Aim: Sports are associated with pelvic floor dysfunction. This work aimed to assess, in nulliparous asymptomatic women, whether previous intense practice of high-impact sports is associated with differences in morphology and contraction of the pelvic floor muscles, when compared to women who practiced low-level physical activity.
Methods: In this prospective pilot study, 7 former high-impact sports practitioners and a control group (N.=7) were compared. Clinical evaluation and self-administered questionnaires were used to gather information about pelvic floor dysfunction and physical activity. Static and cine dynamic MR images were acquired. Morphological measures of the pubovisceral muscle area and thickness, and levator hiatus (LH) anterior-to-posterior diameter, width and area were taken in the static images. LH anterior-to-posterior diameter was again assessed in the dynamic acquisition (consecutive blocks of rest vs. maximal voluntary contraction). The relative variation between these two conditions was used as an indirect measure of contraction.
Results: No abnormal clinical or imaging findings were reported. Former high-impact sports practitioners evidenced decreased pubovisceral muscle thickness (right side P=0.005; left side P=0.004) and area (P=0.004), and larger levator hiatus width and area (P=0.045; P=0.005). Only its anterior-to-posterior diameter was similar (4.89cm±0.35 and 4.81cm±0.17, respectively). Their ability to perform maximum voluntary contractions seems to have decreased (8.03%±0.81 vs. 13.74%±0.95 for controls).
Conclusion: The current results suggest that women who previously practiced high-impact sports, even being asymptomatic, may have suffered damage to the pelvic floor muscles due to the biomechanical impact of the sports. They may require pelvic floor muscle training to increase muscle thickness and hiatal closing capacity.