Physical activity and the pelvic floor.
Physical activity and the pelvic floor.
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DOI：
10.1016/j.ajog.2015.08.067
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发表时间：
2016-02
影响因子：
9.8
通讯作者：
Shaw JM
中科院分区：
文献类型：
--
作者：
Nygaard IE;Shaw JM
骨盆底疾病（PFDs）很常见，四分之一的美国女性报告中度至重度尿失禁，盆腔器官脱垂或大便失禁症状。鉴于这些疾病的高社会负担，确定潜在的可改变的风险因素至关重要。体育活动是一个可能改变的风险因素;大量女孩和妇女参加体育运动和艰苦的训练方案，增加了了解这些接触的相关风险和益处的必要性。本综述的目的是总结报告体力活动和PFDs之间的关联的研究。大多数研究是横断面的，大多数包括少量的参与者。这项审查的主要结果包括：运动过程中尿失禁是常见的，在高强度运动中女性更普遍。轻度到中度的体力活动，如快走，可以降低患尿失禁的几率和风险。对于老年女性来说，轻度至中度的活动也会降低大便失禁的几率;然而，参加高强度活动的年轻女性比不太活跃的女性更有可能报告肛门失禁。缺乏数据表明，在中年妇女中，终身体力活动会略微增加压力性尿失禁的几率，而不会增加盆腔器官脱垂的几率。接受盆腔器官脱垂手术的女性比对照组更有可能报告繁重工作的历史;然而，从盆腔器官脱垂社区招募的女性在检查中报告与没有这项检查发现的女性相似的终生剧烈活动水平。数据不足以确定年轻时的剧烈活动是否易患骨盆底疾病。现有的文献表明，大多数体力活动不会损害骨盆底，并为女性提供许多健康益处。然而，未来的研究需要填补我们知识中的许多空白。需要在所有人群中进行前瞻性研究，包括潜在脆弱的女性，如高遗传风险，提肛肌损伤或无症状盆腔器官脱垂，以及处于潜在脆弱生命期的女性，如产后早期或术后时期。
Pelvic floor disorders (PFDs) are common, with one in four U.S. women reporting moderate to severe symptoms of urinary incontinence, pelvic organ prolapse or fecal incontinence. Given the high societal burden of these disorders, identifying potentially modifiable risk factors is crucial. Physical activity is one such potentially modifiable risk factor; the large number of girls and women participating in sport and strenuous training regimens increases the need to understand associated risks and benefits of these exposures. The aim of this review is to summarize studies reporting the association between physical activity and PFDs. Most studies are cross-sectional and most include small numbers of participants. The primary findings of this review include: Urinary incontinence during exercise is common and is more prevalent in women during high-impact sports. Mild to moderate physical activity, such as brisk walking, decreases both the odds of having and the risk of developing urinary incontinence. In older women, mild to moderate activity also decreases the odds of having fecal incontinence; however, young women participating in high intensity activity are more likely to report anal incontinence than less active women. Scant data suggest that in middle-aged women, lifetime physical activity increases the odds of stress urinary incontinence slightly and does not increase the odds of pelvic organ prolapse. Women undergoing surgery for pelvic organ prolapse are more likely to report a history of heavy work than controls; however, women recruited from the community with pelvic organ prolapse on examination report similar lifetime levels of strenuous activity as women without this exam finding. Data are insufficient to determine whether strenuous activity while young predisposes to pelvic floor disorders later in life. The existing literature suggests that most physical activity does not harm the pelvic floor and does provide numerous health benefits for women. However, future research is needed to fill the many gaps in our knowledge. Prospective studies are needed in all populations, including potentially vulnerable women, such as those with high genetic risk, levator ani muscle injury, or asymptomatic pelvic organ prolapse, and on women during potentially vulnerable life periods, such as the early postpartum or postoperative periods.