Assessment of pelvic floor muscle pressure in female athletes

Objective: To evaluate the pressure of the pelvic floor muscles in female athletes and the associated signs and symptoms of stress urinary incontinence.

Design: A prospective observational study.

Setting: An academic institution, primary level of clinical care.

Participants: Forty women between 18 and 30 years of age divided into 4 groups: 10 volleyball players, 10 handball players, 10 basketball players, and 10 nonathletes.

Methods: The measurement of intracavity pressure was performed with use of a perineometer. The volunteers were instructed to perform 3 maximum isometric contractions of the perineum, held for 4 seconds. Data regarding specific training and urinary symptoms were collected through a questionnaire.

Main outcome measurements: Statistical analysis was performed by analysis of variance, with a significance level of 5%. The Spearman correlation was used to verify the degree of association between variables related to training, urinary symptoms, and perineal pressure.

Results: The average (standard deviation) perineal pressure for nonathletes was 6.73 ± 1.91 mm Hg. The average perineal pressure for handball players was 5.55 ± 1.43 mm Hg; for volleyball players, 4.36 ± 1.43 mm Hg; and for basketball players, 3.65 ± 1.35 mm Hg. Statistically significant differences were found in the perineal pressure of volleyball (P = .009) and basketball players (P = .039) compared with nonathletes. The number of games per year, strength training, and on-court workout correlated significantly with perineal pressure (Spearman correlation coefficient [Rs] of -0.512 for the 3 variables). Urine leakage through effort and nocturia correlated moderately with perineal pressure (Rs of -0.51 and -0.54, respectively). A strong correlation was found between urinary frequency and perineal pressure (Rs of -0.85).

Conclusions: Analysis of these data suggests that perineal pressure is decreased in female athletes compared with nonathlete women. A lower perineal pressure correlates with increased symptoms of urinary incontinence and pelvic floor dysfunction.