Physical Loading, Pelvic Health and Military Occupations: A Study of a Cohort of Australian Female Military Personnel and Veterans

Background:
Higher impact and loaded physical activities (i.e., running, load carriage) have been implicated as risk factors for female pelvic floor dysfunction, such as urinary incontinence. Military occupations often include tasks and roles that require high levels of endurance, strength, load carriage, and physical training. Therefore, female military personnel are at risk of pelvic health issues, which could impact their health and occupational performance.
Aim:
The aims of this investigation were to determine the types of physical loading undertaken by servicewomen within the Australian Defence Force (ADF) and explore the relationships with their pelvic health.
Method:
A cross-sectional anonymous online survey was conducted in adult biological females who had actively served in the ADF for at least six months. The survey explored the prevalence, management strategies, and occupational impacts of female pelvic health issues, along with experiences of physical activity and loading.
Results:
A total of 491 active servicewomen (60%) and veterans (40%) participated in the survey (52.7% Army, 25.7% Air Force, and 21.4% Navy). Servicewomen regularly participated in work related exercise (mode: 5 days/
week) and recreational exercise (mode: 2 days/ week), including aerobic training (45%), work-related physical tasks (37.5%), circuit training (36.5%), and load carriage (21%). With increased frequency of work-related exercise, there was a trend towards a higher prevalence of urinary tract infections. Half the respondents reported engaging in lifting/ carrying tasks at least weekly, predominantly for physical training or normal operational duties within their role. Loading typically lasted 1 – 2 hours, and predominantly involved loads under 25kgs. However, 40% of women also reported carrying additional loads (typically <15kgs), such as weapons/body armour, during these work tasks. Half the respondents
reported they felt adequately prepared and fit enough for these tasks. The frequency of load carriage varied slightly between Services, with over half of women with Army service (58%) reporting participating in lifting tasks weekly or more, compared with 47% and 37% of women serving in the Navy or Air Force, respectively. No differences in prevalence rates were identified for common pelvic health symptoms between those who engaged in lifting/carrying tasks
at least weekly and those performing these tasks fortnightly or less. However, the only women who reported frequent episodes of faecal incontinence (n = 9) participated in lifting at work at least weekly. Pelvic health factors affected the ability of 47% of servicewomen to participate in physical loading tasks at work occasionally to sometimes, and 11% frequently to always. Physical loading tasks were also commonly identified to aggravate pelvic health symptoms, such as urinary incontinence. In addition, one third of respondents believed work-related physical loading negatively influenced their pelvic health, and another third believed it exacerbated pre-existing pelvic health conditions.
Discussion:
Physical loading activities are a common feature of military work for servicewomen. Whilst the prevalence of pelvic health symptoms did not appear to differ significantly between those participating in lower and higher levels of physical loading at work, responses from this cohort of servicewomen and veterans suggest a bidirectional relationship between pelvic health and physical loading that influences their occupational performance.
Conclusion:
With physical fitness and physical training being vital for military personnel, female pelvic health factors that could impact on this training, and training factors that could impact on pelvic health, must be considered. Strategies to mitigate female pelvic health concerns and downstream impacts on physical occupational performance could include pelvic health screening and monitoring, specific pelvic health education and training programs, as well as graded physical conditioning programs.