Physical Activity and Pelvic Floor Disorders

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DESCRIPTION (provided by applicant): Physical activity is crucial in maintaining health. Understanding how physical activity impacts pelvic floor disorders is important: half of American women have urinary incontinence or pelvic organ prolapse and one in nine undergoes surgery for these conditions. Studies to date find both protective and harmful effects of physical activity on pelvic floor disorders. The investigators, a multi-disciplinary team of urogynecologists, exercise scientists and statistician, believe this discrepancy is in large part due to inadequate ascertainment of both physical activity data and pelvic floor outcome measures. The primary aims of this study, addressed in two carefully designed case-control studies, are to determine, after adjusting for confounders, whether 1) moderate to severe stress urinary incontinence, defined by a validated questionnaire, and 2) pelvic organ prolapse, defined by structured pelvic examination, are associated with increased or decreased a) current leisure activity and b) total lifetime activity (leisure, household, and occupational). Participants will include 650 women, largely from primary care clinics: 175 with moderate to severe stress urinary incontinence, 175 with pelvic organ prolapse and 300 controls with neither condition frequency matched for age, body mass index and site. A secondary aim of this study is to establish, from the population screened for these studies, a registry of approximately 1,500 women with neither prolapse nor urinary incontinence; this will provide a foundation for future studies on the incidence of these conditions. Physical activity will be measured using validated questionnaires designed to assess current and cumulative lifetime activity in women; activity items will be supplemented with additional loading and impact physical activities. Lifetime physical activity amongst women with and without each condition will be compared using both MET hours/week (the most widely used and traditionally accepted method) and strenuous activity hours/week. PUBLIC HEALTH RELEVANCE: Pelvic floor disorders including urinary leakage and pelvic organ prolapse (dropping of pelvic organs such as the uterus into or out of the vagina) are very common. Limited data to date suggest that physical activity may be both helpful and harmful in terms of its effect on the pelvic floor. We will study the long-term effects of different levels of activity on pelvic floor disorders. Given the health benefits of activity, we believe that women should be encouraged to be active unless there is scientific evidence to the contrary.