ABSTRACT
RESUMO Atualmente, diversos estudos relatam incontinência urinária (IU) entre mulheres jovens nulíparas e fisicamente ativas. Contudo, alguns investigam a prevalência da IU de acordo com as modalidades esportivas, enquanto outros investigam a carga de treino. A finalidade do presente estudo foi verificar se a modalidade esportiva é mais determinante na prevalência de IU do que a carga de treino entre mulheres jovens nulíparas. Para esta revisão sistemática, três revisores independentes realizaram uma busca de publicações originais nas bases de dados PubMed, LILACS e SciELO, entre 1994 e 2015. Foram utilizadas como estratégia de busca as palavras-chave: urinary incontinence AND (physical activity OR women OR nulliparous OR athletes), registradas na MeSH e no DeCS. Foram incluídos apenas estudos originais publicados nas línguas português, inglês e espanhol, que verificaram a IU em mulheres nulíparas, atletas ou praticantes de atividade física. Foram selecionados 873 estudos, mas somente dez artigos satisfizeram os critérios de inclusão e exclusão. Todos os artigos foram do tipo transversal, dos quais quatro relacionaram a IU com as modalidades esportivas, cinco verificaram a carga de treino com a perda de urina e um estudo verificou ambos os aspectos. Foi encontrada uma alta taxa de prevalência de IU entre atletas. Parece haver evidência de que as atividades que exigem salto, aterrissagem longa e corrida são as mais propensas a provocar perda de urina. Além disso, a maior carga de treino parece estar associada com a quantidade de urina perdida. Esta revisão evidencia as altas taxas de IU em praticantes de grandes cargas de treinamento associadas a esportes com salto, especialmente entre atletas. Contudo, ainda não há resposta para qual fator esportivo é mais determinante para a perda de urina entre mulheres nulíparas.
ABSTRACT Currently, several studies report urinary incontinence (UI) among young nulliparous and physically active young women. However, some studies investigate the prevalence of UI according to sports modality, while others use the training load. The purpose of this study was to verify if the sport modality is more crucial to the prevalence of UI than the training load among nulliparous young women. For this systematic review, three independent reviewers carried out a search of original studies in PubMed, LILACS and SciELO databases between 1994 and 2015. As search strategy we used the keywords urinary incontinence AND (physical activity OR women OR nulliparous OR athletes), registered in MeSH and DeCS. Only original studies published in Portuguese, English and Spanish, which examined UI in nulliparous women, athletes or physical activity practitioners were included. A total of 873 studies were selected, but only ten articles met the inclusion and exclusion criteria. All articles were about cross-sectional studies, of which four related UI to the sport modality, five verified the training load with the urine loss and one study verified both aspects. A high prevalence rate of UI was found among athletes. There seems to be evidence that activities that require jumping, long landing, and running are the most likely to cause loss of urine. Furthermore, the higher training load seems to be associated with the amount of urine lost. This review shows the high UI rates in practitioners of high training loads associated with sports that require jumping, particularly in athletes. However, there is still no answer as to which sporting factor is most decisive for the loss of urine among nulliparous women.
RESUMEN En la actualidad, varios estudios señalan incontinencia urinaria (IU) entre las mujeres nulíparas jóvenes y físicamente activas. Sin embargo, algunos investigan la prevalencia de la IU según las modalidades deportivas, mientras otros investigan la carga de entrenamiento. El propósito de este estudio fue verificar si la modalidad deportiva es más decisiva en la prevalencia de la IU que la carga de entrenamiento entre las mujeres nulíparas jóvenes. Para esta revisión sistemática, tres revisores independientes realizaron una búsqueda de las publicaciones originales en PubMed, LILACS y SciELO, entre 1994 y 2015. Se utilizaron como estrategia de búsqueda las siguientes palabras clave: urinary incontinence AND (physical activity OR women OR nulliparous OR athletes), registradas en MeSH y DeCS. Se incluyeron solo los estudios originales publicados en los idiomas: portugués, inglés y español, que analizaron la IU en mujeres nulíparas, atletas o practicantes de actividad física. Se seleccionaron 873 estudios, pero sólo diez artículos cumplieron los criterios de inclusión y exclusión. Todos los artículos fueron del tipo transversal, de los cuales cuatro relacionaron la IU con las modalidades deportivas, cinco analizaron la carga del entrenamiento con la pérdida de orina y un estudio examinó ambos aspectos. Se encontró una alta prevalencia de la IU entre los atletas. Parece haber evidencias de que las actividades que requieran saltar, largo aterrizaje y correr son las más propensas a causar la pérdida de orina. Además, la mayor carga de entrenamiento parece estar asociada con la cantidad de orina perdida. Esta revisión destaca las altas tasas de IU en practicantes con grandes cargas de entrenamiento relacionadas con los deportes de salto, especialmente entre atletas. Sin embargo, todavía no hay respuesta sobre cual factor deportivo es más decisivo para la pérdida de orina en las mujeres nulíparas.
ABSTRACT
Current evidence points to a high prevalence of urinary incontinence among female athletes. In this context, this study aims to assess if structural and biomechanical characteristics of the pubovisceral muscles may lead to urine leakage. Clinical and demographic data were collected, as well as pelvic Magnetic Resonance Imaging. Furthermore, computational models were built to verify if they were able to reproduce similar biomechanical muscle response as the one measured by dynamic imaging during active contraction by means of the percent error. Compared to the continent ones (n=7), incontinent athletes (n=5) evidenced thicker pubovisceral muscles at the level of the midvagina (p=0.019 and p=0.028 for the right and left sides, respectively). However, there were no differences neither in the strength of contraction in the Oxford Scale or in the displacement of the pelvic floor muscles during simulation of voluntary contraction, which suggests that urine leakage may be related with alterations in the intrafusal fibers than just the result of thicker muscles. Additionally, we found similar values of displacement retrieved from dynamic images and numerical models (6.42 ± 0.36 mm vs. 6.10 ± 0.47 mm; p=0.130), with a percent error ranging from 1.47% to 17.20%. However, further refinements in the mechanical properties of the striated skeletal fibers of the pelvic floor muscles and the inclusion of pelvic organs, fascia and ligaments would reproduce more realistically the pelvic cavity.
