Does Hip Strength Impact Active Females Rate of Pelvic Floor Dysfunction?

Women who participate in high-level physical activity are known to have increased rates of Urinary Incontinence (UI) with prevalence rates of 28-29.6% compared to non-athletes with rates of 9.8-13.4%. The current body of research for active females in pelvic health physical therapy has focused primarily on female athletes with Urinary Incontinence (UI), which is only one symptom under the greater umbrella of Pelvic Floor Dysfunction (PFD). Likewise, systematic reviews of females with PFD have been limited to the exploration of Female UI. Pelvic Floor Dysfunction can be separated into two broad categories: relaxing and nonrelaxing. Relaxing PFD conditions are more common and include diagnoses of UI and prolapse of pelvic structures. Nonrelaxing PFD can include a broad range of non-specific symptoms. These symptoms can include voiding, anorectal, and sexual dysfunction and pain. Specifically, the pain can be insertional or deep dyspareunia, low back pain that can radiate to the thighs or groin, and pelvic pain that may be unrelated to intercourse or may occur after intercourse. Voiding issues may include a sense of incomplete emptying, bladder pain, urinary frequency, urgency or dysuria.

Research related to nonrelaxing pelvic floor dysfunction has been mostly limited to a case example, a case study related to dry needling intervention and a continuing education formatted article from Mayo Clinic. Nonrelaxing PFD has been described as a disorder where "..the muscles of the pelvic floor remain in a contracted state causing increased pressure and pain." From these articles, nonrelaxing PFD can present with a wide range of nonspecific symptoms and can negatively affect quality of life.

An additional area of interest is the impact of anxiety and depression on pelvic floor dysfunction of active females. Anxiety and depression symptoms are common in individuals with PFD (30.9% and 20.3% respectively) and athletes. High performance athletes have depression rates ranging from 6.7% to 34.0% with risk factors including female gender and playing an individual sport. In a systematic review, Beisecker et al explored depression, anxiety and stress among student athletes and found specific themes related to these symptoms, including being a female student athlete, social support, connection and interaction and health components (diet and eating patterns, sleep and alcohol use).

Foster et al researched hip and pelvic floor strength in a different patient population (Urgency and Frequency prominent lower urinary tract symptoms) in 2021 with 18-60 year olds and did not have a classification for level of physical activity. This research group found that there was a reduction in hip external rotation and abduction strength compared to case controls. To this point, there has not been any research assessing the relationship between hip strength and relaxing versus nonrelaxing pelvic floor dysfunction.

I plan to make this work public through submission to the Journal of Women's Health Physical Therapy or the Journal of Orthopaedic & Sports Physical Therapy. Additionally, I will submit my findings to the American Physical Therapy Association Combined Section Meeting for platform presentation.