Conservative interventions for female exercise‐induced urinary incontinence: a systematic review

• Published in: BJU international 2024-12, Vol.134 (6), p.906-917
• Main Authors: Petter Rodrigues, Marina, Bérubé, Marie‐Ève, Charette, Marylène, McLean, Linda
• Format: Article
• Language: English
• Subjects: Aerobics; athletes; Body weight gain; Conservative Treatment - methods; Exercise; Exercise - physiology; Exercise Therapy - methods; Feedback; Female; Humans; Leakage; Pelvic Floor; pelvic floor disorders; pelvic floor muscle training; Pessaries; Physical fitness; Physical training; Population studies; Questionnaires; sports; Tampons; Urinary incontinence; Urinary Incontinence - etiology; Urinary Incontinence - therapy; Urine
• ISSN: 1464-4096; 1464-410X; 1464-410X
• DOI: 10.1111/bju.16474

Objective To systematically review and synthesise what is known about the effectiveness of non‐pharmaceutical conservative interventions for the management of urinary incontinence (UI) experienced by women during physical exercise. Methods A systematic search was performed in the following databases in September 2023: the Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica dataBASE (EMBASE), Scientific Electronic Library Online (SciELO), Latin American and Caribbean Health Sciences Literature (LILACS), and Physiotherapy Evidence Database (PEDro). Studies were deemed eligible if population consisted of females who reported symptoms of UI while participating in physical exercise, and the interventions involved any non‐pharmaceutical conservative treatment to manage symptoms during exercise. The primary outcome was severity of UI signs and symptoms. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO identifier: CRD42022379138). Results Of the 3429 s screened, 19 studies were retained. Pelvic floor muscle training (PFMT) and intravaginal devices were the most commonly investigated modalities. Only two randomised controlled trials (RCTs), both among volleyball players, compared PFMT with no PFM exercise, showing a reduction in pad weight gain after the intervention in the experimental groups only. PFMT with and without biofeedback randomised among soldiers demonstrated a reduction in the frequency of urine leakage episodes in both groups, while supervised and unsupervised PFMT randomised among athletes from different sports showed pad weight gain reduction in the supervised group only. Seven single‐arm studies suggested that PFMT alone or combined with other modalities may reduce UI severity in active women based on questionnaires, bladder diaries, and self‐reported symptoms. A single‐arm and a crossover study found pessary use beneficial in reducing urine leakage based on questionnaires and pad weight gain, respectively. When comparing pessary, tampon, and no intervention, two repeated‐measures studies found tampons may reduce leakage more than pessaries in CrossFit exercisers and women performing aerobic exercises. A vaginal sponge also reduced pad weight gain during aerobic exercises. Other modalities (i.e., an intraurethral device, photobiomodulation, and combined therapies) were investigated using case series