Stress urinary incontinence (SUI) is a prevalent pelvic floor dysfunction in females, particularly among athletes, with a 44% occurrence rate in various sports. Studies on SUI have focused on pelvic floor muscle strength, coordination, and bladder neck descend (BND), a measure of urethral hypermobility. However, there is limited information on SUI in running and its correlation with BND.
We aimed to evaluate the association between urethral hypermobility and SUI in female runners. We hypothesized that there would be a strong association between bladder neck descent (BND) and SUI.

In a case-control study examining BND among female runners, researchers utilized transperineal ultrasound to compare measurements between 13 women without urinary incontinence and 16 women experiencing SUI while running. Classification into the two cohorts was based on their International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) scores. A physical therapist conducted the ultrasound evaluations using a portable 2D device with a convex probe (GE Healthcare-Logiq v2, 2-5 MHz Convex). To ensure accurate Valsalva maneuver results, measurements were taken during a strong 'push' and were recorded both when the bladder was full and when it was empty. BND evaluations were conducted using stored ultrasound recordings, taken more than a week prior by one examiner and re-assessed by another examiner who was not aware of the initial results to ensure objectivity and evaluate inter-rater reliability. Three months following the initial analysis, the second examiner conducted another set of measurements to assess intra-rater reliability. The core assessment involved comparing the position of the urethra at rest to its position during the Valsalva maneuver, with the displacement indicative of the BND.

The two groups of continent females and SUI females were similar in their demographic characteristics: for age (p=0.333), BMI (p=0.417) and total volume of running per week (km) (p=0.227). High intra- and inter-rater reliability was found with a significance level of p<0.001 for both bladder volume conditions (before and after voiding). Significantly higher BND was found in incontinent female runners compared to the continent ones (p=0.001 measured before voiding, and p=0.022 measured after voiding). The BND values were higher in participants with SUI during running. A positive correlation was found between BND values and ICIQ-SF score (p=0.028), but no significant correlation was found between BND and the number of births or total running volume (km per week).

In the study of female runners, the objectively measured BND values were correlated to the self-reported ICIQ-SF. BND was significantly higher in the group of female runners with SUI. The findings of our research align with those of other studies [1, 2]. What sets our research apart is its targeted examination of BND within a particular demographic—female runners experiencing SUI specifically while engaged in running activities. 
Understanding the complex etiology of SUI requires a multifaceted approach. By incorporating objective measurements, we can achieve a more accurate diagnosis. Therefore, we propose a combined assessment of PFM strength and BND as an integral part of pelvic floor physiotherapy examinations. In cases where high BND values are observed alongside normal PFM function, they can serve as indicators for two essential parameters. Firstly, it may suggest impairment of the passive tissue supporting the urethra and bladder, and secondly, it provides insights into the level of hypermobility of the bladder neck. This comprehensive assessment can potentially improve our ability to evaluate prognosis and make informed treatment decisions

In the study of female runners, the objectively measured BND values were correlated to the self-reported ICIQ-SF. BND was significantly higher in the group of female runners with SUI. Sonographic BND assessment, a reliable and objective evaluation, should be a part of SUI evaluation. Additional studies are needed to explore factors associated with BND change.

Turkoglu A, Coskun ADE, Arinkan SA, Vural F (2022) The role of transperineal ultrasound in the evaluation of stress urinary incontinence cases. Int Braz J Urol 48:70-77. doi: 10.1590/s1677-5538.Ibju.2020.1100
Li YQ, Geng J, Tan C, Tang J, Yang X (2017) Diagnosis and classification of female stress urinary incontinence by transperineal two-dimensional ultrasound. Technol Health Care 25:859-866. doi: 10.3233/thc-160786

Continence 12S (2024) 101350
DOI: 10.1016/j.cont.2024.101350