Hypothesis / aims of study
During high-impact and high-intensity sports, the complaint of urine loss is recurrent. Women who perform this type of activity are more susceptible to urinary loss compared to sedentary women in the same age group. For the condition in which the woman loses urine only during physical exercise, the term “Athletic Incontinence” (AI) has been used. Even though it is not official, the terminology brings into focus the symptomatology presented only during the practice of physical exercise, without loss of urine at other times or activities. Activities performed repeatedly and for a prolonged period can result in fatigue of the pelvic muscles. In addition, the impact and displacement of the pelvic floor during exercise, the increase in intra-abdominal pressure, joint hypermobility and the deficiency of the body's energy supply for exercise, favored by a low-calorie and low-nutrient diet are risk factors. important for athletic incontinence. Crossfit® is a model of physical activity characterized as high-impact exercise, encompassing muscular and cardiovascular endurance, strength, flexibility, power, speed, coordination, agility, balance and precision, with varied, functional and high-intensity exercises. Thus, it is necessary to analyze the prevalence of urinary incontinence in the lives of Crossfit® practitioners in order to relate the prevalence of athletic incontinence with the practice of high-impact exercises in women.
The objective of the study is to analyze the occurrence of athletic incontinence in women practitioners of Crossfit®.
Study design, materials and methods
Cross-sectional study, carried out with women practitioners of Crossfit®. Considering a sampling error of 3%, confidence level of 95%, the minimum sample for the study was 1,119 women, determined by convenience, upon invitation through the social networks of each of these women. Women who practice CrossFit® who present some urinary loss during the practice of the activity were included in the study and women who were pregnant at the time and those under 18 years of age were excluded. A questionnaire produced through Google Forms was sent through messages on social networks to women practitioners of Crossfit® to capture socio-demographic data, past history and voiding habits related to the practice of Crossfit and o the Incontinence Severity Index (ISI) which will counterpoint the level of severity according to the self-perception of loss reported by women.
Data analysis was performed using the Statistical Package for Social Sciences (SPSS) version 23.0 for descriptive and analytical analyses. A chi-square test was performed for associations between the presence of athletic incontinence and a history of pregnancy, menopause, knowledge and practice of pelvic exercises. A binary logistic regression (enter method) was performed with the aim of investigating the extent to which athletic urinary incontinence could be predicted by the factors age, weight, Body Mass Index, number of deliveries, vaginal deliveries and time practicing the modality. The accepted significance level was 0.05. Ethical imperatives were considered in accordance with Resolutions 466/2012. The project was submitted to the Research Ethics Committee (CEP), and approved under opinion number 4.131.462.
Results
1,119 women practitioners of Crossfit® participated in the survey. As the data did not show a normal pattern, the median of numerical data was used. As for age, the median was 34 years (SD ± 7), weight was 66kg (SD±10) and height was 163cm (SD±6).
Regarding pregnancy and parity, the responses showed that 51.5% had already become pregnant. In addition, the median Body Mass Index of the participants was 25.15, showing adequate weight for height. However, the most repeated value (mode) among the answers was 27.34, indicating overweight.
As for urine loss, it is important to differentiate athletic incontinence from other types, since 100% of the women who participated in the study reported losing urine while practicing CrossFit®. Thus, he was questioned about the loss of urine before practicing these high-impact exercises, and the results showed a prevalence of 63.4% (n=709) of women who did not lose urine before practicing CrossFit® and who did not lose urine in any other situation, only during the practice of the exercise.
A bivariate analysis was performed between athletic incontinence and pregnancy history, menopause, knowledge and practice of pelvic floor exercise, where the first and last variable showed a statistically significant association (Table 01).
Through regression analysis (Table 02) the impact of age, weight, Body Mass Index, number of deliveries, number of vaginal deliveries and CrossFit time for the presence of athletic incontinence was verified. The predictive variables of athletic incontinence were evaluated and the most significant ones were the number of deliveries and the Body Mass Index.
The number of deliveries had a statistically significant impact (exp (B)=1.367) [95% CI: 1.140 – 1.639]) and BMI (exp (B)=1.130) [95% CI: 1.052 – 1.214]).
The model was statistically significant [𝜒2(6)= 50.281, p= 0.000; Nagelkerke R2 = 0.06], being able to adequately predict 65.12% of cases (where 92.1% of cases correctly classified for those who have athletic incontinence and 18.3% of cases correctly classified for those who do not).
Interpretation of results
Having become pregnant and performing pelvic floor exercise were configured as protective variables for athletic incontinence, considering that both presented odds lower than one, 0.618 and 0.654 respectively.
This result of pregnancy as a protective factor contradicts the literature that indicates pregnancy and childbirth as factors related to urinary incontinence in several studies, pointing out that nulliparous and nulliparous women have a significantly lower risk of developing this disease. However, the results indicate that at each delivery; increases the chances of a woman having athletic incontinence by 1.3, as well as each point of increase in the Body Mass Index, increases the chance of having athletic incontinence by 1.13 times. It is known that the Body Mass Index does not differentiate adipose tissue from muscle mass, however, overweight added to high-impact exercises increases intra-abdominal pressure, resulting in increased intra-vesical pressure and loss of urine [2].
Concluding message
Having become pregnant and performing pelvic floor exercise were configured as protective variables for athletic incontinence, considering that both presented odds lower than one, 0.618 and 0.654 respectively. The self-report of the women evidenced a high percentage (75.2%) of moderate loss of urine during exercise.This result of pregnancy as a protective factor contradicts the literature that indicates pregnancy and childbirth as factors related to urinary incontinence in several studies, pointing out that nulliparous and nulliparous women have a significantly lower risk of developing this disease. However, the results indicate that at each delivery; increases the chances of a woman having athletic incontinence by 1.3, as well as each point of increase in the Body Mass Index, increases the chance of having athletic incontinence by 1.13 times.
It is known that the Body Mass Index does not differentiate adipose tissue from muscle mass, however, overweight added to high-impact exercises increases intra-abdominal pressure, resulting in increased intra-vesical pressure and loss of urine.