Abstract
Introduction and hypothesis
It is known that high-impact exercises can cause an increase in intra-abdominal pressure and provide overload in the pelvic floor structures. We hypothesized that female CrossFit practitioners would report symptoms of pelvic floor dysfunction (PFD) and that there will be factors associated with these dysfunctions.
Methods
The study design is an online cross-sectional survey. Demographic and anthropometric data, the characterization of CrossFit activity, the description of PFD and previous obstetric history were collected through a structured web-based questionnaire. Associations between PFD and the clinical and CrossFit-related independent variables were tested using logistic regression analysis.
Results
A total of 828 female CrossFit practitioners answered the questionnaire. The most prevalent symptom was anal incontinence (AI) (52.7%), with flatus incontinence (FI) being the most reported (93.3%). Women who reported constipation are 1.7 times more likely to have FI, and women who practice CrossFit more than five times a week are 3.0 times more likely to have FI. Urinary incontinence(UI) affected 36% of women, and 84.2% of participants reported urinary loss during CrossFit practice. The occurrence of dyspareunia was reported by 48.7% and showed an inverse association with age and body mass index. POP was reported by only 1.4% of the sample.
Conclusion
There is a high prevalence of PFD in female CrossFit practitioners, with AI being the most reported symptom, especially FI. In addition, constipation and weekly training frequency were significantly associated with FI. UI occurred primarily in CrossFit exercises, and dyspareunia was the most prevalent sexual symptom.
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References
Messelink B, Benson T, Berghmans B, et al. Standardization of terminology of pelvic floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the international continence society. Neurourol Urodyn. 2005;24:374–80. https://doi.org/10.1002/nau.20144.
Vitton V, Baumstarck-Barrau K, Brardjanian S, et al. Impact of high-level sport practice on anal incontinence in a healthy young female population. J Women’s Heal. 2011;20:757–63. https://doi.org/10.1089/jwh.2010.2454.
Sung VW, Hampton BS. Epidemiology of pelvic floor dysfunction. Obstet Gynecol Clin N Am. 2009;36:421–43. https://doi.org/10.1016/j.ogc.2009.08.002.
Almeida MBA, Barra AA, Saltiel F, et al. Urinary incontinence and other pelvic floor dysfunctions in female athletes in Brazil: a cross-sectional study. Scand J Med Sci Sports. 2016;26:1109–16. https://doi.org/10.1111/sms.12546.
Bø K. Urinary incontinence, pelvic floor dysfunction, exercise and sport. Sport Med. 2004;34:451–64. https://doi.org/10.2165/00007256-200434070-00004.
Carvalho C, da Silva Serrão PRM, Beleza ACS, Driusso P. Pelvic floor dysfunctions in female cheerleaders: a cross-sectional study. Int Urogynecol J. 2020;31:999–1006. https://doi.org/10.1007/s00192-019-04074-w.
Claudino JG, Gabbett TJ, Bourgeois F, et al. CrossFit overview: systematic review and meta-analysis. Sport Med - open. 2018;4:11. https://doi.org/10.1186/s40798-018-0124-5.
Glassman G. Understanding Crossfit. Crossfit J. 2007;56:1–2.
Gephart LF, Doersch KM, Reyes M, et al. Intraabdominal pressure in women during CrossFit exercises and the effect of age and parity. Baylor Univ Med Cent Proc. 2018;31:289–93. https://doi.org/10.1080/08998280.2018.1446888.
Teixeira RV, Colla C, Sbruzzi G, et al. Prevalence of urinary incontinence in female athletes: a systematic review with meta-analysis. Int Urogynecol J. 2018;29:1717–25. https://doi.org/10.1007/s00192-018-3651-1.
Araújo MP de, Brito LGO, Rossi F, et al. Prevalence of female urinary incontinence in Crossfit practitioners and associated factors: an internet population-based survey. Female Pelvic Med Reconstr Surg. 2020;26:97–100. https://doi.org/10.1097/SPV.
Yang J, Cheng JW, Wagner H, et al. The effect of high impact crossfit exercises on stress urinary incontinence in physically active women. Neurourol Urodyn. 2019;38:749–56. https://doi.org/10.1002/nau.23912.
Elks W, Jaramillo-Huff A, Barnes KL, et al. The stress urinary incontinence in CrossFit (SUCCeSS) study. Female Pelvic Med Reconstr Surg. 2020;26:101–6. https://doi.org/10.1097/SPV.
High R, Thai K, Virani H, et al. Prevalence of pelvic floor disorders in female CrossFit athletes. Female Pelvic Med Reconstr Surg. 2019;00:1–5. https://doi.org/10.1097/SPV.
von Elm E, Altman DG, Egger M, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg. 2014;12:1495–9. https://doi.org/10.1016/j.ijsu.2014.07.013.
Moher D, Schulz KF, Simera I, Altman DG. Guidance for developers of health research reporting guidelines. PLoS Med. 2010;7:e1000217. https://doi.org/10.1371/journal.pmed.1000217.
Haylen BT, Ridder D de, Freeman RM, et al (2010) An international Urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn 29:4–20. https://doi.org/10.1002/nau.
Rockwood TH, Church JM, Fleshman JW, et al. Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index. Dis Colon Rectum. 1999;42:1525–31. https://doi.org/10.1007/BF02236199.
Drossman DA. The functional gastrointestinal disorders and the Rome III process. Gastroenterology. 2006;130:1377–90. https://doi.org/10.1053/j.gastro.2006.03.008.
Drossman D, Corazziari E, Delvaux M, et al. Appendix B: Rome III diagnostic criteria for functional gastrointestinal disorders. Am J Gastroenterol. 2010;105:798–801. https://doi.org/10.1038/ajg.2010.73.
Bharucha AE, Wald A, Enck P, Rao S. Functional anorectal disorders. Gastroenterology. 2006;130:1510–8. https://doi.org/10.1053/j.gastro.2005.11.064.
Tamanini JTN, Dambros M, D’Ancona CAL, et al. Validação para o português do “International Consultation on Incontinence Questionnaire - Short Form” (ICIQ-SF). Rev Saude Publica. 2004;38:438–44. https://doi.org/10.1590/s0034-89102004000300015.
Hentschel H, Alberton DL, Capp E, et al. Validação do female sexual function index (FSFI) para uso em língua portuguesa. Rev HCPA Fac Med Univ Fed Rio Gd do Sul. 2007;27(10–14):lil–685672.
Tamanini JTN, Almeida FG, Girotti ME, et al. The Portuguese validation of the international consultation on incontinence questionnaire-vaginal symptoms (ICIQ-VS) for Brazilian women with pelvic organ prolapse. Int Urogynecol J. 2008;19:1385–91. https://doi.org/10.1007/s00192-008-0641-8.
Hosmer DW, Jovanovic B, Lemeshow S. Best subsets logistic regression. Biometrics. 1989;45:1265. https://doi.org/10.2307/2531779.
Nygaard IE, Thompson FL, Svengalis SL, Albright JP. Urinary incontinence in elite nulliparous athletes. Obstet Gynecol. 1994;84:183–7 8041527.
Nygaard IE. Does prolonged high-impact activity contribute to later urinary incontinence? A retrospective cohort study of female olympians. Obstet Gynecol. 1997;90:718–22. https://doi.org/10.1016/S0029-7844(97)00436-5.
Amselem C, Puigdollers A, Azpiroz F, et al. Constipation: a potential cause of pelvic floor damage? Neurogastroenterol Motil. 2010;22:150–4. https://doi.org/10.1111/j.1365-2982.2009.01409.x.
Lourenço TR de M, Matsuoka PK, Baracat EC, MilhemHaddad J (2018) Urinary incontinence in female athletes: a systematic review. Pubish online - Int Urogynecological Assoc. https://doi.org/10.1007/s00192-018-3629-z.
Goforth J, Langaker M. Urinary Incontinence in Women. N C Med J. 2016;77:423–5. https://doi.org/10.18043/ncm.77.6.423.
Milsom I, Altman DCR, et al. Incontinence : 6th international consultation on incontinence, Tokyo, September 2016. In: Abrams P, Cardozo L, Wagg AWA, editors. Epidemiology of urinary incontinence (UI) and other lower urinary tract symptoms (LUTS), pelvic organ prolapse(POP) and anal incontinence(AI). 6th ed. Bristol: International Continence Society; 2017. p. 1–141.
Dos Santos KM, Da Roza T, da Silva LL, et al. Female sexual function and urinary incontinence in nulliparous athletes: an exploratory study. Phys Ther Sport. 2018;33:21–6. https://doi.org/10.1016/j.ptsp.2018.06.004.
Assimakopoulos K, Panayiotopoulos S, Iconomou G, et al. Assessing sexual function in obese women preparing for bariatric surgery. Obes Surg. 2006;16:1087–91. https://doi.org/10.1381/096089206778026442.
Olmsted MP, McFarlane T. Body weight and body image. BMC Womens Health. 2004;4:S5. https://doi.org/10.1186/1472-6874-4-s1-s5.
Krychman ML. Obesity and sexual function. Menopause J ofThe North Am Menopause Soc. 2015;22:1151–2. https://doi.org/10.1097/GME.0000000000000539.
Mozafari M, Khajavikhan J, Jaafarpour M, et al. Association of body weight and female sexual dysfunction: a case control study. Iran Red Crescent Med J. 2015;17:1–6. https://doi.org/10.5812/ircmj.24685.
Elmerstig E, Wijma B, Swahnberg K. Young Swedish women’s experience of pain and discomfort during sexual intercourse. Acta Obstet Gynecol Scand. 2009;88:98–103. https://doi.org/10.1080/00016340802620999.
Zhang C, Cui L, Zhang L, et al. Sexual activity and function assessment in middle-aged Chinese women using the female sexual function index. Menopause J N Am Menopause Soc. 2017;24:669–76. https://doi.org/10.1097/GME.0000000000000812.
Graziottin A. Evidence based physical therapy for the pelvic floor. In: Bo K, Berghmans B, Mørkved S, Van Kampen M, editors. Evidence-based physical therapy for the pelvic floor - bridging science and clinical practice., 1st ed. Philadelphia: Churchill Livingstone Elsevier; 2007. p. 266–87.
Choi BCK, Pak AWP. A catalog of biases in questionnaires. Prev Chronic Dis. 2005;2:1–13.
Coughlin SS. Recall bias in epidemiologic studies. J Clin Epidemiol. 1990;43:87–91. https://doi.org/10.1016/0895-4356(90)90060-3.
Dumoulin C, Cacciari L, Hay-Smith E. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women (review). Res Nurs Health. 2019:2–258. https://doi.org/10.1002/14651858.CD005654.pub4www.cochranelibrary.com.
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The authors thank the participants who were involved in the project for their contribution to the data collection.
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Pisani, G.K., de Oliveira Sato, T. & Carvalho, C. Pelvic floor dysfunctions and associated factors in female CrossFit practitioners: a cross-sectional study. Int Urogynecol J 32, 2975–2984 (2021). https://doi.org/10.1007/s00192-020-04581-1
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DOI: https://doi.org/10.1007/s00192-020-04581-1