Abdominal Hypopressive Training for Stress Urinary Incontinence in Female Athletes: A Narrative Review of Physiological Mechanisms and Rehabilitation Outcomes

Abstract

Stress urinary incontinence (SUI) is a common, though often unrecognized, condition in young female athletes involved in high impact sports. Repetitive increases in IAP, pelvic floor overload, and neuromuscular fatigue can impair the function of pelvic floor muscle (PFM), and impact athletic performance, mental health, and quality of life. Conventional pelvic floor muscle training (PFMT) is the foundation of conservative management, but there is increasing evidence that PFMT may not be the optimal choice in athletic populations, such as nulliparous adolescents and young women who may be subjected to repetitive mechanical stress. Abdominal hypopressive training (AHT) is a relatively new rehabilitation therapy that seeks to lower IAP and promote reflex activation of the deep abdominal and PFMs. This review introduces a critical appraisement of the current evidence on physiology, biomechanics and clinical use of AHT in athletes with SUI. Sport specific risk factors, assessment strategies, imaging and functional outcome measures, and the relationship between core stability and pelvic floor function are also discussed. Existing clinical trials suggest that AHT may lead to better improvement in PFM displacement, symptom severity, continence outcomes and health related quality of life when compared to PFMT alone. However, methodological weaknesses persist concerning the use of a variety of intervention protocols, short-term follow-up, and a lack of adequate high-quality randomized controlled trials in adolescent athletes. Existing research indicates the use of AHT in broader sports physiotherapy approaches for pelvic floor dysfunction in female athletes. In order to develop standardized rehabilitation protocol, optimization of parameters for exercise prescription, and understanding of the long term therapeutic effects of AHT in sports-related pelvic floor dysfunction, further longitudinal and mechanistic research is required.