Urinary incontinence (UI) and pelvic organ prolapse (POP) are highly prevalent among nulliparous women who practice high-impact and/or high-intensity sports; in fact, it is estimated that 1 in 4 women suffer or will suffer from urinary incontinence, mostly of effort type (1,2). Different studies have demonstrated that prolonged exposure to elevated intra-abdominal pressure constitutes a risk factor for the development of pelvic floor dysfunctions (PFD), even in nulliparous women (3). Despite the significant psychological and physiological impact of these pathologies, prevention strategies among athletes have not been widely studied. 

A significant gap in knowledge regarding pelvic floor health is evident within the general population. Thus, prior to discussing treatment options, it may be imperative to educate individuals about perineal health and strategies for its maintenance. 

Therefore, the aim of this study was to analyse whether an educational programme, delivered via telemedicine, improved the knowledge of perineal health and pelvic floor dysfunctions (PFD) in female athletes. Leading to improved sexual function, quality of life and exercise behaviour. In addition, also was observed whether this procedure was satisfactory for the women.

A quasi-experimental pilot study was conducted. Women professional or semi-professional sports women aged between 18 to 35 years old were participated. Inclusion criteria were: practice high-intensity or high-impact physical activity of at least 3,000 metabolic equivalents (METs) per week, consistently maintaining this level for at least the preceding year and above 18 years of age. Exclusion criteria were: pregnant or postpartum women, reported urogynecological interventions, pathologies in progress and were physically and cognitively able to understand the procedure.

Firstly, all women completed an initial online questionnaire including four validated and reliable Spanish-language questionnaires administered via the “LimeSurvey” platform, this questionnaire reported the assessment of the quality of life through European Quality of Life-5 Dimensions questionnaire (EQ-5D), female sexual function through the Female Sexual Function Index (FSFI-19) and pelvic floor health and knowledge through Prolapse and Incontinence Knowledge Questionnaire (PIKQ). Finally, the satisfaction of the women was reported using a numerical scale from 0 to 10, where 0 represented " dissatisfied" and 10 "very satisfied".

Then, during 3 weeks all women received a total of six video-tutorials (two for week) each video reported a duration of 10-15 minutes and were provided in the form of educational modules delivering relevant information on pelvic floor anatomy, function, pathophysiology, treatment, and prevention of SUI and POP in both sporting and daily life contexts.

Finally, after viewing all the video-tutorials, we evaluated the effect on the different outcomes and the women’s satisfaction with the format throughout a final questionnaire. In addition to the previous questionnaires, we added the six questions of satisfaction with the type and format of the educational programme.

Sample size was calculated using G*Power software. Considering the primary outcome as PIKQ-7 total score, an error margin of 0.05 with a confidence interval of 95% with a power of 0.8 and an expected effect size of 0.8 for a sample proportion of 50%. it would be necessary to recruit 52 women.

Data analysis was conducted using the "IBM SPSS Statistics" software, employing the non-parametric paired samples testing (Wilcoxon test) to analyse pre- and post-intervention questionnaire responses.

A total of 14 women aged between 18 and 35 were included in the study. Statistical analysis revealed significant differences in general knowledge of pelvic floor dysfunctions (p<0.05), specifically in items 7 and 9 regarding urinary incontinence, and items 8-10-11 concerning prolapse, from the Prolapse and Incontinence Knowledge Questionnaire (PIKQ). Additionally, statistically significant differences (p<0.05) were found in items 12 and 17 related to climax and pain reduction during sexual intercourse from the Female Sexual Function Index questionnaire (FSFI-19). However, no differences were observed in the total score of the FSFI-19 questionnaire (p>0.05). There were neither statistic differences in the participants' quality of life (p>0.05).Lastly, women expressed satisfaction with the perineal health online programme, with an average score of 8.72 (1.59) points out of 10.

Our hypothesis is that improvement in general knowledge about the topic at hand could decrease the rate of SUI and POP, the most prevalent pelvic floor dysfunctions, within female sports, thanks to both the self-management of the athlete and the proactive measures taken by clubs in terms of season preparation. For future research, it is suggested to implement preventive educational measures for nulliparous athletes, as well as sessions incorporating pelvic floor muscle training. This will allow for a study of outcomes of applying a multimodal programme combining two of the most effective approaches identified in the literature.

In summary, an educational intervention comprising 6 concise educational video-tutorial has demonstrated to improve the pelvic floor muscles and pelvic floor dysfunction knowledge. Awareness of these pelvic floor dysfunctions could prove beneficial in improving the performance of female athletes and their perineal health. This study advocates for further investigation into pelvic health issues among female athletes.

1.	Machado L da S, Marques Cerentini T, Laganà AS, Viana da Rosa P, Fichera M, Telles da Rosa LH. Pelvic floor evaluation in CrossFit® athletes and urinary incontinence: a cross-sectional observational study. Women Heal [Internet]. 2021;61(5):490–9. Available from: https://doi.org/10.1080/03630242.2021.1927288
2.	Verbeek M, Hayward L. Pelvic Floor Dysfunction And Its Effect On Quality Of Sexual Life. Sex Med Rev [Internet]. 2019;7(4):559–64. Available from: https://doi.org/10.1016/j.sxmr.2019.05.007
3.	Sorrigueta-Hernández A, Padilla-Fernandez BY, Marquez-Sanchez MT, Flores-Fraile MC, Flores-Fraile J, Moreno-Pascual C, et al. Benefits of physiotherapy on urinary incontinence in high-performance female athletes. Meta-analysis. J Clin Med. 2020;9(10):1–12.

Continence 12S (2024) 101416
DOI: 10.1016/j.cont.2024.101416