Reduced urinary loss
Eleven years after giving birth, fifteen percent of the female participants in this study experienced a some form of urinary incontinence; twenty years after giving birth, this was twenty-three percent. Women who with the highest levels of physical activity (more than six hours per week) experienced less stress urinary incontinence after eleven years, compared to women with the lowest activity levels. After twenty years, women with the highest activity levels scored significantly lower on all forms of urinary incontinence (SUI, UUI, MUI: mixed urinary incontinence), compared to women with the lowest activity levels.
ALSPAC-study
The research team used data of 2,770 women who participated in the Avon Longitudinal Study of Parents and Children (ALSPAC-study), a study containing data from 14,500 women (primarily white) who gave birth between 1991 and 1992. At baseline – approximately eight years post-delivery – no signs of urinary loss were allowed. Eleven years after giving birth, the participants completed the Bristol Female LUTS questionnaire (BFLUTS, see frame). At twenty years of follow up, the researchers used the International Consultation on Incontinence Questionnaire on Female LUTS (ICIQ-FLUTS, see frame) to obtain an overview of lower urinary tract symptoms.
Physical activity
The researchers determined physical activity by asking the participants how long they would exercise on average during a standard week at baseline. Potential activities that were considered were aerobics, jogging, yoga, squash, tennis, badminton, swimming, (brisk) walking, weight lifting and cycling. Subsequently, the researchers converted these numbers to an estimated energy consumption (in METs, metabolic equivalents) per week.
Possible explanations
The researchers provided a number of explanations for the influence of physical activity on urinary incontinence: 1) women became more aware of their overall health if they were more physically active; 2) the participants potentially performed pelvic floor exercises already, strengthening the muscles of the pelvic floor, and reducing the risk of urinary incontinence; and 3) physical activity could decrease the risk of urinary incontinence by reducing the Body Mass Index (BMI), and thereby lowering the intra-abdominal pressure.
Study limitations
Since the group of participants primarily consisted white women who gave birth, the results of this study are not representative for women from another race or women who have not given birth.
Prevalence
According to the authors, urinary incontinence is a common problem which strongly affects the quality of life. Its prevalence in middle-aged women from North-America and Europe is estimated at 76.3 percent. Risk factors for developing urinary incontinence are a higher age, the number of pregnancies, obesity, and the method of delivery.
> From: Alhababi et al., J Urol (2019) (Epub ahead of print). All rights reserved to American Urological Association Education and Research, Inc. Click here for the online summary. Translation by Brent van Saarloos
BFLUTS
The Bristol Female LUTS (BLUTS) questionnaire is a questionnaire evaluating lower urinary tract symptoms in females, with the main focus on urinary incontinence.
ICIQ-FLUTS
The International Consultation on Incontinence Questionnaire on Female LUTS (ICIQ-FLUTS) is a questionnaire evaluating lower urinary tract symptoms in females and its impact on the quality of life.
Expert opinion by Maya Elling
A study that fits within our era of healthy aging. Does having an active lifestyle effects the occurrence of urinary loss? A popular question in clinical practice.
Previous studies managed to prove that above a BMI of >25 the risk of stress (urinary) incontinence increases as BMI increases. Moreover, a poor condition, nutritional health and general health status influence the functional loading capacity of the pelvic floor.
In this prospective study, a number of explanations is provided for the association between physical activity and urinary loss. One of these explanations is that the participants of the study perhaps already performed pelvic floor exercises, which reduce the risk of urinary incontinence. However, this is merely an assumption, and it has not been examined. This is an interesting research question: does the combination of more physically active lifestyle and pelvic floor exercises reduce the risk of urinary incontinence even more?
An explanation which is not given in this article, is that the pelvic floor is a part of an extension chain, primarily created by the m. extensor hallucis longus, m. biceps femoris, m. obturatorius internus, m. rectus abdominus, m. obliquus internus and externus, m. latissimus dorsi and the cervical flexor muscles. Activation of the extensor muscle chain, which happens frequently during sports, will put the pelvic floor under tension and therefore increase muscle activity.
An evident limitation of this study is that only white women who gave birth were included, which makes the results not representative for all women.
In short: there is still a long way to go for all physiotherapists to motivate our patients in performing moderate to intense physical activity, for a minimum of 150 minutes per week (spread over several days).
