Differences in pelvic floor anatomy may explain UI in female athletes

Urinary incontinence in nulliparous female elite athletes may have multifactorial aetiology, as shown by differences seen in dynamic pelvic MRI, reports a study.

This cross-sectional study involved 29 nulliparous female athletes from the National Collegiate Athletic Association Division 1 and compared symptomatic (ie, currently or previously experienced urinary leakage during exercise) and asymptomatic participants.

The authors assessed demographics, sport characteristics, relevant medical history (including Brief Eating Disorder in Athletes Questionnaire), and validated genitourinary symptom questionnaires (Lower Urinary Tract Dysfunction Network Symptom Index-29 [LUTDNSI-29] and Female Genitourinary Pain Index).

Pelvic floor at rest and at maximal strain was evaluated via pelvic examination and dynamic MRI. The authors also used MRI to assess and segment the anatomic structures of the pelvic floor.

Of the female athletes, 18 were symptomatic and 11 asymptomatic. Demographics, sport characteristics, and pelvic examination findings did not significantly differ between groups.

Symptomatic athletes were found to have significantly worse urinary symptoms (median LUTDNSI-29 8.5 vs 8.0; p=0.022) and genitourinary pain (median Genitourinary Pain Index 7 vs 3; p=0.036).

In addition, the symptomatic group showed greater anterior thickness of the striated urethral sphincter muscle (median 2.5 vs 1.8 mm; p=0.016) and puborectalis and levator ani muscles (median 10.3 vs 8.6 mm; p=0.028), and worse disordered eating (median Brief Eating Disorder in Athletes Questionnaire 7.5 vs 4.5; p=0.022).

“In nulliparous female elite athletes with UI, dynamic pelvic MRI identified differences in pelvic floor anatomy, which may be part of a multifactorial aetiology of UI,” the authors said.