EVB Sport White paper 2020

White Paper – EVB Sport Research Urinary incontinence affects up to one in three women (1) causing considerable morbidity and reducing quality of life. Running as a leisure activity is growing in popularity, and exercise is known to exacerbate symptoms (2)(3).

Current therapeutic approaches for stress incontinence include lifestyle modification, biofeedback, pharmacological and surgery. In terms of sustained symptom control, or acceptable levels of complications, successive surgical developments have been disappointing (4). A safe, effective conservative option would be a welcome management tool in this difficult area.

The concept of a garment with pelvic floor support is relatively new, and it is postulated that the additional positive pressure provided would reduce leakage. Research on ‘Shaper’ underwear in Japan demonstrated significant bladder neck elevation on MRI in women with stress urinary incontinence (5) : a subsequent comparative study of this product demonstrated a comparable effect to pelvic floor muscle training (6). In 2013 EVB Sport garment was custom designed using engineering principles for female runners with urinary leakage: its varying elasticity provides compression to gluteal muscles and thighs while providing nonelastic compression uplift and support to pelvic floor muscles. This is achieved mechanically by suspending the central section of the garment from the high waistband, resulting in a hammock or sling effect secured during motion. The mix, panelling and layering of the fabrics act together to encourage the pelvis into a neutral, aligned position and this impacts posture positively.

EVB Sport garments/shorts have been used and promoted for urinary leakage and prolapse by physiotherapists, gynaecologists and urologists, with over 15,000 sold to date. We present the current scientific evidence on EVB shorts, acquired in four crossover studies conducted in Irish academic centres. The first three focus on urinary leakage.

Sixteen women in their forties with urinary incontinence following pregnancy were tested for leakage at the School of Health and Human Performance at UCD (7). Wearing either EVB or normal shorts, they ran on a treadmill: the subjects’ pulse, blood pressure, and oxygen uptake were not affected, but both the confidence ratings and the number of women reporting no leakage were significantly higher in those wearing EVB shorts. Enjoyment scores also tended to be higher following exercise in EVB shorts users.

A study conducted in the School of Physiotherapy, RCSI, evaluated 7 middle-aged women with stress incontinence during exercise, wearing either EVB, or normal running shorts (8). The volume of urinary leakage was halved with EVB shorts, but the number of women was too small for results to be significant. In the School of Nursing and Midwifery, Trinity College Dublin a survey identifying women with urinary leakage who exercised regularly between 3-12 months following delivery of their first baby was performed (9). Thirty-four of these women of were randomised in a double-blind cross-over trial of EVB shorts, and another commercially available ‘support shorts’ and reported in the PLEASE Directors Yvonne Brady & Brian Hughes VAT No. 01112303FH Company Reg No. 518123

study .More than four-fifths of women (28) found EVB sports helped them to feel confident, supported and secure while exercising for at least 30 minutes twice per week, even though they leaked urine, compared to less than half using the other shorts. However, more women felt comfortable using the generic shorts during exercise. Research conducted this year in the Department of Biomedical Engineering at UCD examined the effects of compression shorts on running gait (10). Ten female runners in their twenties ran on a treadmill. Their gait was recorded and analysed wearing EVB shorts and conventional sportswear, again in crossover fashion. EVB shorts were shown to significantly reduce contralateral pelvic drop: this has potential implications for improving running form and prevention of sports injuries. An additional effect on intraabdominal, and consequently bladder pressure may be a mechanism for reducing urine leakage.

Conclusions from these studies on EVB shorts in exercising women with urinary leakage are limited because of the small numbers of subjects involved. However, the research has been carried out independently, has been well designed, and has shown a consistent beneficial effect on urinary leakage. The reduced comfort levels found in the TCD work may be related to awareness by the wearer of the pelvic floor support offered by the EVB shorts. However, the reduction in leakage may improve overall confidence, encouraging women to exercise, and ultimately improving their quality of life.

Confirmatory evidence of efficacy for urinary leakage will be sought from larger studies: if forthcoming, the potential benefit offered by a low-cost readily available tool to the wider nonexercising female population with urinary incontinence is enormous.

(1) Melville JL, Katon W, Delaney K, Newton K. (2005) Urinary incontinence in US women: a population-based study. Arch Intern Med. 14;165(5):537-42.

(2) Hagovska M1, Švihra J, Buková A, Horbacz A, Dračková D, Švihrová V, Kraus L (2017) Prevalence of Urinary Incontinence in females Performing High Impact Exercise. Int J Sports Med. 38 (3): 210-6. Epub (3) de Araujo MP, Sartori MG, Girão MJBC. (2017) Athletic Incontinence – Proposal of a new term for a new woman. Rev Bras Ginecol Obstet 39:441–442 (4) Imamura M, Hudson J, Brazzelli M (2019). Surgical interventions for women with stress urinary incontinence: systematic review and network meta-analysis of randomised controlled trials. BMJ 365: 1842. Pub online 2019 June 5.

(5) Ninomiya S, Saito I , Masaki K, Endo Y, Morikawa S, Okayama H. (2014) Single Arm Pilot Study to determine the effectiveness of the support power of underwear in elevating the bladder neck and reducing symptoms of stress urinary incontinence in women. Lower Urinary Tract Symptoms 6(2) 81-7.

(6) Okayama H, Ninomiya S, Naito K, Endo Y, Morikawa S. (2019) Effects of wearing supportive underwear versus pelvic floor muscle training or no treatment in women with symptoms of stress urinary incontinence: an assessor-blinded randomised controlled trial. Int Urogynaecol J. 30 (7) 1093-9.

(7) Sheridan, S E, Ghrefa, Z, Moyna, N. Final Report - Physiological, metabolic, perceptual and psychological responses during treadmill running in women with a history of urinary incontinence: effect of wearing traditional and specially designed sports briefs. (2015) Dublin College University Research Study, School of Health & Human Performance for publication as part of PhD (8) Reynolds S, Boyd M, Cusack C. A Pilot study to investigate the effect of wearing support shorts during exercise on women with stress urinary incontinence. (2014) Pilot Study, RCSI School of Physiotherapy, Physiotherapy Department, Rotunda Hospital (9) Deirdre Daly, Susie Hannon, C Begley Postnatal Leakage, Exercise and Activity Shorts Evaluation (PLEASE) Study. (2017) Trial registration ISRCTN10972784 Trinity College Dublin, School of Nursing and Midwifery (10) Donal Holland Conor Whelan Analysis of the Effect of Compression Garments on Running Gait. (2019) Thesis submitted for Master of Biomedical Engineering (ME) University College Dublin.

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