, S. C. (2020). Pelvic Organ Prolapse. Urologic Principles and Practice, 487–497. https://doi.org/10.1007/978-3-030-28599-9_29
Hagovska, M., Švihra, J., Buková, A., Horbacz, A., Dračková, D., Švihrová, V., & Kraus, L. (2017). Prevalence of Urinary Incontinence in Females Performing High-Impact Exercises. International Journal of Sports Medicine, 38(3), 210–216. https://doi.org/10.1055/s-0042-123045
Haylen, B. T., Maher, C. F., Barber, M. D., Camargo, S., Dandolu, V., Digesu, A., Goldman, H. B., Huser, M., Milani, A. L., Moran, P. A., Schaer, G. N., & Withagen, M. I. J. (2016). An International Urogynecological Association (IUGA) / International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). International Urogynecology Journal, 27(2), 165–194. https://doi.org/10.1007/s00192-015-2932-1
Haylen, B. T., Ridder, D., Freeman, R. M., Swift, S. E., Berghmans, B., Lee, J., Monga, A., Petri, E., Rizk, D. E., Sand, P. K., & Schaer, G. N. (2010). An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourology and Urodynamics, 29(1), 4–20. https://doi.org/10.1002/nau.20798
Karim, R., Begum, S., Ayub, S., Pervaiz, K. F., & Akhtar, R. (2019). INCONTINENCE OF URINE IN PREGNANT WOMEN. Journal of Postgraduate Medical Institute (Peshawar - Pakistan), 33(2), Article 2. https://jpmi.org.pk/index.php/jpmi/article/view/2427
Kisner, C., & Colby, L. A. (2009). Exercícios terapêuticos: Fundamentos e técnicas (5a edição). Manole. Kruger, J. A., Dietz, H. P., & Murphy, B. A. (2007). Pelvic floor function in elite nulliparous athletes. Ultrasound in Obstetrics & Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology, 30(1), 81–85. https://doi.org/10.1002/uog.4027
Kruger, J. A., Heap, S. W., Murphy, B. A., & Dietz, H. P. (2008). Pelvic floor function in nulliparous women using threedimensional ultrasound and magnetic resonance imaging. Obstetrics and Gynecology, 111(3), 631–638. https://doi.org/10.1097/AOG.0b013e3181655dc2
Lasak, A. M., Jean-Michel, M., Le, P. U., Durgam, R., & Harroche, J. (2018). The Role of Pelvic Floor Muscle Training in the Conservative and Surgical Management of Female Stress Urinary Incontinence: Does the Strength of the Pelvic Floor Muscles Matter? PM & R: The Journal of Injury, Function, and Rehabilitation, 10(11), 1198–1210.
https://doi.org/10.1016/j.pmrj.2018.03.023
Livingston, B. (2016). Anatomy and Neural Control of the Lower Urinary Tract and Pelvic Floor. Topics in Geriatric Rehabilitation, 32(4), 280–294. https://doi.org/10.1097/TGR.0000000000000123
Louis-Charles, K., Biggie, K., Wolfinbarger, A., Wilcox, B., & Kienstra, C. M. (2019). Pelvic Floor Dysfunction in the Female Athlete. Current Sports Medicine Reports, 18(2), 49–52. https://doi.org/10.1249/JSR.0000000000000563
Lourenco, T. R. de M., Matsuoka, P. K., Baracat, E. C., & Haddad, J. M. (2018). Urinary incontinence in female athletes: A systematic review. International Urogynecology Journal, 29(12), 1757–1763. https://doi.org/10.1007/s00192-018-3629-z
Mitchell, J. H., Haskell, W., Snell, P., & Van Camp, S. P. (2005). Task Force 8: Classification of sports. Journal of the American College of Cardiology, 45(8), 1364–1367. https://doi.org/10.1016/j.jacc.2005.02.015
Pires, T. F., Pires, P. M., Moreira, M. H., Gabriel, R. E. C. D., João, P. V., Viana, S. A., & Viana, R. A. (2020). Pelvic Floor Muscle Training in Female Athletes: A Randomized Controlled Pilot Study. International Journal of Sports Medicine, 41(4), 264–270. https://doi.org/10.1055/a-1073-7977
Pires, T., Pires, P., Moreira, H., Gabriel, R., Viana, S., & Viana, R. (2020). Assessment of pelvic floor muscles in sportswomen: Quality of life and related factors. Physical Therapy in Sport, 43, 151–156. https://doi.org/10.1016/j.ptsp.2020.02.015
Pires, T., Pires, P., Moreira, H., & Viana, R. (sem data). Prevalence of Urinary Incontinence in High-Impact Sport Athletes: A Systematic Review and Meta-Analysis. Journal of Human Kinetics, 73, 10.
Pires, T., Pires, P., Moreira, M., & Viana, R. (2020). Prevalence of Urinary Incontinence in High-Impact Sport Athletes: A Systematic Review and Meta-Analysis. Journal of Human Kinetics, 73, 279–288. https://doi.org/10.2478/hukin-2020-0008
Pirpiris, A., Shek, K. L., & Dietz, H. P. (2010). Urethral mobility and urinary incontinence. Ultrasound in Obstetrics & Gynecology, 36(4), 507–511. https://doi.org/10.1002/uog.7658
Teixeira, R. V., Colla, C., Sbruzzi, G., Mallmann, A., & Paiva, L. L. (2018). Prevalence of urinary incontinence in female athletes: A systematic review with meta-analysis. International Urogynecology Journal, 29(12), 1717–1725. https://doi.org/10.1007/s00192-018-3651-1
Ying, T., Li, Q., Xu, L., Liu, F., & Hu, B. (2012). Three-dimensional Ultrasound Appearance of Pelvic Floor in Nulliparous Women and Pelvic Organ Prolapse Women. International Journal of Medical Sciences, 9(10), 894–900. https://doi.org/10.7150/ijms.4829
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2020 Millenium - Journal of Education, Technologies, and Health
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who submit proposals for this journal agree to the following terms:
a) Articles are published under the Licença Creative Commons (CC BY 4.0), in full open-access, without any cost or fees of any kind to the author or the reader;
b) The authors retain copyright and grant the journal right of first publication, allowing the free sharing of work, provided it is correctly attributed the authorship and initial publication in this journal;
c) The authors are permitted to take on additional contracts separately for non-exclusive distribution of the version of the work published in this journal (eg, post it to an institutional repository or as a book), with an acknowledgment of its initial publication in this journal;
d) Authors are permitted and encouraged to publish and distribute their work online (eg, in institutional repositories or on their website) as it can lead to productive exchanges, as well as increase the impact and citation of published work
Documents required for submission
Article template (Editable format)
