Abstract
Background: Pelvic floor dysfunction (PFD) encompasses a variety of conditions affecting bladder, bowel and sexual function, such as urinary incontinence (UI). PFD is common; approximately 46% of Australian women report symptoms. PFD may negatively impact the health, well-being, and occupational performance of women. Women involved in physically demanding activities and roles, such as athletes and servicewomen, may have an increased risk of PFD, due to the high loads regularly applied to the pelvic floor. Therefore, identifying safe and effective prevention and management strategies is important.
Aim: The aim of this systematic review was to identify the prevention and management interventions used for PFD in female military personnel and elite athletes and determine their safety and effectiveness.
Method: A systematic search using the keywords “female”, “military”, “athlete” and “pelvis” identified studies relating to prevention and management strategies for PFD. Two independent reviewers identified, appraised and extracted data from the included studies and undertook a critical narrative synthesis of the results.
Results: Of 581 studies identified, nine were eligible for inclusion in the review (six military, three athlete). Only one included study, a systematic review in athletes, was published within the past five years, and there were only two controlled clinical trials. The quality of the included studies was determined to be low to moderate.
Eight studies specifically focused on UI, with the other being a military case study on the success of surgery for a female soldier with faecal incontinence. Pelvic floor muscle training (PFMT) was a common intervention for both prevention and management of PFD in the UI studies and were associated with improved symptoms. The addition of education to PFMT was also shown to be beneficial in elite female volleyballers. Athletes and military women were found to engage in a range of self-management strategies for their PFD symptoms, including fluid restriction and pad use. No adverse outcomes were reported from the intervention strategies reported.
Discussion: Few studies have investigated the safety and effectiveness of prevention and management strategies for PFD in female military personnel and athletes. Women used a range of strategies to manage symptoms of PFD. Of concern is that strategies such as fluid restriction may compromise health through dehydration.
From the evidence available, PFMT and education demonstrated promising findings. Although there were no high quality clinical trials, this finding is consistent with general recommendations for PFMT to be a first line intervention for PFD. However, further research is required to determine how these strategies are best implemented to optimise prevention and management of PFD in military women.
Other management approaches for PFD that have not been specifically examined in this population include use of mechanical devices such as pessaries, and surgery. Pessaries are reported to be effective in 60% of female PFD cases. Low to moderate quality evidence exists supporting surgery for UI and pelvic organ prolapse. There have been no studies comparing the outcomes of surgery with lower cost-conservative management strategies in this population. Further research in the military context is required to determine the safety, feasibility, cost-effectiveness and impacts of a wider range of interventions for the prevention and management of PFD.
A range of limitations were identified within the included studies. There were few controlled clinical trials, limited interventions investigated, and a predominant focus on UI, meaning that other types of PFD were not represented. Seven of the studies were conducted in the U.S. and most were not recently published.
Conclusion: PFMT and education were the most common interventions used for the prevention and management of PFD in military and athlete populations and were found to be safe and improve symptoms.
Aim: The aim of this systematic review was to identify the prevention and management interventions used for PFD in female military personnel and elite athletes and determine their safety and effectiveness.
Method: A systematic search using the keywords “female”, “military”, “athlete” and “pelvis” identified studies relating to prevention and management strategies for PFD. Two independent reviewers identified, appraised and extracted data from the included studies and undertook a critical narrative synthesis of the results.
Results: Of 581 studies identified, nine were eligible for inclusion in the review (six military, three athlete). Only one included study, a systematic review in athletes, was published within the past five years, and there were only two controlled clinical trials. The quality of the included studies was determined to be low to moderate.
Eight studies specifically focused on UI, with the other being a military case study on the success of surgery for a female soldier with faecal incontinence. Pelvic floor muscle training (PFMT) was a common intervention for both prevention and management of PFD in the UI studies and were associated with improved symptoms. The addition of education to PFMT was also shown to be beneficial in elite female volleyballers. Athletes and military women were found to engage in a range of self-management strategies for their PFD symptoms, including fluid restriction and pad use. No adverse outcomes were reported from the intervention strategies reported.
Discussion: Few studies have investigated the safety and effectiveness of prevention and management strategies for PFD in female military personnel and athletes. Women used a range of strategies to manage symptoms of PFD. Of concern is that strategies such as fluid restriction may compromise health through dehydration.
From the evidence available, PFMT and education demonstrated promising findings. Although there were no high quality clinical trials, this finding is consistent with general recommendations for PFMT to be a first line intervention for PFD. However, further research is required to determine how these strategies are best implemented to optimise prevention and management of PFD in military women.
Other management approaches for PFD that have not been specifically examined in this population include use of mechanical devices such as pessaries, and surgery. Pessaries are reported to be effective in 60% of female PFD cases. Low to moderate quality evidence exists supporting surgery for UI and pelvic organ prolapse. There have been no studies comparing the outcomes of surgery with lower cost-conservative management strategies in this population. Further research in the military context is required to determine the safety, feasibility, cost-effectiveness and impacts of a wider range of interventions for the prevention and management of PFD.
A range of limitations were identified within the included studies. There were few controlled clinical trials, limited interventions investigated, and a predominant focus on UI, meaning that other types of PFD were not represented. Seven of the studies were conducted in the U.S. and most were not recently published.
Conclusion: PFMT and education were the most common interventions used for the prevention and management of PFD in military and athlete populations and were found to be safe and improve symptoms.
| Original language | English |
|---|---|
| Publication status | Published - 27 Nov 2020 |
| Event | 2020 Australasian Military Medicine Conference: Before the Next Mission - Virtual Conference, Australia Duration: 25 Nov 2020 → 27 Nov 2020 https://www.amma.asn.au/amma2020/ https://jmvh.org/wp-content/uploads/2020/12/AMMA-JMVH-October-2020-1.pdf (abstracts) |
Conference
| Conference | 2020 Australasian Military Medicine Conference |
|---|---|
| Abbreviated title | Preparing for conflict and disaster |
| Country/Territory | Australia |
| Period | 25/11/20 → 27/11/20 |
| Internet address |