**1. Introduction**

68 Urinary Incontinence

[22] Bo K, Talseth T, Holme I (1999) Single blind, randomized controlled trial of pelvic florr

[23] Rosner B (1986) Fundamentals of Biostatistics. 2nd Ed. Massachusetts: PWS Publishers

[24] Gunnnarsson M, Mattiasson A (1999) Female stress, urge and mixed urinary

[26] Rett MT, Simoes JA, Herrmann V. et al (2007) Management of stress urinary

[27] Bernstein IT (1997) the pelvic floor muscles: muscle thickness in healthy and urinary

[28] Otcenasek M, Halaska M, Krcmar M, Maresova D, Halaska MG (2002) New approach to

[29] Rovner ES, Wein AJ (2003) Evaluation of lower urinary tract symptoms in females. Curr

[30] Weil EH, van Waalwijk van Doom Es, Heesakkers Jp, Meguid T, Janknegt RA (1993)

[31] Brandt FT, Albuquerque CDC, Lorenzato FRB, Lopes DSG, Cunha ASC, Costa RF. A

[32] Sartori JP; Martins JAM; Castro RA; Sartori MGF; Girão MJBC, Sling de aponeurose e

[33] Herrmann V, Potrick BA, Palma PCR, Zanettini CL, Marques A, Júnior NRN (2003)

[34] Balmforth JR, Montle J, Bidmead J, Cardozo L (2006) A prospective observational trial

[35] Rett MT, Simões JA, Herrmann V, Gurgel MSC, Moraes SS (2007) Women's life quality

using vaginal surface electromyography. Neurourol Urodyn 18:613-21. [25] Bo K (2003) Pelvic floor muscle strength and response to pelvic training for stress

genuine stress incontinence in women. BJM 318:487-93.

urinary incontinence. Neurourol Urodyn 22(7):654-8.

reproductive age. Physical Therapy 87(2):136-142.

genuine stress incontinence. Eur Urol 24:226-30.

esforço. Radiol Bras 2007;40(6):371–376

442-80.

75.

103(1):72-74.

Opin Urol 13(4):273-8.

Janeiro Mar. 2008

Obstet 29(3):134-40.99

49(4): 401-5.

811-7.

exercise, electrical stimulation, vaginal cones and no treatment in management of

incontinence are associated with a chronic and preogessive pelvic floor/vaginal neuromuscular disorder: an investigation of 317 health and incontinent women

incontinence with surface electromyography-assisted biofeedback in women of

incontinent women measured by a perineal ultrasonography with reference to the effect of pelvic floor training estrogen receptor studies. Neurourol Urodyn 16:237-

the urogynecological ultrasound examination. Eur J Obstet Gynecol Reprod Biol

Transvaginal ultra-sonography: a study with healthy volunteers and women with

importância da ultra-sonografia transvulvar na avaliação de parâmetros anatômicos relevantes no tratamento de mulheres com incontinência urinária de

com faixa sintética sem tensão para o tratamento cirúrgico da incontinência urinária de esforço feminina. Rev. Bras. Ginecol. Obstet. vol.30 no.3 Rio de

Eletroestimulação transvaginal do assoalho pélvico no tratamento da incontinência urinária de esforço: avaliações clínica e ultra-sonográfica. Rev Assoc Med Bras

of pelvic floor muscle training for female stress urinary incontinence. BJU Int 98(4):

after physical therapy treatment for stress urinary incontinence. Rev. Bras. Ginecol

Aerobic exercises, as well as those for muscle strength and flexibility, might play a positive role in preventing and treating heart diseases, hypertension, osteoporosis, obesity and diabetes, to name a few, especially when practiced on a regular basis, under supervision and properly adapted to each individual (Carrol & Dudfield, 2004). Furthermore, the benefits brought by physical activity reach as far as the emotional aspects of the individual and help prevent the negative effects of stress, reduce tensions, enhance mood, lower the symptoms of stress and anxiety (Gorayeb & Turibio, 1999), and, eventually, improve health and boost the quality of life. According to the American Heart Association, the lack of physical activity can lead to a higher mortality and morbidity rate (America Heart Association, [AHA], 2007) Disengagement in physical activities is quite often associated to sedentary habits which might lead up to degenerative-chronic diseases, offering great risk to the population as a whole (Who, 1995). There are evidences that the incidence of these pathologies, plus other health conditions, including diabetes mellitus, osteoporosis, some cancers, obesity, the maintenance of body mass index (BMI) and hypertension, can be reduced by encouraging a more active life style, based on a constant and regular physical practice.

Urinary incontinence is a disease which interferes with the practice of physical activities, mostly among women; since physical workouts may trigger involuntary episodes and urinary leaking, incontinent women are likely to be caught on an embarrassing and uncomfortable spot while exercising (Brown & Miller, 2001; Caetano et al., 2009a). This is a huge limitation for the practice of physical exercises by women (especially those with moderate to severe incontinence), and dangerous for female health (Nygaard et al., 2005; Stach-Lempinem et al., 2004). Significant morbidity and mortality prevalence has been reported among women with urinary incontinence (Mullins & Subak, 2005). Putting it this way, quitting physical activities and sports practice might lead up to a sedentary life style, a major risk for and cause of several diseases.

Given that, this chapter aims to: (1) review publications on important available data about urinary incontinence as related to sports and physical activities.; (2) based on a systematic program of physical activities, introduce strategies which enable the Physical Education instructor and other professionals to take supplementary action in order to help prevent urinary incontinence in women and lower its prevalence rate.

Incontinence: Physical Activity as a Supporting Preventive Approach 71

order to maintain urinary continence, the bladder must be complacent capable of storing hundreds of milliliters in volume, the urethra must be preserved and in a normal position, innervations must be intact, which is crucial for the sphincters integrity. A properly long urethra is also important, as it allows urethral mucosal coaptation which mechanically

However, the female urinary continence mechanism is also supported by a healthy perineum structure, such as muscle and fascias (tissues) which provide structural framework for the internal organs as well as the closure of the pelvic opening. (Ashton-Miller & DeLancey, 2001). The perineum comprises all soft tissues that circle the pelvis and keep viscera in the upright position. In a simplistic analogy, the pelvic floor is compared to \*the foundations of a house, the diaphragm would be the ceiling and the abdominal muscles would make the front and side walls, while the spinal muscles and cord would make the back walls" (Grosse & Sengler, 2002). The pelvic floor muscles encompass three different layers (or plans), known as deep, middle and superficial. All layers, but the superficial, have voluntarily active muscle parts which can help keep continence when proper and

The deep layer consists of the main pelvic diaphragm, comprised by two muscles: the levator ani and the ischiococcygeus. The outward section of the levator ani is called elevator, its sphincter-like (consists of two hammock-like muscles – the pubococcygeus and the iliococcygeus) and has the support of the ischiococcygeus muscles; the inward section is formed by the pubovaginal and puborectal muscles. For the physical trainer, the levator ani is crucially important, as the pelvic floor muscle strength and quality can be improved by

The layer in the middle has three muscles: two deep transverse and the external urethral sphincter. The latter has the shape of a ring, circles the mid-third of the urethra and plays a fundamental role in the maintenance of continence. It's made of non-fatigable slow fibers which form the intra-urethral section plus a group of stretched muscles formed by slow fibers, fast and strong but highly fatigable fibers, called peri-urethral section. Despite being formed by striated fibers, the external sphincter is always in a state of contraction, helping to keep the pressure in a balanced level; in addition, it helps eliminate involuntary urinary

Stress urinary incontinence is classified as the involuntary urine leaking as a result of physical exercises, physical efforts, sneezing and/or coughing (Abrams et al., 2002). It occurs when the urethral sphincter cannot withstand the urinary flow resulting from physical activities that increase intra-abdominal pressure; whenever a weakness or flaw occurs in the pelvic floor, there is an incorrect pressure transmission for the physical efforts, thus damaging the urinary continence mechanism and leading up to an unintended urinary leaking. This kind of incontinence is probably due to anatomic reasons; hypoestrogenism; after-effects of baby deliveries and pregnancies which might relocate and weaken the pelvic floor muscles. Other causes of stress urinary incontinence in women are: obesity; chronic diseases; gynecological surgeries; bowel obstruction; caffeine ingestion; smoking; hereditary reasons; medicinal drug ingestion (for example,

flow as urinary needs can be controlled by strong and quick contractions.

prevents the flowing of urine or the voiding. (Wei et al., 1999).

supervised training takes place.

alpha-adrenergic) and physical exercises.

exercising this muscle.
