UROGYNECOLOGY

ORIGINAL RESEARCH n

Effect of Kegel Exercises on Lower Urinary Tract Symptoms

in Young Gymnasts: A Prospective Cohort Study
Importance Lower urinary tract symptoms (LUTS) have been shown to exist Celia Rodríguez-Longobardo, MSc,*
in young athletes. The use of pelvic floor muscle training as a preventive Amelia Guadalupe-Grau, PhD,†‡
strategy at an early age may be useful to avoid possible pelvic floor Miguel Ángel Gómez-Ruano, PhD,*
and Olga López-Torres, PhD§
dysfunction in the future.
Objectives The aim of the study was to describe LUTS in underaged
Author affiliations, Conflicts of Interest, and
gymnasts. We also aimed to evaluate the effects of a 12-week Kegel article information are provided at the end of
this article.
exercise intervention for LUTS and urinary incontinence (UI) and their
relationship to bother.
Study Design A quasi-experimental (nonrandomized, noncontrolled)
pre-post study was conducted. Nineteen gymnasts with a mean age of 13.
21 ± 1.84 were selected from a gymnastics club in Madrid, Spain. WHY THIS MATTERS
Outcomes of LUTS and quality of life were measured using the International Because of the lack of studies
Consultation on Incontinence Questionnaire-Female Lower Urinary Tract measuring lower urinary tract
symptoms (LUTS) in young ath-
Symptoms validated questionnaire at baseline and at the end of the 12-week
letes, we wanted to set the pre-
intervention. liminary basis for further studies
Results The participants presented with certain LUTS such as urgency UI and fill this gap in the literature. To
(57.7%) or stress UI (47.4%), which negatively affect their daily lives by our knowledge, this is the first
pelvic floor intervention study to
feeling annoyed in various aspects (when practicing gymnastics, getting up be conducted in underaged ath-
during the night to urinate or feeling bladder pain among others). No letes. Because of the high preva-
significant differences in LUTS and quality of life variables were observed lence on LUTS found already at
this early age, more studies are
after the exercise intervention ( P > 0.05).
needed to clarify the effects of
Conclusions A high prevalence of LUTS was observed in a sample of sports on pelvic floor structures.
underaged high-level gymnasts. The 12-week Kegel exercise intervention There is a need for a better un-
did not significantly reduce the presence of pelvic floor problems and even derstanding of pelvic floor muscle
training from coaches as a part of
intensified some of them, probably because of an increased awareness.
the physical preparation for ath-
Pelvic floor muscle training as a preventive strategy at an early age seems to letes, with them being the first link
be necessary to avoid possible pelvic floor dysfunction in the future. to prevent future problems and
improve the quality of life of their
Urogynecology 2023;00:00–00 trainees.
DOI: 10.1097/SPV.0000000000001331

ower urinary tract symptoms (LUTS) is a global term, which encom-

L passes storage, voiding, and postmicturition urinary symptoms.1

When storage-related LUTS appear, they may indicate the occur-
rence of urinary incontinence (UI).2
Low muscle tone and strength of the pelvic floor can lead to UI or other
problems, such as pelvic organ prolapse. These disorders are included in
what is known as pelvic floor dysfunction (PFD), which implies the mod-
erate to severe impairment of the musculature or involved neural structures Supplemental Digital Content

Rodríguez-Longobardo, et al. UROGYNECOLOGY Vol 00 Issue 00 Month 2023 1

Copyright © 2023 American Urogynecologic Society. Unauthorized reproduction of this article is prohibited.
n ORIGINAL RESEARCH
that can affect both the innervation of pelvic floor
muscles and their control.3
Pelvic floor dysfunction is common in athletes, in
particular UI, with studies showing a high prevalence,4
especially in some disciplines, such as volleyball (30%),
aerobics (40%), or gymnastics (56%).5 Different stud-
ies performed in athletes of different sports6 concluded
that high-impact activities are more related to urine
leakage than low-impact activities, jumping being the
activity most likely to provoke leakage5 and UI.7
The prevalence of UI during sports among young
nulliparous elite athletes varies between 0% (golf ) and
80% (trampolinists).8 Gymnastics is a high
strain-eliciting sport, which is thought to generate
ground reaction forces close to 10 times body mass in
prepubertal children.9 It may be possible that high
strenuous exercises during the prepuberty years in fe-
males may affect future pelvic floor function due to
both changes in hormones, weight and bone and mus-
cle structures during this period, and an increased risk
of connective tissue injury.10 Olympic gymnasts are
often younger than 24 years with a training history of
more than 10 years.11 This fact implies that exposure of
gymnasts to prolonged and repeated high-impact
practice may require an optimal tone and strength in
the pelvic floor muscles to counteract increases in the
abdominal pressure.8 Because of the youth of
the gymnasts (that often reach elite level while
underaged), implementing preventive programs that
include compensatory and strengthening exercises of
the pelvic floor muscles may help reduce LUTS in this
population, prevent future PFD, and ensure a healthy
transition into adulthood.
In particular, Kegel exercises have been proved as an
effective resource to train pelvic floor muscles and
prevent or reduce UI, consisting of voluntary tightening
and relaxing the muscles of the pelvic floor at different
rhythms and intensities in a cycle of several times.12,13
Specifically, several studies showed that using a Kegel
exercise program during 8 to 16 weeks helps reduce UI
in different populations.14–16
Urinary incontinence, especially stress UI, could be-
come a real problem in daily life activities and exercise
practice, affecting quality of life (QoL). In young nul-
liparous female athletes, like young gymnasts, stress UI
is usually underreported and underdiagnosed, proba-
bly because of lack of knowledge and awareness. This
situation, prolonged over time, might negatively affect
the personal and social life of young females.17 Urinary
incontinence has been proved to be related to anxiety
and depression at different levels, according to the type
2 Rodríguez-Longobardo, et al.
Copyright © 2023 American Urogynecologic Society. Unauthorized reproduction of this article is prohibited.
Effect of Kegel Exercises on LUTS
and degree of UI.18 The available literature shows that
approximately 25% of the physically active young
women studied reported symptoms of UI and worse
QoL than those who were continent, the prevalence of
stress UI being higher in high-impact sports, which
leads to decreased QoL in sportswomen.19,20
There is little information on how high-impact
sports affect continence and thus QoL in young nul-
liparous sportswomen. Therefore, the aims of the
present study were to describe LUTS in underaged
gymnasts and to evaluate the effects of a 12-week
Kegel exercise intervention performed 3 times per week
for LUTS and UI and their relationship to bother.
MATERIALS AND METHODS
A quasi-experimental (nonrandomized, noncontrolled)
pre-post study was conducted. Signed informed con-
sent was obtained from the legal guardian of each par-
ticipant. The study was approved by Technical Uni-
versity of Madrid (number 2022-038). The study is in
accordance with The Code of Ethics of the World
Medical Association (Declaration of Helsinki) for ex-
periments involving humans and the European Data
Protection Regulation.
The hypothesis of this study was that the gymnasts,
despite their young age, would present with LUTS due
to the practice of gymnastics, affecting their QoL, and
that the pelvic floor muscle training (PFMT) protocol
would help improve these LUTS and QoL. Therefore,
the primary outcome of this study was LUTS and
bother improvement.
Sample Characteristics
A sample size calculation was performed using
G*Power software (version 3.1, Düsseldorf,
Germany),21 yielding a result of 57 participants. A
sample of 19 gymnasts was obtained for this study,
which is similar to that used by previous PFMT inter-
ventions carried out with young athletes.22–24 A par-
ticipant flow diagram is presented in Figure 1. The 19
underaged gymnasts had a mean age of 13.21 ± 1.84
and were selected from a gymnastics club in Madrid,
Spain. This club was chosen by convenience because
of the ease of access to the sample. Inclusion criteria
were as follows: (1) nulliparous female between 12
and 17 years, (2) at least 4 years of experience
practicing gymnastics, and (3) gymnasts still active.
During the study intervention, all the participants
trained between 3 and 18 h/wk (mean, 9.2 h/wk) and at
UROGYNECOLOGY Vol 00 Issue 00 Month 2023
Effect of Kegel Exercises on LUTS
ORIGINAL RESEARCH n

FIGURE 1. Participant flow diagram.

least 3 d/wk. Exclusion criteria were as follows: (1) study and informed consent was signed by both of
prior urologic diagnosis, (2) taking medication that them. The questionnaires (personal and gymnastic data
could affect the outcomes of the study, or (3) injured and the International Consultation on Incontinence
gymnasts. Descriptive data of the sample are shown Questionnaire-Female Lower Urinary Tract Symptoms
in Table 1. [ICIQ-FLUTS]) were sent to the guardians of the par-
ticipants via email and filled out by the gymnasts under
Study Protocol their supervision at baseline and under the coaches and
researchers at follow-up.
The study protocol was divided into the following 3
Baseline data were collected before starting the first
parts: (1) initial data collection (baseline question-
week of training, and the familiarization session was
naires) and familiarization with Kegel exercises; (2)
performed to inform the participants how to properly
12 weeks of specific Kegel exercise program; and (3)
contract and relax the pelvic floor muscles and the
follow-up data collection.
feeling and sensations while doing the Kegel exercises,
Before the beginning of the data collection, a meet-
avoiding gluteal and adductor muscle contraction.
ing was held where the gymnasts and their legal
Moreover, an explanatory video was recorded and
guardians were informed of the characteristics of the
sent to the parents and gymnasts after the familiari-
zation session, summarizing the different exercises
TABLE 1. Descriptive Data of the Sample of Gymnasts that the gymnasts would do throughout the 12-week
n Mean SD intervention.
Age, y 19 13.21 1.84 The 12-week intervention program was directed by
Height, cm 19 147 0.15 the coaches, who were first instructed through a theo-
Weight, kg 19 43.43 1.25 retical class in the anatomical and physiological aspects
BMI 19 20.10 0.54 of the pelvic floor (structures that compose it, where it
Years of training 19 6.74 2.05 is located, and its main functions). This was followed
Menarcheal 5 by three 20-minute practice sessions, where the coaches
No menarcheal 14 learned how to properly contract the muscles, through
RC 2 the sensation of “stopping the action of urination,”
NC 17 without the presence of synergistic contractions of the
BMI, body mass index (calculated as weight in kilograms divided by height in me-
gluteus, adductors, or rectus abdominis, as well as how
ters squared); NC, national-level gymnasts; RC, regional-level gymnasts. to explain it to the gymnasts through simple

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Copyright © 2023 American Urogynecologic Society. Unauthorized reproduction of this article is prohibited.
n ORIGINAL RESEARCH
instructions on what to feel during the exercises and
how to contract as hard as possible and completely re-
lax the pelvic floor without involving other muscula-
ture. The Kegel exercises were included in the warm-up
part of the training session. This methodology was
chosen to facilitate adherence to the program by in-
cluding it as one more part of the gymnastic training,
with scientific evidence supporting the effectiveness of
performing Kegel contractions without the need for
medical supervision or a physical therapist to treat
UI.25 During the 12 weeks, constant communication
was maintained between researchers and trainers to
ensure the correct development of the sessions.
After finishing the 12-week intervention, the partic-
ipants repeated (postmeasure) the ICIQ-FLUTS
questionnaire.
Data Collection
To evaluate the LUTS at baseline and after 12 weeks of
intervention, and how they affect their QoL, a ques-
tionnaire was used: The ICIQ-FLUTS, which is a vali-
dated questionnaire for evaluating female LUTS and
the impact on QoL in research and clinical practice. It
consists of 12 items (nocturia, urgency, bladder pain,
frequency, hesitancy, straining, intermittency, urgency
UI, frequency of UI, stress UI, unexplained UI, and
nocturnal enuresis). Participants indicated for each item
the frequency that the item happens (Likert scale from 0
to 4) and how much does it bother them (Likert scale
from 0 to 10; see supplementary material, http://links.
lww.com/FPMRS/A391).
Intervention Characteristics
The Kegel exercise intervention consisted of 3 coach led
sessions per week of approximately 10 minutes each to
be performed by the gymnasts in the warm-up section
for 12 weeks (see supplementary material, http://links.
lww.com/FPMRS/A392), which seems to be the optimal
pelvic floor muscle workload to minimize urine loss.26
Along the 12 weeks, the intensity of the exercises in-
creased according to the following 3 variables: duration
and intensity of the contractions (slow and long or fast
and short), number of contractions, and execution
posture. The recovery time between contractions
ranged from 1 to 12 seconds, depending on the number
of contractions performed.
Statistical Analysis
Descriptive and frequency tests were performed to de-
scribe the initial status of the pelvic floor muscle. To test
4 Rodríguez-Longobardo, et al.
Copyright © 2023 American Urogynecologic Society. Unauthorized reproduction of this article is prohibited.
Effect of Kegel Exercises on LUTS
the homogeneity of dispersion from the normal distri-
bution, a Shapiro-Wilk test was conducted. The data
showed a nonnormal distribution ( P < 0.05); thus,
descriptive results were presented as median and
interquartile range, and the nonparametric Wilcoxon
test for repeated measures was used to analyze the pre-
post measures. The effect size estimations were calcu-
lated using the η2 (η2 = Z2/N) where Z indicates the
Wilcoxon test statistic, and N is the total number of
observations.27 The interpretation follows the sug-
gested ranges of interpretation: 0.01 ≤ effect size (ES)
<0.06 small effect, 0.06 ≤ ES <0.14 moderate effect,
and ES ≥ 0.14 large effect.28 The Statistical Package for
Social Science (version 26.0) was used for statistical
analysis (IBM SPSS, Inc, Chicago, Ill). All probability
values of P < 0.05 were considered statistically
significant.
RESULTS
Fifty-one gymnasts were screened for participation in
this study, of which 20 were finally selected. Results of
the intervention for the different parameters were ob-
tained from 19 gymnasts and are shown in Table 2.
The answers from the ICIQ-FLUTS questionnaire at
baseline showed that the participants presented with
certain LUTS at the beginning of the intervention. One
of the participants reported getting up once during the
night to urinate, despite of her youth. Ten of the 19
participants (52.6%) reported having troubles with a
sudden need to rush to the toilet to urinate (8 of the
gymnasts chose occasionally, one marked sometimes
and another one selected most of the time), and 3 par-
ticipants (15.8%) reported occasionally (n = 2) or
sometimes (n = 1), when referring to urine leaking be-
fore reaching the toilet, with 4 gymnasts having
reporting urine leakage at least once per week (21.1%).
These results indicate the presence of urgency UI in
57.7% of the sample at baseline. Similarly, 4 partici-
pants reported having pain in the bladder, needing to
strain to urinate, or a delay before they can start to
urinate, whether occasionally or sometimes (21.1%).
Regarding the need of stop and start more than once
while urinating, 4 gymnasts selected occasionally while
one of them reported all of the time, which represents
26.4% of the sample reporting this kind of symptom.
When the participants were asked about stress or idio-
pathic UI, 47.4% and 10.5% of them, respectively,
showed signs of UI. Regarding the first percentage, 7
gymnasts selected occasionally, one gymnast marked
most of the time and another one all of the time; 10.5%
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Effect of Kegel Exercises on LUTS
ORIGINAL RESEARCH n

TABLE 2. Median and IQR Before and After 12 Weeks of Intervention and Wilcoxon Nonparametric Test Values for the
Different ICIQ-FLUTS Questionnaire Parameters (0–4 Scale)
Pre Post
Median IQR Median IQR Z P ES
Nocturia 0 0 0 0 −0.577 0.564 0.01
Urgency 1 1 1 1 0.632 0.527 0.01
Bladder pain 0 0 0 1 0 1 0
Micturition frequency 0 0 0 0 0 1 0
Hesitancy 0 0 0 1 0.541 0.589 0.01
Straining 0 0 0 1 0 1 0
Intermittency 0 1 0 1 0.106 0.916 0
Urge UI 0 0 0 1 1.89 0.059 0.09
Frequency of UI 0 0 0 1 1.414 0.157 0.05
Stress UI 0 1 0 1 −0.749 0.454 0.01
Unexplained UI 0 0 0 0 0 1 0
Noctural enuresis 0 0 0 0 1.00 0.317 0.03
F subscore 1 2 1 2 0.098 0.922 0
V subscore 0 2 0 2 0.537 0.591 0.01
I subscore 1 2 0 3 0.816 0.414 0.02
ES, effect size; F subscore, filling symptoms subscore; I subscore, incontinence symptoms subscore; ICIQ-FLUTS, International Consultation on Incontinence Question-
naire-Female Lower Urinary Tract Symptoms; IQR, interquartile range; UI, urinary incontinence; V subscore, voiding symptoms subscore.

of the gymnasts with signs of idiopathic IU marked
sometimes. About the relationship to QoL through the
question of how each item bothers the gymnasts in their
daily life, responses were collected on a Likert scale
from 0 to 10, where 0 was no bother at all and 10 was a
great deal (Table 3). The lowest maximal score (3 of
10) was selected for the question if they needed to stop
and start again during urination. However, a maximal
score of 4 was selected for the following items: getting
up during the night to urinate, a delay before start uri-
nating, strain to urinate, and idiopathic UI. The sudden
need to rush to the toilet and having pain in the bladder
obtained for some of the participants a score of 6, while
urgency incontinence obtained a 7, the frequency of
leaking an 8, which raised to a 9 when the leakage oc-
curred during physical activity.
When the differences in the follow-up were ana-
lyzed, no significant differences were found in any of

TABLE 3. Median and IQR Before and After 12 Weeks of Intervention and Wilcoxon Nonparametric Test Values for the ICIQ-
FLUTS Questionnaire Parameters Related to QoL (0–10 Scale)
Pre Post
Median IQR Median IQR Z P ES
Nocturia 0 0 0 0 0.184 0.854 0
Urgency 0 2 0 3 1.848 0.065 0.09
Bladder pain 0 0 0 2 0.422 0.673 0
Micturition frequency 0 0 0 0 0.707 0.480 0.01
Hesitancy 0 0 0 0 −0.408 0.683 0
Straining 0 0 0 0 −1.378 0.168 0.05
Intermittency 0 0 0 0 0.351 0.726 0
Urge UI 0 0 0 2 0.674 0.500 0.01
Frequency of UI 0 0 0 0 −0.315 0.752 0
Stress UI 0 2 0 3 −0.409 0.683 0
Unexplained UI 0 0 0 0 0.000 1.000 0
Noctural enuresis 0 0 0 0 0.000 1.000 0
ICIQ-FLUTS, International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms; IQR, interquartile range; QoL, quality of life; UI, urinary
incontinence.

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n ORIGINAL RESEARCH
Simply Stated
Women who practice sports are at higher risk of
experiencing urinary leakage than those who are seden-
tary. In high-impact sports that involve actions such as
running and jumping, this risk is intensified. Through this
study, we wanted to verify whether these problems al-
ready occur in young athletes and whether it affects their
quality of life. In addition, a training intervention of the
pelvic floor musculature was carried out to prevent future
pelvic floor dysfunction.
Nineteen young gymnasts participated in this study,
with a mean age of 13.21 ± 1.84 years. Through the use
of validated questionnaires, it was found that they pre-
sented with certain problems, such as urinary inconti-
nence, that affected their daily life. The pelvic floor train-
ing intervention did not produce improvements in the
gymnasts, possibly due to an increased awareness.
the variables studied. A negative tendency to signifi-
cance was observed ( P = 0.059, effect size = 0.09, me-
dium) in the item of urine leaking before getting to the
toilet, where more gymnasts reported having occa-
sionally a sudden need to rush to the toilet to urinate in
the follow-up questionnaire.
DISCUSSION
The present study is focused on LUTS and bother and
the effect of 12 weeks of Kegel exercises on young nul-
liparous gymnasts.
Surprisingly, the ICIQ-FLUTS questionnaire
showed that the prevalence of certain LUTS among the
participants at baseline was high, with 2 of the items
asked, sudden need to rush to the toilet and stress UI
those that showed the highest prevalence. Different
studies have also reported LUTS, such as UI in active
females early in life.4,5,29 In a study carried out by
Thyssen et al5 where female athletes from different
sports with a mean age of 22.8 years were compared,
the authors found that 51.9% of the participants ex-
perienced urine loss, 43% while exercising their sport,
and 42% during normal daily life activities, being the
group of gymnasts, which presented the highest pro-
portion (56%) of urinary leakage, among all the other
groups. The volunteers participating in the present
study were younger than the athletes from the previ-
ously mentioned study but also reported some pelvic
floor problems at that early age.
Gymnastics has been reported in different studies to
be one of the sport disciplines with the highest preva-
lence of UI.5 The participants in this study presented a
6 Rodríguez-Longobardo, et al.
Copyright © 2023 American Urogynecologic Society. Unauthorized reproduction of this article is prohibited.
Effect of Kegel Exercises on LUTS
relative high prevalence of UI according to the
ICIQ-FLUTS questionnaire, reporting having a sudden
need to go to the toilet or urgency UI, 57.7% of the
sample. The gymnasts in this study also reported a high
prevalence (45%) of stress UI, in concordance with the
results that were shown by Thyssen et al.5
Urinary incontinence affects numerous women,8
and the present investigation shows that gymnasts are
affected by this type of problem at a very early age.
Although no significant effects were found in the re-
duction of LUTS symptoms after the 12-week inter-
vention, the sample showed an increase in the reported
presence of some LUTS, which indicates that the inter-
vention was not effective to reduce the symptoms and
even intensified some of them. In addition to the
existing difficulty in locating the pelvic muscles to
perform the exercises, the fact that the coaches could
not “see” the contraction made it more difficult to
monitor the exercises, which could be a reason why the
gymnasts were not able to do the exercises efficiently.
Furthermore, because of the youth of the sample and
the sensitivity of the issue, it could be considered as a
possibility that the gymnasts were not completely
aware of the subject at baseline. After the intervention,
the awareness might have increased (because of the in-
tervention per se and the information received), the
gymnasts reporting in the follow-up questionnaire an
increase in LUTS. These results are in concordance with
those found by de Andrade et al,30 in which 50 women
from the intervention group increased their knowledge
related to the location, functions, and dysfunction of
the pelvic floor muscles after the 4-week intervention,
although maximum voluntary contraction, the ability
to contract the pelvic floor muscles, or the self-reported
severity of UI did not significantly improve.
The strength of this study lies in the fact that it is, to
our knowledge, the first pelvic floor intervention study
to be conducted in underaged athletes, setting the pre-
liminary basis for further studies to fill this gap in the
literature. Because of the high prevalence on LUTS
found already at this early age, more studies are needed
to clarify the effects of sports on pelvic floor structures
that allow researchers and coaches to implement strat-
egies that help prevent future pelvic floor problems. For
future studies, it would be interesting to include objec-
tive measures to quantify the quality and quantity of
the pelvic floor muscle contractions in young female
athletes. Even so, this study is intended as an approxi-
mation toward future research.
Therefore, the present study presents some limita-
tions, such as the small sample size and the short
UROGYNECOLOGY Vol 00 Issue 00 Month 2023
Effect of Kegel Exercises on LUTS
duration of the study, which prevents being able to de-
termine whether the intervention will prevent athletes
from later developing PFDs. Another limitation was the
use of self-reported data instead of objective measure-
ments. Nevertheless, objective measurements normally
imply the use of intracavital devices. Because of the age
and because most of the participants did not reach
menarche yet, performing these tests might present an
ethical issue, leading parents or legal guardians to deny
these practices.
ARTICLE INFORMATION
ACKNOWLEDGMENTS
The authors want to thank the “Club de gimnasia Los Cantos-Alcorcón” and
all the volunteers and coaches that participated in this study.
From the *Social Sciences of Physical Activity, Sport and Leisure depart-
ment, Faculty of Physical Activity and Sport Sciences, Universidad
Politécnica de Madrid, Madrid; †GENUD Toledo Research Group,
Universidad de Castilla-La Mancha, Toledo; ‡CIBER of Frailty and Healthy
Aging (CIBERFES); and §Faculty of Sport Sciences, Universidad Europea
de Madrid, Madrid, Spain.
Correspondence: Celia Rodríguez-Longobardo. E-mail:
celia.rlongobardo@upm.es.
Celia Rodríguez-Longobardo: 0000-0001-8419-8963
Amelia Guadalupe-Grau: 0000-0003-2573-4572
Miguel Ángel Gómez-Ruano: 0000-0002-9585-3158
Olga López-Torres: 0000-0002-4030-1305
The authors have declared they have no conflicts of interest.
The study was approved by the Technical University of Madrid (number
2022-038).
All the participants and their legal guardians were informed of the
characteristics of the study, and an informed consent was signed by both of
them.
Permission to reproduce material from other sources: No permission
required.
C.R.L. and O.L.T. did the data collection, data analysis, and text drafting. A.
G.G. and G.R.M.A. did the data analysis and text drafting revision.
Supplemental digital content is available for this article. Direct URL citations
are provided in the HTML and PDF versions of this article on the journal’s
website (www.urogynecologyjournal.org).
© 2023 American Urogynecologic Society. All rights reserved.
REFERENCES
1. Chapple CR, Wein AJ, Abrams P, et al. Lower urinary tract symptoms
revisited: a broader clinical perspective. Eur Urol 2008;54(3):
563–569. doi:10.1016/j.eururo.2008.03.109.
2. Patel AK, Chapple CR. Lower urinary tract symptoms and urinary
incontinence. Ceylon Med J. 2008;53:117–120. doi:10.4038/cmj.
v53i4.279
3. Rocca Rossetti S. Functional anatomy of pelvic floor. Arch Ital Urol
Androl 2016;88(1):28–37. doi:10.4081/aiua.2016.1.28.
Rodríguez-Longobardo, et al. UROGYNECOLOGY Vol 00 Issue 00 Month 2023
Copyright © 2023 American Urogynecologic Society. Unauthorized reproduction of this article is prohibited.
ORIGINAL RESEARCH n
4. Giagio S, Salvioli S, Pillastrini P, et al. Sport and pelvic floor dysfunction
in male and female athletes: A scoping review. Neurourol Urodyn
2021;40(1):55–64. doi:10.1002/nau.24564.
5. Thyssen HH, Clevin L, Olesen S, et al. Urinary incontinence in elite
female athletes and dancers. Int Urogynecol J Pelvic Floor Dysfunct
2002;13(1):15–17. doi:10.1007/s001920200003.
6. Sorrigueta-Hernández A, Padilla-Fernandez BY, Marquez-Sanchez MT,
et al. Benefits of physiotherapy on urinary incontinence in
high-performance female athletes. Meta-analysis. J Clin Med 2020;
9(10):3240. doi:10.3390/jcm9103240.
7. de Mattos Lourenco TR, Matsuoka PK, Baracat EC, et al. Urinary
incontinence in female athletes: a systematic review. Int Urogynecol J
2018;29(12):1757–1763. doi:10.1007/s00192-018-3629-z.
8. Bø K. Urinary incontinence, pelvic floor dysfunction, exercise and sport.
Sports Med 2004;34(7):451–464. doi:10.2165/00007256-
200434070-00004.
9. Christoforidou A, Patikas DA, Bassa E, et al. Landing from different
heights: biomechanical and neuromuscular strategies in trained
gymnasts and untrained prepubescent girls. J Electromyogr Kinesiol
2017;32:1–8. doi:10.1016/j.jelekin.2016.11.003.
10. Nygaard IE, Shaw JM. Physical activity and the pelvic floor. Am J Obstet
Gynecol 2016;214(2):164–171. doi:10.1016/j.ajog.2015.08.067.
11. Longo AF, Siffredi CR, Cardey ML, et al. Age of peak performance in
Olympic sports: a comparative research among disciplines. J Hum
Sport Exerc 2016;11(1):31–41. doi:10.14198/jhse.2016.111.03.
12. Huang YC, Chang KV. Kegel Exercises. In: StatPearls. Treasure Island
(FL): StatPearls Publishing; 2022.
13. Park SH, Kang CB, Jang SY, et al. Effect of kegel exercise to prevent
urinary and fecal incontinence in antenatal and postnatal women:
systematic review. J Korean Acad Nurs 2013;43(3):420–430. doi:10.
4040/jkan.2013.43.3.420.
14. Eder SE. Evaluation of the EmbaGYN™ pelvic floor muscle stimulator in
addition to Kegel exercises for the treatment of female stress urinary
incontinence: a prospective, open-label, multicenter, single-arm study.
Womens Health 2014;10(1):17–27. doi:10.2217/WHE.13.67.
15. Ong TA, Khong SY, Ng KL, et al. Using the Vibrance Kegel device with
pelvic floor muscle exercise for stress urinary incontinence: a
randomized controlled pilot study. Urology 2015;86(3):487–491. doi:
10.1016/J.UROLOGY.2015.06.022.
16. Weinstein MM, Pulliam SJ, Richter HE. Randomized trial comparing
efficacy of pelvic floor muscle training with a digital therapeutic
motion-based device to standard pelvic floor exercises for treatment of
stress urinary incontinence (SUV trial): an all-virtual trial design. Contemp
Clin Trials 2021;105:106406. doi:10.1016/J.CCT.2021.106406.
17. Joseph C, Srivastava K, Ochuba O, et al. Stress urinary incontinence
among young nulliparous female athletes. Cureus 2021;13(9):
e17986. doi:10.7759/cureus.17986.
18. Stach-Lempinen B, Hakala AL, Laippala P, et al. Severe depression
determines quality of life in urinary incontinent women. Neurourol
Urodyn 2003;22:563–568. doi:10.1002/nau.10137.
19. Alves JO, Luz STD, Brandão S, et al. Urinary incontinence in physically
active young women: prevalence and related factors. Int J Sports Med
2017;38(12):937–941. doi:10.1055/s-0043-115736.
20. Pires T, Pires P, Moreira H, et al. Assessment of pelvic floor muscles in
sportswomen: quality of life and related factors. Phys Ther Sport 2020;
43:151–156. doi:10.1016/j.ptsp.2020.02.015.
21. Faul F, Erdfelder E, Lang AG, et al. G*Power 3: a flexible statistical power
analysis program for the social, behavioral, and biomedical sciences.
Behav Res Methods 2007;39(2):175–191. doi:10.3758/BF03193146.
22. Pires TF, Pires PM, Moreira MH, et al. Pelvic floor muscle training in
female athletes: a randomized controlled pilot study. Int J Sports Med
2020;41(4):264–270. doi:10.1055/a-1073-7977.
7
n ORIGINAL RESEARCH Effect of Kegel Exercises on LUTS

23. Sousa M, Viana R, Viana S, et al. Effects of a pelvic floor muscle training
in nulliparous athletes with urinary incontinence: biomechanical models
protocol. Lecture Notes in Computational Vision and Biomechanics
2015;21:83–90. doi:10.1007/978-3-319-15799-3_6.
24. da Roza T, de Araujo MP, Viana R, et al. Pelvic floor muscle training to
improve urinary incontinence in young, nulliparous sport students: a
pilot study. Int Urogynecol J 2012;23(8):1069–1073. doi:10.1007/
s00192-012-1759-2.
25. Cavkaytar S, Kokanali MK, Topcu HO, et al. Effect of home-based
Kegel exercises on quality of life in women with stress and mixed urinary
incontinence. J Obstet Gynaecol 2015;35(4):407–410. doi:10.3109/
01443615.2014.960831.
26. García-Sánchez E, Ávila-Gandía V, López-Román J, et al. What pelvic
floor muscle training load is optimal in minimizing urine loss in
women with stress urinary incontinence? A systematic review and
meta-analysis. Int J Environ Res Public Health 2019;16(22):4358. doi:
10.3390/ijerph16224358.
27. Morse DT. MINSIZE2: a computer program for determining effect size
and minimum sample size for statistical significance for univariate,
multivariate, and nonparametric tests. Educ Psychol Meas 1999;59(3):
518–531.
28. Cohen J. Statistical Power Analysis for the Behavioral Sciences. L.
New Jersey: Erlbaum Associates; 1988.
29. Louis-Charles K, Biggie K, Wolfinbarger A, Wilcox B, Kienstra CM.
Pelvic Floor Dysfunction in the Female Athlete. Curr Sports Med Rep.
2019;18:49–52. doi:10.1249/JSR.0000000000000563
30. de Andrade RL, Bø K, Antonio FI, et al. An education program about
pelvic floor muscles improved women’s knowledge but not pelvic floor
muscle function, urinary incontinence or sexual function: a randomised
trial. J Physiother 2018;64(2):91–96. doi:10.1016/j.jphys.2018.02.010.

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