Skip to main content

Symptoms of pelvic organ prolapse in women who lift heavy weights for exercise: a cross-sectional survey

International Urogynecology Journal volume 31, pages 1551–1558 (2020)Cite this article

Abstract

Introduction and hypothesis

The aim of the study was to determine the prevalence of symptoms of pelvic organ prolapse (POP), defined as the sensation of a vaginal bulge, and associated risk factors in women over 18 years of age who lift light (≤15 kg), moderate (16–50 kg), and heavy (>50 kg) weights for exercise, and those who do not lift weights for exercise.

Methods

Women completed an online survey about risk factors for pelvic floor dysfunctions, physical activity history, and pelvic floor symptoms. A question about a vaginal bulge sensation from the validated Pelvic Floor Distress Inventory (PFDI-20) was used to indicate symptoms of POP. Relationships between symptoms of POP and possible risk factors were assessed through logistic regression analysis.

Results

Of the 3,934 survey participants, the total prevalence of POP symptoms was 14.4% (n = 566). Category of weight lifted, age, vaginal parity, history of constipation or hemorrhoids, and family history of POP were significantly associated with symptoms. Physically active women lifting weights ≤15 kg were more likely to report symptoms of pelvic organ prolapse than women lifting weights greater than 50 kg (59.7% vs 15.2%; adjusted odds ratio 2.1; 95% confidence interval 1.7–3.4). There was no relationship between POP symptoms and body mass index, forceps delivery, cesarean section, hysterectomy, or menopausal status.

Conclusion

Physically active women who lift heavy weights for exercise do not have an increased prevalence of POP symptoms. Advice on the contribution of heavy weight lifting as part of a physical activity regime to the pathophysiology of POP requires further investigation.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. World Health Organization. Global recommendations on physical activity for health [Internet]. Geneva Switzerland: WHO; 2010. Available from: http://apps.who.int/iris/bitstream/handle/10665/44399/9789241599979_eng.pdf;jsessionid=88A67F63A40247A5CC9C863CF6E60DBC?sequence=1. Accessed 1 December 2018.

  2. Brown WJ, Bauman AE, Bull FC, Burton NW. Development of evidence-based physical activity recommendations for adults (18-64 years). Report prepared for the Australian Government Department of Health [Internet]. Canberra ACT: Commonwealth of Australia; 2012. Available from: https://www.health.gov.au/internet/main/publishing.nsf/Content/F01F92328EDADA5BCA257BF0001E720D/$File/DEB-PAR-Adults-18-64years.pdf. Accessed 18 August 2018.

  3. Urogynaecological Society of Australasia. Pelvic organ prolapse information sheet [Internet]. Melbourne VIC: UGSA; 2018. Available from: https://www.ugsa.com.au/wp-content/uploads/2019/01/Pelvic-Organ-Prolapse.pdf. Accessed 11 April 2018.

  4. Kruger J, Hayward L, Nielsen P, Loiselle D, Kirton R. Design and development of a novel intra-vaginal pressure sensor. Int Urogynecol J. 2013;24(10):1715–21.

    Article  Google Scholar 

  5. Gerten KA, Richter HE, Wheeler TL, Pair LS, Burgio KL, Redden DT, et al. Intraabdominal pressure changes associated with lifting: implications for postoperative activity restrictions. Am J Obstet Gynecol. 2008;198(3):306.e1–5.

    Article  Google Scholar 

  6. Weir LF, Nygaard IE, Wilken J, Brandt D, Janz KF. Postoperative activity restrictions: any evidence? Obstet Gynecol. 2006;107(2):305–9.

    Article  Google Scholar 

  7. Hsu Y, Hitchcock R, Niederauer S, Nygaard IE, Shaw JM, Sheng X. Variables affecting intra-abdominal pressure during lifting in the early postpartum period. Female Pelvic Med Reconstr Surg. 2018;24:287–91.

    Article  Google Scholar 

  8. Shaw JM, Hamad NM, Coleman TJ, Egger MJ, Hsu Y, Hitchcock R, et al. Intra-abdominal pressures during activity in women using an intra-vaginal pressure transducer. J Sports Sci. 2014;32(12):1176–85.

    Article  Google Scholar 

  9. Watson SL, Weeks BK, Weis LJ, Harding AT, Horan SA, Beck BR. High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: the LIFTMOR randomized controlled trial. J Bone Miner Res. 2018;33(2):211–20.

    Article  Google Scholar 

  10. Tegerstedt G, Maehle-Schmidt M, Nyren O, Hammarstrom M. Prevalence of symptomatic pelvic organ prolapse in a Swedish population. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16(6):497–503.

    Article  Google Scholar 

  11. Barber MD, Walters MD, Bump RC. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol. 2005;193(1):103–13.

    CAS  Article  Google Scholar 

  12. Lukacz ES, Lawrence JM, Buckwalter JG, Burchette RJ, Nager CW, Luber KM. Epidemiology of prolapse and incontinence questionnaire: validation of a new epidemiologic survey. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16(4):272–84.

    Article  Google Scholar 

  13. Miedel A, Tegerstedt G, Maehle-Schmidt M, Nyren O, Hammarstrom M. Nonobstetric risk factors for symptomatic pelvic organ prolapse. Obstet Gynecol. 2009;113(5):1089–97.

    Article  Google Scholar 

  14. World Health Organization. Obesity: preventing and managing the global epidemic [Internet]. Geneva Switzerland: WHO; 2000. Available from: https://www.who.int/nutrition/publications/obesity/WHO_TRS_894/en/. Accessed 1 December 2018.

  15. Barber MD, Neubauer NL, Klein-Olarte V. Can we screen for pelvic organ prolapse without a physical examination in epidemiologic studies? Am J Obstet Gynecol. 2006;195(4):942–8.

    Article  Google Scholar 

  16. Tan JS, Lukacz ES, Menefee SA, Powell CR, Nager CW. Predictive value of prolapse symptoms: a large database study. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16(3):203–9.

    Article  Google Scholar 

  17. Majumdar A, Saleh S, Hill M, Hill SR. The impact of strenuous physical activity on the development of pelvic organ prolapse. J Obstet Gynaecol. 2013;33(2):115–9.

    CAS  Article  Google Scholar 

  18. Middlekauff ML, Egger MJ, Nygaard IE, Shaw JM. The impact of acute and chronic strenuous exercise on pelvic floor muscle strength and support in nulliparous healthy women. Am J Obstet Gynecol. 2016;215(3):316.e1–7.

    Article  Google Scholar 

  19. Masenga GG, Shayo BC, Rasch V. Prevalence and risk factors for pelvic organ prolapse in Kilimanjaro, Tanzania: a population based study in Tanzanian rural community. PLoS One. 2018;13(4):e0195910.

    Article  Google Scholar 

  20. Giannini A, Russo E, Cano A, Chedraui P, Goulis DG, Lambrinoudaki I, et al. Current management of pelvic organ prolapse in aging women: EMAS clinical guide. Maturitas. 2018;110:118–23.

    Article  Google Scholar 

  21. Gyhagen M, Bullarbo M, Nielsen TF, Milsom I. Prevalence and risk factors for pelvic organ prolapse 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG. 2013;120(2):152–60.

    CAS  Article  Google Scholar 

  22. Milsom I, Altman DG, Cartwright R, Lapitan MC, Nelson R, Sillen U, et al. Epidemiology of urinary incontinence (UI) and other lower urinary tract symptoms (LUTS), pelvic organ prolapse (POP) and anal (AI) incontinence. In: Abrams P, Cardozo L, Wagg A, Wein A, editors. Incontinence. Paris: Health Publications; 2017. p. 61–74.

    Google Scholar 

  23. Durnea CM, Khashan AS, Kenny LC, Durnea UA, Smyth MM, O’Reilly BA. Prevalence, etiology and risk factors of pelvic organ prolapse in premenopausal primiparous women. Int Urogynecol J. 2014;25:1463–70.

    CAS  Article  Google Scholar 

  24. Acheson AG, Scholefield JH. Management of haemorrhoids. BMJ. 2008;336(7640):380–3.

    Article  Google Scholar 

  25. Glazener C, Elders A, Macarthur C, Lancashire RJ, Herbison P, Hagen S, et al. Childbirth and prolapse: long-term associations with the symptoms and objective measurement of pelvic organ prolapse. BJOG. 2013;120(2):161–8.

    CAS  Article  Google Scholar 

  26. Durnea CM, Khashan AS, Kenny LC, Durnea UA, Dornan JC, O’Sullivan SM, et al. What is to blame for postnatal pelvic floor dysfunction in primiparous women—pre-pregnancy or intrapartum risk factors? Eur J Obstet Gynecol Reprod Biol. 2017;214:36–43.

    Article  Google Scholar 

  27. Giri A, Hartmann KE, Hellwege JN, Velez Edwards DR, Edwards TL. Obesity and pelvic organ prolapse: a systematic review and meta-analysis of observational studies. Am J Obstet Gynecol. 2017;217(1):11–26.e3.

    Article  Google Scholar 

  28. Cooper J, Annappa M, Dracocardos D, Cooper W, Muller S, Mallen C. Prevalence of genital prolapse symptoms in primary care: a cross-sectional survey. Int Urogynecol J. 2015;26(4):505–10.

    Article  Google Scholar 

  29. Gyhagen M, Al-Mukhtar Othman J, Åkervall S, Nilsson I, Milsom I. The symptom of vaginal bulging in nulliparous women aged 25–64 years: a national cohort study. Int Urogynecol J. 2019;30(4):639–47.

    Article  Google Scholar 

  30. Swift SE, Tate SB, Nicholas J. Correlation of symptoms with degree of pelvic organ support in a general population of women: what is pelvic organ prolapse? Am J Obstet Gynecol. 2003;189(2):372–7.

    Article  Google Scholar 

  31. Nygaard I, Girts T, Fultz NH, Kinchen K, Pohl G, Sternfeld B. Is urinary incontinence a barrier to exercise in women? Obstet Gynecol. 2005;106(2):307–14.

    Article  Google Scholar 

  32. De Mattos Lourenco TR, Matsuoka PK, Baracat EC, Haddad JM. Urinary incontinence in female athletes: a systematic review. Int Urogynecol J. 2018;29(12):1757–63.

    Article  Google Scholar 

Download references

Author information

Affiliations

  1. School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia

    Lori B. Forner & Michelle D. Smith

  2. School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia

    Emma M. Beckman

Authors
  1. Lori B. Forner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emma M. Beckman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michelle D. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

L.B. Forner: project development, data collection, data analysis, manuscript writing; E.M. Beckman: project development, data collection, data analysis, manuscript writing; M.D. Smith: project development, data collection, data analysis, manuscript writing.

Corresponding author

Correspondence to Lori B. Forner.

Ethics declarations

Conflicts of interest

L.B. Forner is a private practice physiotherapist. E.M. Beckman and M.D. Smith declare that they have no conflicts of interest.

Financial disclaimer

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 20 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Forner, L.B., Beckman, E.M. & Smith, M.D. Symptoms of pelvic organ prolapse in women who lift heavy weights for exercise: a cross-sectional survey. Int Urogynecol J 31, 1551–1558 (2020). https://doi.org/10.1007/s00192-019-04163-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-019-04163-w

Keywords

  • Pelvic organ prolapse
  • Prolapse
  • Bulge
  • Heavy weight lifting
  • Exercise
  • POP