Injuries to female reproductive tract
8 likes1,873 views
The document discusses injuries to the female reproductive tract in athletes, highlighting that pelvic injuries are rare due to protective anatomical structures, while stressing the occurrence of exercise-induced urinary incontinence primarily in postmenopausal and elite young female athletes. It details common causes and risks associated with urinary stress incontinence, as well as treatment options, and describes breast injuries, their causes, and preventive measures, including the importance of well-fitting sports bras. Additionally, it emphasizes the need for regular breast examinations and mammography for early detection of breast cancer.
Injuries to female reproductive tract
- 1. INJURIES TO FEMALE REPRODUCTIVE TRACT Dr. Usha (PT) Assistant Professor
- 2. Common Injuries •Pelvic injuries •Exercise incontinence •Breast injuries
- 3. Pelvic injuries • Contrary to earlier misconceptions, pelvic injuries are rare. • Because reproductive organs of females are extremely well protracted by bony, ligamentous and muscular structures especially compared to those of males.
- 4. • A recent review of the literature on abdominal, chest injuries in sports found lower than 2% of all injuries occurs to this area, even in contact sports. • Occasionally pelvic contusions occur, usually just surface bruises not affecting the internal structures of the ovaries, vagina or uterus.
- 5. • Lacerations injuries to vagina by ‘forceful vaginal douches” in water skiing & jet skiing, The wearing of tight-fitting wetsuit pants should be mandatory for all female water-skiers. • It is recommended that women participating in these sports wear reinforced neoprene rubber pants or a pant girdle. • A rare case of perforation of a uterus by an IUD after a blow to the pelvis was cited by Haycock and Gillette in 1976.
- 6. • Based on present research, one can conclude that injuries to the reproductive organs of female athletes are unlikely. • Occasionally women cyclists can suffer injury or discomfort to the perineal region. • Other injuries and conditions included traumatic contact with the top tube of the bicycle (32%), Urethral structures (1.8%), & pelvic Fractures (1.5%)
- 7. • stress fractures occur more frequently in amenorrheic women than in those who are menstruating normally. The exact mechanism of the development of stress fractures in amenorrheic women is uncertain and may not necessarily be related to low bone density. • However, menstrual status should be assessed in all female athletes who present with stress fractures. A bone density measurement should be considered in these athletes. • Vulval contusions and lacerations can occur from direct trauma, especially in gymnastics. These should be treated with the application of ice and surgical repair of the laceration if necessary.
- 8. • Treatment for bicycle seat to a gender specific type that decreases compression upon the perineal area, adjusting the bike seat and position, wearing bike shorts with appropriate padding and taking more frequent breaks on long distance rides.
- 9. Exercise Incontinence • Commonly found in post menopausal women. • However, young elite female athletes also suffer frim exercise incontinence • Urinary stress incontinence (USI) is the involuntary loss of urine during physical activity.
- 10. Three common types: 1. Stress Incontinence 2. Urge Incontinence 3. Overflow Incontinence • An athlete women may have all these 3 components.
- 11. Causes of USI • Genetic factors • Previous Gynec surgery • Vaginal births • Underlying neurologic, GI or Pulmonary disease • Smoking • Obesity • Occupational or recreational factors
- 12. • Intrinsic urethral sphincter deficiency and pelvic floor muscle weakness coupled with an increase in intra abdominal pressure from high impact exercise can result in leakage for exercising women. Eg. Basket ball • The condition of urinary stress incontinence, is under reported. Only 30-35% of incontinent women seek medical attention.
- 13. Who are at Risk? • Female athletes participating in running and high impact activities • High impact movements, subjects the pelvic floor ligaments to forces 3-4 times a women’s body weight. • Over prolonged periods of time, the ligaments can not sustain these high loads. • They become damaged, especially if the women already has week levator ani muscles, resulting in bothersome urinary leakage.
- 14. • Gymnastic (67%)> Tennis (50%)> Basketball (44%)> Field hockey (32%)> Track (26%)> Volleyball (9%)> Swimming (6%)> Softball (6% rare) > Golf (0%) • Women who have experienced incontinence during activity. • Data from American college of Obs & Gynec. (UI in elite nulliparous athlets)
- 15. Treatment • Pelvic muscles strengthening/retraining with or without biofeedback and electrical stimulation. • Kegel’s exercises • Use of – Tampons, vaginal cones, bladder-neck support prosthesis (BNSP), Barrier devices • Medication • Surgery
- 17. Other helpful techniques: • Pre-exercise voiding • Avoidance of alcohol or caffeine • Wearing shock absorptive shoes • Using sanitary napkins • Participating in less jarring activities/exercises or ceasing exercises all together
- 18. Breast Injuries • Occurs much more frequently although rarely serious • Most common in the soft tissue injury • The superficial location of breast makes it prone to blunt trauma that can result into: Bruising Swelling Tenderness Lacerations Deep haematoma formation
- 19. • Breast trauma is not common but a contusion may occur as a result of a direct blow from a ball, racquet or opponent. This is contusion is associated with bleeding and swelling. • It should be treated with ice, analgesics and support. Occasionally, a deep hematoma will require aspiration. There is no evidence that trauma to the breast causes tumors.
- 20. Breast Pain • Intense activity and exercises often result in breast pain secondary to excessive motion or improperly fitting protective wear. Jogger’s nipple • Results from prolonged rubbing of the nipple adjacent to the bra or shirt • Problem typically of running sports and not of women, more common in males than females. • A well designed sports bra or covering the nipple with a Band- aid or specifically designed nipple guards before the sporting activities.
- 21. Bicyclists Nipple • An unusual condition caused not by friction but exposure to cold • Cold weather and perspiration result in the combination of evaporation and wind chill to lower the temperature, causing cold and painful nipples. • In addition to a well fitting sports bra, the cyclists should wear a layer of clothing and wind breaking jacket.
- 22. Recommendations: • Monthly breast self examination • Yearly breast examination by Obs/ Gynec • Mammography is useful in early detection of breast cancer • A baseline mammogram is suggested by age 40, every 1-2 year between ages 40-49, and annually thereafter. • Female athlete participation examination
- 23. Sports bras • Excessive movement of the breasts, particularly in an up and down motion, occurs during exercise. This may lead to pain and discomfort and affect sports performance. A number of specialized sports bras are now available. Sports bras should give support from above, below and the sides. They should be made of a material that is firm, mostly non-elastic, non-abrasive and has good absorptive quality. The straps should be of non-stretch material and, ideally, criss-crossed or Y-shaped at the back. There should be no seams or ridges in the nipple area and no fasteners or hooks. • The e sports bra should be individually fitted and be comfortable both at rest and with vigorous activity. • There should also be provision for the insertion of padding for use in contact sports. Various degrees of padding can be added to the bra. In certain sports, such as martial arts and football, a plastic cup bra may be placed over the normal sports bra. Protective chest pads should be worn in soft ball and hockey.