More women participate in sports than ever before and the proportion of women athletes at the Olympic Games is nearly 50%. The pelvic floor in women may be the only area of the body where the positive effect of physical activity has been questioned. The aim of this narrative review is to present two widely held opposing hypotheses on the effect of general exercise on the pelvic floor and to discuss the evidence for each. Hypothesis 1: by strengthening the pelvic floor muscles (PFM) and decreasing the levator hiatus, exercise decreases the risk of urinary incontinence, anal incontinence and pelvic organ prolapse, but negatively affects the ease and safety of childbirth. Hypothesis 2: by overloading and stretching the PFM, exercise not only increases the risk of these disorders, but also makes labor and childbirth easier, as the PFM do not obstruct the exit of the fetus. Key findings of this review endorse aspects of both hypotheses. Exercising women generally have similar or stronger PFM strength and larger levator ani muscles than non-exercising women, but this does not seem to have a greater risk of obstructed labor or childbirth. Additionally, women that specifically train their PFM while pregnant are not more likely to have outcomes associated with obstructed labor. Mild-to-moderate physical activity, such as walking, decreases the risk of urinary incontinence but female athletes are about three times more likely to have urinary incontinence compared to controls. There is some evidence that strenuous exercise may cause and worsen pelvic organ prolapse, but data are inconsistent. Both intra-abdominal pressure associated with exercise and PFM strength vary between activities and between women; thus the threshold for optimal or negative effects on the pelvic floor almost certainly differs from person to person. Our review highlights many knowledge gaps that need to be understood to understand the full effects of strenuous and non-strenuous activities on pelvic floor health.

中文翻译：

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女性骨盆底运动是好事还是坏事？叙事评论。

妇女参加体育运动的人数比以往任何时候都要多，奥运会上女运动员的比例接近50％。妇女的骨盆底可能是身体中唯一受到身体活动的积极影响的区域。这篇叙述性评论的目的是针对普遍锻炼对骨盆底的影响提出两个被广泛反对的假说，并讨论每个假说的证据。假设1：通过增强骨盆底肌肉（PFM）并减少提肌裂孔，运动可降低尿失禁，肛门失禁和盆腔器官脱垂的风险，但会对分娩的难易程度和安全性产生负面影响。假设2：通过使PFM超负荷和伸展运动，锻炼不仅增加了患这些疾病的风险，而且使分娩和分娩更加容易，因为PFM不会阻塞胎儿的出口。这篇综述的主要发现支持了这两种假设的各个方面。与没有运动的女性相比，运动的女性通常具有相似或更强的PFM强度和更大的提肛肌，但这似乎并没有更大的阻碍分娩或分娩的风险。此外，在怀孕期间专门训练自己的PFM的女性不太可能出现与分娩阻塞有关的预后。轻度至中度的体育活动（例如步行）可降低尿失禁的风险，但与对照组相比，女运动员发生尿失禁的可能性大约高三倍。有证据表明，剧烈运动可能导致并加剧盆腔器官脱垂，但数据不一致。在运动之间和女性之间，与运动相关的腹腔内压力和PFM强度均不同。因此，每个人对骨盆底产生最佳或负面影响的阈值几乎肯定会有所不同。我们的评论强调了许多知识上的空白，需要理解这些空白才能理解剧烈和非剧烈活动对骨盆底健康的全面影响。