Kari Bø

Purpose: Diastasis recti abdominis (DRA) is common postpartum, but its association with low back pain (LBP), pelvic girdle pain (PGP), and pelvic floor dysfunction (PFD) remains unclear due to inconsistent findings. Women reporting visible protrusion or hollowing along the linea alba were considered to have DRA. The aim was to compare the prevalence of and risk factors for LBP, PGP, and PFD among primiparous participants with and without self-reported symptoms of DRA 6–8 months postpartum. Methods: This cross-sectional study included 460 primiparous participants. Data were collected using a web-based questionnaire assessing DRA (including photos of abdominal protrusion/hollowing), LBP, PGP, and PFD. Validated outcome measures included the Oswestry Disability Index, Pelvic Girdle Questionnaire, and Pelvic Floor Distress Inventory-Short Form 20. Results: Of 436 respondents, 96 (22%) reported DRA. There were no differences between groups in LBP prevalence or severity. A higher proportion of participants with self-reported symptoms of DRA reported PGP (45.3% vs. 23.9%), but no between-group differences were found in PGP severity. There were no differences in the prevalence of PFD. Mean Pelvic Floor Distress Inventory-Short Form 20 total scores were higher among participants with self-reported symptoms of DRA (81.7 ± 53.2 vs. 58.3 ± 35.6), although this difference was not observed in subscale analyses. Discussion: Self-reported symptoms of DRA were associated with a higher prevalence of PGP, but not with LBP or PFD, at 6–8 months postpartum. These findings contribute to the evidence base and may support pelvic health physical therapists providing evidence-informed counseling to women concerned about DRA and related symptoms.

Objectives: The first aim was to describe longitudinal changes in levator hiatus area from 21 weeks' gestation in the first pregnancy to 1 and 8 years after first delivery, according to subsequent vaginal parity in women with vaginal delivery or Cesarean section (CS) at first delivery. The second aim was to assess the effect of subsequent vaginal delivery on levator hiatus area after first vaginal delivery. Methods: In this prospective cohort study with an 8‐year recall extension, 183 initially nulliparous women underwent three‐ and four‐dimensional transperineal ultrasound examination at 21 weeks' gestation and 1 and 8 years after first delivery. The levator hiatus area at rest, during maximum pelvic floor muscle contraction and during maximum Valsalva maneuver was assessed at each timepoint. Participants with multiple vaginal deliveries (vaginal multiparae), only one vaginal delivery (vaginal primiparae), CS for all deliveries and vaginal birth after CS were compared. The differences between study groups in levator hiatus area over time were assessed using a linear mixed model. Results: Overall, vaginal multiparae showed a statistically significant non‐linear increase in levator hiatus area from 21 weeks' gestation to 8 years after first delivery ( P < 0.001). In contrast, participants who delivered exclusively by CS showed a decrease in levator hiatus area from 21 weeks' gestation to the 8‐year follow‐up. Subsequent vaginal delivery after an initial vaginal delivery did not affect the levator hiatus area during Valsalva maneuver. At the 1‐year and 8‐year follow‐up after the first vaginal delivery, levator hiatus area at rest remained unchanged in vaginal multiparae but decreased in vaginal primiparae. At the 8‐year follow‐up, vaginal multiparae had a larger hiatus area during pelvic floor muscle contraction than did vaginal primiparae. Conclusions: In this study, the levator hiatus area was influenced by the mode of the first delivery and by subsequent vaginal deliveries. Overall, the levator hiatus area increased from 21 weeks' gestation to 8 years in participants with at least one vaginal delivery and decreased in those who delivered exclusively by CS. Subsequent vaginal delivery after a first did not seem to affect the levator hiatus area measured during Valsalva maneuver. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Introduction: Pelvic and genital pain is a common symptom among women with endometriosis and may negatively affect sexual functioning. Pelvic floor muscle training (PFMT) may improve sexual functioning, but whether this applies to women with endometriosis remains to be explored. This study is a planned secondary analysis in which we aimed to examine how general exercise and PFMT, when added to pain management, affect sexual functioning among women with endometriosis. Material and Methods: Planned secondary analysis of a two‐armed, parallel‐group randomized controlled trial with intention‐to‐treat analysis. Women aged 18–45 years with laparoscopically confirmed endometriosis and experiencing pelvic/genital pain were eligible. All participants attended a pain management course. In addition to weekly home training, the exercise group ( n = 41) participated in weekly supervised general exercise training, including PFMT, for 4 months. The control group ( n = 40) received no further intervention. Between‐group differences in sexual function were assessed using the total score of the Female Sexual Function Index (FSFI) at the end of the 4‐month intervention and at the 12‐month follow‐up. We also examined differences in the subdomains—desire, arousal, lubrication, orgasm, satisfaction, and pain—at these time points. Clinical Trial registration: NCT05091268. Results: Four months post‐intervention, the exercise group showed significantly higher total FSFI scores compared to the control group (mean difference = 3.52, 95% CI 0.49–6.54, p = 0.023). Significant between‐group differences were also observed for the subdomains lubrication (mean difference = 0.90, 95% CI 0.17–1.63, p = 0.016) and orgasm (mean difference = 0.81, 95% CI 0.07–1.55, p = 0.033). No significant between‐group differences were found for desire, arousal, or pain at the end of the 4‐month intervention, or at 12 months follow‐up for any domain. Conclusions: The findings suggest that the combined intervention of supervised exercise and PFMT, when added to pain management, may lead to short‐term improvements in sexual function at the end of the 4‐month intervention. Whether this effect is attributable to general exercise, PFMT, or their combination cannot be determined from the present study. However, the findings should be interpreted cautiously due to differences in sexual activity status between groups.

The purpose of the study was to elucidate life-course and current exercise levels among women aged 50–69 who participated in BreastScreen Norway during the period from 2006 to 2015, and to estimate the risk of breast cancer based on exercise trajectory classes and current exercise level. Self-reported data from 325,953 women were utilized for descriptive and exploratory analyses. Retrospective information about exercise levels at ages 15–19, 20–29, 30–39, and 40–49 was used to establish exercise trajectory classes, while reported exercise at ages 50–69 was considered as current activity. Hazard Ratios (HR) with 95% confidence intervals (CIs) were estimated using Cox proportional hazards models adjusting for age, educational level and body mass index (BMI). Adjusted HR of breast cancer was 0.92 (95% CI: 0.87–0.98) for women in the stable high class and 0.94 (95% CI: 0.89–0.99) for those in the increasing trajectory class compared to the stable low class. The HRs was 0.89 (95% CI: 0.82–0.97) for 4.5 h current exercise per week and 0.72 (95% CI: 0.62–0.84) for ≥ 6 h, compared to those reporting no current exercise. Statistically significant results were observed for asymptomatic (screen-detected) and symptomatic cancers. Stratification by BMI and smoking status did not reveal substantial differences in the risk estimates. Engaging in high-level exercise throughout one's lifetime significantly reduces the risk of breast cancer. This study highlights the importance of maintaining or increasing physical activity levels throughout life to mitigate breast cancer risk. The online version contains supplementary material available at 10.1007/s10552-026-02184-7.

Introduction and Hypothesis: A recent study found that young power and weightlifters reported a high prevalence of pelvic floor disorders (PFDs) with urinary incontinence (UI) 50%, anal incontinence 80% and pelvic organ prolapse 23%. Performing “the knack”, a voluntary pre-contraction of the pelvic floor muscles (PFMs), before and during stressful events, can prevent UI during coughing and daily activities. However, the effect of this manoeuvre has not been investigated during strenuous exercises. This study was aimed at investigating the feasibility of using the femfit® to measure intra-abdominal pressure (IAP) and PFM pressure during strength exercises and at discovering if a voluntary pre-contraction of the PFMs can exceed increases in IAP during strength exercises. Methods: This was a short-term, cross-sectional, experimental study. Eleven participants were tested in squat, deadlift, leg press and curl up, performed in a random order with and without voluntary pre-contraction of the PFMs. Assessment of the ability to contract the PFMs was conducted by suprapubic 2D ultrasound. IAP and PFM pressure were measured with the femfit®. Wilcoxon Signed Rank Test was used to estimate differences in change between IAP and PFM pressure with and without voluntary pre-contraction during the strength exercises. Results: No participants reported displacement or discomfort from the femfit® device. Voluntary pre-contraction of the PFMs did not exceed the rise in IAP during squat, deadlift, leg press and curl up. Conclusions: The PFM pressure was not significantly higher than the IAP during strength exercises. Further longitudinal studies are warranted to investigate if systematic PFM training can improve the strength of the voluntary pre-contraction.

Background: Urinary incontinence (UI) is known to be prevalent among elite female athletes. A need for additional sports-specific research has been identified, along with a need to understand female athletes’ experience of UI. There is a dearth of research on elite Female Gaelic (Irish) sports players competing in national competitions. Aim: To investigate elite female Gaelic sports (Camogie and Football players) athletes’ experiences of UI. Design: A qualitative descriptive design using one-to-one interviews. Methods: Following University ethics approval, purposive sampling was used to recruit elite female Gaelic sports athletes aged 18 years or older playing at the county level between November 2022 and August 2023. Data were analysed thematically using reflexive thematic analysis, a six-phase process. Findings: Nine players consented to and completed an interview. Four key themes and nine sub-themes were generated. Four themes were: (1)‘Oh, that happened me’ (when and why of UI); (2) ‘Then I can manage it that way’ (what to do about UI); (3) ‘It is frustrating. . . and it bothers me’ (impact of UI) and (4) ‘No one ever talked’ (talking about UI). High-intensity and high-impact activities were identified by all players as triggers for UI, suggesting stress urinary incontinence. Strategies to manage UI were used by all nine players and included extra and frequent pre-match voiding, wearing protection, and modifying their clothing or fluid intake. Players minimised the extent of their UI; however, all spoke of experiencing either a physical or an emotional impact because of the UI. Conclusions: This study provided qualitative evidence on elite female athletes’ experience of UI. Players used strategies to self-manage their UI, few spoke about, or sought help for their UI whilst many expressed a desire for education. Findings suggest a need for education programmes among players to include information about the condition of UI as well as available treatment options.

Elite athletes routinely undertake strenuous training routines, which often involve high-intensity sessions. However, there are knowledge gaps in how they experience training during pregnancy and subsequent return to sport. Combined with inadequate financial and contractual safety, female athletes may jeopardise their careers when starting families. This study aimed to describe female athletes' experiences and perspectives related to pregnancy and motherhood within the context of elite sports in Norway. We interviewed five world-class athletes between October 2022 and April 2023, using a descriptive qualitative approach. Full interview transcripts were analysed based on a reflexive thematic analysis model. Five overarching themes were identified: (1) uncertainty, (2) lack of supportive networks, (3) physical capacity, (4) the impact of postpartum return to sports on maternal health, and (5) combining motherhood and elite sports. Our findings emphasise the challenges that Norwegian pregnant and postpartum athletes face in balancing motherhood with successful careers, highlighting the importance of providing adequate support systems to ensure their health and the well-being of their child.

The pelvic floor and its associated disorders are a unique and often overlooked aspect of women’s rugby. This review discusses relevant biopsychosocial considerations specific to the pelvic floor and rugby. Pelvic floor disorders (PFDs) can present at any time across the female lifespan, but are more prevalent during pregnancy and postpartum. This is because of the substantial physiological and anatomical changes experienced during pregnancy and vaginal childbirth. Consequently, PFDs can impact a player’s ability to perform, maintain engagement with or return to rugby as a result of symptoms. Players need to be informed, supported and guided through focused pelvic floor muscle training to condition the muscles and “ready” them for the varied demands of rugby. Health and fitness professionals should understand the risk of PFDs across the female lifespan, and screen players for symptoms when supporting them to maintain or return to rugby. Rugby players who have symptoms of PFDs should be signposted to specialist services and/or resources to manage their symptoms. Once engaging in rugby training, ongoing evaluation of player load tolerance and implementation of individualized strategies to support managing rugby-related loads to the pelvic floor should be considered. Finally, surveillance and research focusing specifically on rugby players and pelvic floor function are needed.

Objective To establish expert consensus on prescreening and contraindications to moderate-to-vigorous intensity physical activity (MVPA) during the first year postpartum. Methods A Delphi survey of clinical and exercise professionals working with postpartum women and people was conducted until consensus was reached (≥75% agreement). Round I consisted of questions about relative and absolute contraindications to MVPA. Rounds II and III included additional questions based on the thematic coding of open-ended responses from the previous rounds. The results were used to develop a postpartum MVPA preparticipation screening tool. Results 120 participants completed round I, 105 completed round II and 95 completed round III. Consensus was reached in 46/49 (94%) statements. Twenty-four relative contraindications to MVPA were identified: (loss of consciousness; neurological symptoms; kidney disease; calf pain or swelling suggestive of deep vein thrombosis; severe abdominal pain; vaginal bleeding not associated with menses; postpartum cardiomyopathy; caesarean section with symptoms that worsen with MVPA; unstable hypertension; eating disorder; malnutrition; anaemia; excessive fatigue; fractures or other significant musculoskeletal injuries; haemodynamic instability; breathing difficulties; acute systemic infection accompanied by fever, body aches, or swollen lymph glands; the new onset of chest pain, discomfort, and other angina-like symptoms with exertion; dizziness or lightheadedness during MVPA; new symptoms of heart disease, stroke; and other medical or physical conditions that may affect the ability to be physically active. Key biopsychosocial barriers to MVPA were identified. Conclusion This Delphi study recommends relative contraindications to MVPA for the first year postpartum that were incorporated into a postpartum MVPA pre-participation screening tool the Get Active Questionnaire for Postpartum.

While moderate exercise supports regular menstrual cycle (MC) function, many female athletes experience MC symptoms that negatively influence their training and performance. Hereby, knowledge and communication about this topic are important to promote an athlete’s health and wellbeing. Hence, this study aimed to assess the knowledge and communication surrounding the MC among Norwegian rhythmic gymnasts, ballerinas, and dancers. In total, 116 rhythmic gymnasts, ballerinas, and dancers aged ≥ 16 years training ≥ 3 days per week completed an electronic questionnaire. Of these, 63% (n = 73) reported a lack of knowledge about the MC’s influence on physical fitness and performance, and 39% (n = 45) rated their coaches’ or pedagogues’ knowledge as low. With only 32% of participants discussing the MC with their coaches/pedagogues, communication was found to be limited. Seventy-three percent felt uncomfortable during training or competition due to their attire and recommended darker colors and more options in size and layering. The study highlights a significant gap in knowledge and communication about the MC among female athletes and coaches/pedagogues in aesthetic sports. It also recommends improving athletes’ choice of attire for greater comfort and confidence.