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Pelvic floor symptoms are an overlooked barrier to exercise participation: a survey of 4556 symptomatic women

      Introduction: Physical inactivity is the second highest contributor to chronic disease and injury in Australian women. Pelvic floor (PF) disorders are highly prevalent; 25% of women in the general population report symptoms. This study aimed to (i) investigate barriers to exercise in women with PF symptoms (urinary incontinence [UI], anal incontinence [AI] and pelvic organ prolapse [POP]) (ii) determine factors associated with reporting PF symptoms as a substantial exercise barrier and (iii) investigate the association between reporting PF symptoms as an exercise barrier and physical inactivity.
      Methods: Australian women, 18-65 years with PF symptoms (n=4556), completed a survey containing validated PF and physical activity questionnaires. Participants reported exercise barriers and the degree they limited participation. Binary logistic regression was used to identify variables associated with (a) identifying PF symptoms as a substantial exercise barrier (stops exercise participation often/all of the time) and (b) physical inactivity.
      Results: In this cohort, 31% (n=1429) reported PF symptoms as a substantial exercise barrier, UI was the most frequently reported barrier. Two-thirds of participants who identified POP and UI as exercise barriers, had stopped exercising. The odds of reporting PF symptoms as a substantial exercise barrier were significantly higher for women with severe UI (odd ratio (OR):4.77 CI:3.60, 6.34), high symptom bother (UI OR:10.19, CI:7.24, 14.37; POP OR:22.38, CI:13.04, 36.60; AI OR:29.66, CI:7.21,122.07), those who experienced vaginal birth (one birth OR:2.04, CI:1.63, 2.56) or a 3rd/4th degree obstetric tear (OR:1.47, CI:1.24, 1.76). The odds of being physically inactive were greater in women who identified PF symptoms as an exercise barrier than those who did not (OR:1.33, CI:1.1, 1.59).
      Discussion: A high prevalence of PF symptoms in women has been previously established. This study demonstrated that PF symptoms are a substantial barrier to exercise participation, causing one in three symptomatic women to stop participation in exercise often/all the time. Physical inactivity is a major cause of mortality and morbidity in Australian women. Pelvic floor symptoms stop women of all ages from participating in exercise, including younger nulliparous women. Those who identify their PF symptoms as a substantial barrier to exercise have higher odds of being physically inactive. Pelvic floor muscle training has level 1A evidence as an effective, low-risk form of conservative management for UI symptoms in the general population. Identification and management of PF symptoms could allow women to remain physically active across their lifespan.
      Conflict of interest statement: This study is funded by the Physiotherapy Research Foundation Seeding Grant and The Australian Bladder Foundation managed by the Continence Foundation of Australia.