Pelvic floor muscle activity during impact activities in continent and incontinent women: a systematic review

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Introduction and hypothesis

Investigating the activity of the pelvic floor muscles (PFMs) in women during impact activities such as jumping, running or coughing may elucidate different aspects of PFM activation and therefore clarify the pathophysiology of stress urinary incontinence (SUI). A systematic review (PROSPERO 2016:CRD42016035624) was conducted to summarize current evidence on PFM activity during impact activities in both continent and incontinent women.


PubMed, EMBASE, Cochrane, and SPORTDiscus databases were systematically searched for studies published up to December 2016. The PICO approach (patient, intervention, comparison, outcome) was used to construct the search queries. Original studies were included that investigated PFM activity during impact activities if they included terms related to muscle activity and measurement methods, test positions, activities performed and continence status. Two reviewers screened titles and abstracts independently to ascertain if the included studies fulfilled the inclusion criteria, and extracted data on outcome parameters.


The search revealed 28 studies that fulfilled the inclusion criteria, of which 26 were cross-sectional studies. They used different electromyography measurement methods, test activities, test positions, and comparisons with other structures. Ten studies compared continent and incontinent women. The timing of PFM activity in relation to the activity of other trunk muscles seems to be a crucial factor in maintaining continence. Women with SUI have delayed PFM activity.


The findings of this systematic review suggest that impact activities causing involuntary and reflex PFM activity should be the subject of further study. This may help guide clinical studies to improve our understanding of how the PFMs react during impact activities and to determine best practices that can be included in rehabilitation programmes.

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Fig. 1



Pelvic floor muscles


External anal sphincter


Stress urinary incontinence




Newcastle-Ottawa scale


Maximum voluntary contractions


Root mean square


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We thank Kali Tal for her editorial suggestions.



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Correspondence to Helene Moser.

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Moser, H., Leitner, M., Baeyens, J. et al. Pelvic floor muscle activity during impact activities in continent and incontinent women: a systematic review. Int Urogynecol J 29, 179–196 (2018).

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  • Cough
  • Electromyography
  • Exercise
  • Female
  • Pelvis
  • Stress urinary incontinence