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Pelvic floor dysfunctions in female cheerleaders: a cross-sectional study

  • Cristiano Carvalho
  • Paula Regina Mendes da Silva Serrão
  • Ana Carolina Sartorato Beleza
  • Patricia DriussoEmail author
Original Article
  • 4 Downloads

Abstract

Introduction and hypothesis

Cheerleaders perform high-impact maneuvers that can be associated with pelvic floor dysfunction. We hypothesized that female cheerleaders would report more symptoms of pelvic floor dysfunction and fewer symptoms of premenstrual syndrome than nonathletic women.

Methods

This cross-sectional study included high-performance female cheerleaders and young nonathletic, nulliparous, and normal-weight females. Demographics, sports practices, and pelvic floor dysfunction data were collected through an electronic questionnaire. Urinary symptoms were collected through the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and King’s Health Questionnaire. Intestinal symptoms were collected through the use of Criterion F of item C3, referring to functional constipation of Rome III and Fecal Incontinence Severity Index. Data on sexual function were collected through the Female Sexual Function Index. Data on pelvic organ prolapse were obtained through the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS). In addition, questions about premenstrual syndrome—dysmenorrhea, irritability, headache, tiredness, fluid retention, and constipation—were collected through the Menstrual Symptom Questionnaire. The comparison between groups of the quantitative variables was performed using the Mann-Whitney U test. Odds ratios (OR) and 95% confidence intervals (CI) were estimated for comparison between groups on the occurrence of pelvic floor muscle dysfunction symptoms. A significance level of 5% was adopted.

Results

A total of 156 women (78 cheerleaders and 76 nonathletes) completed the electronic questionnaire. Anal incontinence was the most prevalent symptom of pelvic floor muscle dysfunction. Cheerleaders were 2.3 times more likely to report symptoms regarding anal incontinence than nonathletic women. For the other symptoms of pelvic floor dysfunction, no statistical differences between the groups were found. Cheerleaders reported fewer symptoms of tiredness and constipation during the premenstrual period than did nonathletic women.

Conclusion

Pelvic floor dysfunction, particularly anal incontinence, appears to be more prevalent among cheerleaders than among nonathletic women. In addition, cheerleaders demonstrated fewer symptoms of tiredness and constipation during the premenstrual period.

Keywords

Anal incontinence Athletes Cheerleading Epidemiology Pelvic floor muscle Urinary incontinence Women’s health 

Notes

Acknowledgments

We thank the support of the União Brasileira de Cheerleading (UBC) for their assistance in disseminating this research.

Funding

Funding for this study was provided by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil, Finance Code 001.

Compliance with ethical standards

Conflicts of interest

None.

References

  1. 1.
    Slieker-ten Hove MC, Pool-Goudzwaard AL, Eijkemans MJC, Steegers-Theunissen RPM, Burger CW, Vierhout ME. Pelvic floor muscle function in a general female population in relation with age and parity and the relation between voluntary and involuntary contractions of the pelvic floor musculature. Int Urogynecol J. 2009;20(12):1497–504.CrossRefGoogle Scholar
  2. 2.
    Messelink B, Benson T, Berghmans B, Bø K, Corcos J, Fowler C, 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.CrossRefGoogle Scholar
  3. 3.
    Sung VW, Hampton BS. Epidemiology of pelvic floor dysfunction. Obstet Gynecol Clin N Am. 2009;36:421–43.CrossRefGoogle Scholar
  4. 4.
    Davis K, Kumar D. Pelvic floor dysfunction: a conceptual framework for collaborative patient centred care. J Adv Nurs. 2003;43:555–68.CrossRefGoogle Scholar
  5. 5.
    Milsom I, Altman D, Cartwright R et al. Epidemiology of urinary incontinence (UI) and other lower urinary tract symptoms (LUTS), pelvic organ prolapse (POP) and anal incontinence (AI). In Abrams P, Cardozo L, Wagg A, Wein A (eds) Incontinence 6th Edition. ICI-ICS. International Continence Society, Bristol UK, ISBN: 978-0956960733; 2017. p. 1–141.Google Scholar
  6. 6.
    Vitton V, Baumstarck-Barrau K, Brardjanian S, Caballe I, Bouvier M, Grimaud JC. Impact of high-level sport practice on anal incontinence in a healthy young female population. J Women's Health. 2011;20(5):757–63.CrossRefGoogle Scholar
  7. 7.
    Coco AS. Primary dysmenorrhea. Am Fam Physician. 1999;60:489–96.Google Scholar
  8. 8.
    Ruoff G, Lema M. Strategies in pain management: new and potential indications for COX-2 specific inhibitors. J Pain Symptom Manag. 2003;25:S21–31.CrossRefGoogle Scholar
  9. 9.
    Libarle M, Simon P, Bogne V, et al. Management of dysmenorrhea. Rev Med Brux. 2018;39(4):264–72.Google Scholar
  10. 10.
    Bo K, Borgen JS. Prevalence of stress and urge urinary incontinence in elite athletes and controls. Med Sci Sports Exerc. 2001;33:1797–802.CrossRefGoogle Scholar
  11. 11.
    Eliasson K, Larsson T, Mattsson E. Prevalence of stress incontinence in nulliparous elite trampolinists. Scand J Med Sci Sports. 2002;12:106–10.CrossRefGoogle Scholar
  12. 12.
    Thyssen H, Clevin L, Olesen S, Lose G. Urinary incontinence in elite female athletes and dancers. Int Urogynecol J Pelvic Floor Dysfunct. 2002;13(1):15–7.CrossRefGoogle Scholar
  13. 13.
    Nygaard IE, Thompson F, Svengalis B, Albright JP. Urinary incontinence in elite nulliparous athletes. Obstet Gynecol. 1994;84:183–7.Google Scholar
  14. 14.
    Almeida MBA, Barra AA, Saltiel F, Silva-Filho AL, Fonseca AM, Figueiredo EM. 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.CrossRefGoogle Scholar
  15. 15.
    LaBella CR, Mjaanes J. Cheerleading injuries: epidemiology and recommendations for prevention. Pediatrics. 2012;130:966–71.CrossRefGoogle Scholar
  16. 16.
    Currie DW, Fields SK, Patterson MJ, Comstock RD. Cheerleading injuries in United States high schools. Pediatrics. 2016;137:1–11.CrossRefGoogle Scholar
  17. 17.
    Moher D, Schulz KF, Simera I, Altman DG. Guidance for developers of health research reporting guidelines. PLoS Med. 2010;7(2):1–9.CrossRefGoogle Scholar
  18. 18.
    Tamanini JTN, Dambros M, D’Ancona CAL, Palma PCR Jr, Netto NR. Validation of the “International Consultation on Incontinence Questionnaire – Short Form” (ICIQ-SF) for Portuguese. Rev Saude Publica. 2004;38(3):438–44.CrossRefGoogle Scholar
  19. 19.
    Tamanini JTN, D’Ancona CAL, Botega NJ Jr, Netto NR. Validation of the Portuguese version of the King’s health questionnaire for urinary incontinent women. Rev Saude Publica. 2003;37(2):203–11.CrossRefGoogle Scholar
  20. 20.
    Drossman DA. Funcional gastrointestinal disorders: history, pathophysiology clinical features, and Rome IV. Gastroenterology. 2016;150(6):1262–79.CrossRefGoogle Scholar
  21. 21.
    Rome Foundation Diagnostic Algorithms. Appendix B: Rome III diagnostic criteria for functional gastrointestinal disorders. Gastroenterology. 2010;105:798–801.Google Scholar
  22. 22.
    Rockwood TH, Church JM, Fleshamn JW, Kane RL, Mavrantonis C, Thorson AG, et al. Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence – the Fecal Incontinence Severity Index. Dis Colon Rectum. 1999;42:1525–32.CrossRefGoogle Scholar
  23. 23.
    Hentschel H, Alberton DL, Capp E, Goldim JR, Passos EP. Validação do Female Sexual Function Index (FSFI) para uso em língua portuguesa. Rev HCPA. 2007;27(1):10–4.Google Scholar
  24. 24.
    Tamanini JTN, Almeida FG, Girotti ME, Riccetto CL, Palma PC, Rios LA. The Portuguese validation of the international consultation on incontinence questionnaire-vaginal symptoms (ICIQ-VS) for Brazilian women with pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(10):1385–91.CrossRefGoogle Scholar
  25. 25.
    Chesney MA, Tasto DL. The development of the menstrual symptom questionnaire. Behav Res Ther. 1975;13:237–44.CrossRefGoogle Scholar
  26. 26.
    Haylen BT, De Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21:5–26.Google Scholar
  27. 27.
    Bharucha AE, Zinsmeister AR, Locke GR, Seide BM, McKeon K, Schleck CD, et al. Prevalence and burden of fecal incontinence: a population-based study in women. Gastroenterology. 2005;129:42–9.CrossRefGoogle Scholar
  28. 28.
    Ree ML, Nygaard I, Bø K. Muscular fatigue in the pelvic floor muscles after strenuous physical activity. Acta Obstet Gynecol Scand. 2007;86(7):870–6.CrossRefGoogle Scholar
  29. 29.
    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.CrossRefGoogle Scholar
  30. 30.
    Teixeira RV, Colla C, Sbruzzi G, Mallmann A, Paiva LL. Prevalence of urinary incontinence in female athletes: a systematic review with meta-analysis. Int Urogynecol J. 2018;29(12):1717–25.CrossRefGoogle Scholar
  31. 31.
    Ashton-Miller JA, DeLancey JOL. Functional anatomy of the female pelvic floor. Ann N Y Acad Sci. 2007;1101:266–96.CrossRefGoogle Scholar
  32. 32.
    Bo K. Urinary incontinence, pelvic floor dysfunction, exercise and sport. Sports Med. 2004;34(7):451–64.CrossRefGoogle Scholar
  33. 33.
    Kudish BI, Iglesia CB, Gutman RE, Sokol AI, Rodgers AK, Gass M, et al. Risk factors for prolapse development in white, black, and Hispanic women. Female Pelvic Med Reconstr Surg. 2011;17(2):80–90.CrossRefGoogle Scholar
  34. 34.
    Nygaard I, Bradley C, Brandt D. Pelvic organ prolapse in older women: prevalence and risk factors. Obstet Gynecol. 2004;104(3):489–97.CrossRefGoogle Scholar
  35. 35.
    Larsen WI, Yavorek T. Pelvic prolapse and urinary incontinence in nulliparous college women in relation to paratrooper training. Int Urogynecol J. 2007;18(7):769–71.CrossRefGoogle Scholar
  36. 36.
    Brown J, Brown S. Exercise for dysmenorrhoea. Cochrane Database Syst Ver. 2011;17:CD004142.Google Scholar
  37. 37.
    Ortiz M, Cortés-Márquez SK, Romero-Quezada LC, Murguía-Cánovas G, Jaramillo-Díaz AP. Effect of a physiotherapy program in women with primary dysmenorrhea. Eur J Obstet Gynecol Reprod Biol. 2015;194:24–9.CrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2019

Authors and Affiliations

  1. 1.Department of Physical TherapyFederal University of São CarlosSão CarlosBrazil
  2. 2.Physical Therapy Post-Graduate ProgramFederal University of São CarlosSão CarlosBrazil

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