Physiotherapy - Theses
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ItemPelvic floor disorders in exercising women( 2023-09)Physical inactivity is a global societal and economic burden, increasing the risk of chronic disease. Women participate in organised sports at lower rates than men and 86% of Australian women do not meet all components of the National Physical Activity Guidelines. Sport and exercise activities may provoke symptoms of pelvic floor (PF) disorders. Pelvic floor symptoms are highly prevalent in exercising women. One in three women report symptoms of urinary incontinence (UI) across all sports and up to 80% of women engaging in high impact sports or heavy weight-lifting report UI and/or anal incontinence (AI). It is therefore important to understand how PF symptoms limit or stop exercise participation in women. The thesis research aimed to: establish the impact of female PF symptoms (UI, AI and pelvic organ prolapse) on sport and exercise participation; determine current PF symptom screening and management within Australian sport and exercise settings; and explore the preferences, barriers and enablers for future PF symptom screening and management within sport and exercise settings from the perspectives of exercising women and health or exercise professionals. Study One was a systematic review of the impact of PF symptoms on sport and exercise. Whilst UI adversely impacted exercise in one in two women, the evidence certainty was low. Important gaps in the knowledge of other PF symptoms (beyond UI) and the degree and nature of impact of all PF symptoms on participation were established. Study Two, an observational, cross-sectional study of 4,556 Australian women with PF symptoms, examined the research gaps determined by systematic review. One in two women stopped a form of exercise they had previously participated in, secondary to PF symptoms. A secondary data analysis (Study Two, Part B) found that women with more severe UI symptoms (OR=4.77; 95% CI:7.24 to 14.37), and higher bother (UI: OR=10.19; 95% CI:7.24 to 14.37; POP: OR=22.38; 95% CI:13.0 to 36.60; AI: OR=29.66; 95% CI: 7.21 to 122.07) were at greater odds of identifying their PF symptoms as a barrier stopping participation (often or all the time). Study Three, a qualitative descriptive study, interviewed symptomatic women (n=23) about their experience of PF symptoms within sport and exercise settings. Symptoms inhibited their ability to participate in exercise in the manner they wanted. Restrictive and complex coping strategies were used to avoid symptom provocation, which limited their spontaneity and enjoyment of sport and exercise. Study Four, an observational, cross-sectional survey study completed by Australian health and exercise professionals (n=636), found that PF symptom screening was not common practice within Australian sports and exercise settings, especially in at-risk groups such as high-impact athletes. Professionals were willing to engage in future screening and management, but required training, resources and access to referral networks prior to implementation. Study Five, an explanatory-sequential mixed methods design, synthesised quantitative and qualitative data (‘following a thread’) exploring symptomatic women’s experience of PF symptom disclosure and screening within sports and exercise settings. Most women had not told anyone about their symptoms due to embarrassment, limited pelvic health knowledge or not being asked. Women conveyed important preferences for future screening and management of PF symptoms within sports settings, including recommendations for how to start a conversation on pelvic health in an acceptable manner. Additional factors to facilitate disclosure, and make sports and exercise settings safer and more inclusive for symptomatic women were explored. Together, this thesis established that PF symptoms stop women from participating in sports and exercise in their preferred manner, limiting enjoyment and increasing the odds of physical inactivity. Currently, women are not usually provided the opportunity to seek help for their symptoms within sports and exercise settings. However, women and professionals felt that the provision of screening, education and management would be acceptable if appropriate support was provided and sensitively and safely implemented.