Football practice and urinary incontinence: Relation between morphology, function and biomechanics

Area of Science:

• Biomedical Engineering
• Sports Medicine
• Pelvic Floor Physiology

Background:

• Urinary incontinence is prevalent in female athletes.
• The role of pubovisceral muscle characteristics in athletic incontinence requires further investigation.

Purpose of the Study:

• To assess if structural and biomechanical features of pubovisceral muscles contribute to urine leakage in female athletes.
• To compare biomechanical responses between continent and incontinent athletes using computational models.

Main Methods:

• Collected clinical, demographic, and pelvic Magnetic Resonance Imaging data.
• Developed computational models to simulate pubovisceral muscle biomechanical response during contraction.
• Validated models against dynamic imaging data to assess percent error.

Main Results:

• Incontinent athletes exhibited thicker pubovisceral muscles compared to continent athletes (p=0.019 and p=0.028).
• No significant differences were found in muscle contraction strength (Oxford Scale) or pelvic floor displacement during simulated voluntary contraction.
• Computational models demonstrated good agreement with dynamic imaging data (percent error 1.47%-17.20%).

Conclusions:

• Thicker pubovisceral muscles may be associated with urinary incontinence in female athletes.
• Urine leakage might be linked to alterations in intrafusal muscle fibers, not just muscle bulk.
• Further model refinements are needed for a more realistic simulation of the pelvic cavity biomechanics.