The femfit® (version 3.0) is a pressure sensor array designed to measure intravaginal (IVP) and intraabdominal (IAP) pressure simultaneously (ref). It consists of eight pressure sensors which measure pelvic floor activation pressure (sensors 1-6) and abdominal pressure, (sensor 7 – 8). The primary aim of this study was to measure IVP and IAP using femfit® during selected sports activities in female elite athletes with and without stress urinary incontinence (SUI) and determine if there was a difference between the two groups.  The secondary aim was to quantify the amount of urine leakage, during the activities using an innovative pad weighing test (iPWT).

This was an observational pilot case-controlled study. Ten female elite athletes five with and five without SUI were included from local sports clubs. SUI was determined using the International Consultation on Incontinence Questionnaire. Institutional ethical approval was obtained for the study. Each participant had their own femfit® as it is a single user device, which was self-inserted according to the instructions – to insert it like a tampon.
	Measurements of IVP and IAP were carried out during the following sport activities: jumps on the ground up to 10 cm during 30 seconds, relaxation for 30 seconds, jumps on a trampoline up to 20 cm during 30 seconds, relaxation for 30 seconds, weightlifting with 25% of body weight (60 kg weight of the athlete corresponds to a load of 15 kg) during 30 seconds, relaxation for 30 seconds, slow running during 30 seconds, relaxation for 30 seconds, fast run during 30 seconds, relaxation for 30 seconds.
	A modified innovative pad weighing test (iPWT) was included for all athletes which involved emptying of the bladder, then an intake of 500 ml of fluid over 15 minutes, waiting for 15 minutes, then performing the sport activities, as described above.  The pads were changed and weighed after each activity.
        The following inclusion criteria were used for this study: (1) nulliparous women; (2) aged 18–35; (3) high-intensity physical activity (4) performed sport at least three days per week, 90 minutes per day, for more than two years. Exclusion criteria were: (1) disabled sportswomen; (2) performance of various kinds of sport; (3) surgical treatment of gynaecological and urological illnesses; (4) urinary tract infection; (5) disease of respiratory tract;(6) body mass index greater than 30 (BMI = kg/m2, where kg =  weight in kilograms and m =  height in metres); (7) symptoms of OAB.  
     The data are presented as mean values and standard deviations (SD), p values were obtained using a t test with ANOVA. The significance level was set at p < 0.05.

Intravaginal pressures were recorded from the first to the sixth sensors and abdominal pressure from the seventh and eighth sensors in mmHg. The femfit® recorded 40 measurements every second and an average was taken from the difference between the minimum and maximum pressure per second (Figure 1). The highest mean intravaginal pressures among the 10 participants were recorded when jumping on the ground and the trampoline (53.7 ± 21.6 mmHg), followed by  fast and slow running (24.7 ± 8.0 mmHg), with the lowest mean intravaginal pressures measured during weightlifting (11.6 ± 4.0 mmHg). The intraabdominal pressures measured followed the same pattern:  (59.6 ±14.3 mmHg) for jumping on the ground and the trampoline , (27.1 ± 6.8 mmHg) fast and slow running, with the lowest intraabdominal pressure measured during weightlifting (10.3 ± 2.5 mmHg).  During all sports activities tested, intravaginal and intraabdominal pressures were higher in the group without SUI than in the group with SUI, but the differences were not statistically significant.
      The overall mean urine leakage in the group with SUI from the five activities was 6.6 ± 1.8 g. Urine leakage of 1.4± 0.5 g during trampoline jumping, weightlifting, and slow running, urine leakage of 1.2 ± 0.4 g was measured during ground jumping and fast running. In the group without SUI, urinary leakage was not measured for any of the activities.

Figure 1 Intravaginal and intrabdominal pressure (mmHg) from sensors during sports activities in a woman with SUI
Legend: A - jumps on the ground, B - jumps  on trampoline, C - weightlifting, D - slow running, E - fast running

In this pilot study, the athletes without SUI were able to generate higher intravaginal pressures overall, when compared to the group with SUI. The ability of the pelvic floor to respond sufficiently to increases in abdominal pressure, during high intensity activity appears to be less in those athletes with SUI. The higher intravaginal and abdominal pressures measured during trampolining corresponded with the most amount of urine leakage in those athletes with SUI, suggesting a negative impact on the pelvic floor during this activity. 
	Interestingly, Weightlifting (25% of body weight) measured lower intravaginal pressures developed overall, yet those athletes with SUI, still had a higher volume of leakage during this activity, suggesting perhaps the threshold for leakage is dependent on the more than just pressure generation. However, these results should be interrupted with caution due to the small sample size. Nonetheless, the ability of femfit® to measure a vaginal pressure profile during activity is encouraging for a larger trial in these two groups.
These results imply that it is important to recognize the impact of different sporting activities, on pressure profiles and their potential impact on pelvic floor function.

The femfit® pressure measurement during sports activities revealed lower intravaginal pressures in the female elite athletes with stress urinary incontinence, when compared to those without. The innovative pad weighing test is a suitable method to objectify stress urinary incontinence in female elite athletes.

Neurourology and Urodynamics. 2020;39:253-260

Continence 12S (2024) 101629
DOI: 10.1016/j.cont.2024.101629