World Continence Week is a health campaign run by the International Continence Society (ICS) every year to raise awareness of incontinence-related issues. This year, it takes place from 21-27 June.
Continence is the term used to describe the control of the bladder and bowel. Incontinence means the inability to voluntarily control the bladder or bowel. The NHS estimates that between three million and six million people in the UK may suffer from some form of urinary incontinence. Studies suggest that in the UK ‘major faecal incontinence’ affects 1.4% of the general population over 40 years old and constipation affects between 3% and 15% of the population.
Incontinence can affect either the bladder, the bowels or both. Faecal incontinence describes the involuntary loss of faeces or wind.
Types of urinary incontinence include:
- stress urinary incontinence, which is the loss of urine due to increased intra-abdominal pressure such as during a cough, sneeze, laugh, when lifting or during exercise
- urge urinary incontinence, which occurs during or after an intense and uncontrollable urge to pass urine
- mixed incontinence, which is when both stress and urge incontinence are experienced.
The fitness professional’s role
It is likely that some of your clients will experience incontinence. Sometimes you will notice those clients who leave a class or training session to go to the toilet. Others will keep silent about their issues, for example leaking urine during exercise. Both men and women can be affected by incontinence and many people keep it a secret due to its embarrassing nature and do not ask for help. Starting a conversation with your clients can reveal issues affecting their exercise performance and quality of life. As a fitness professional, you are well placed to assist them to seek further advice, as well as to adjust their programming where needed.
Screening your clients for pelvic floor issues
Start with considering screening your clients using some basic questions around their pelvic floor fitness and awareness. Often it is easier to talk about the pelvic floor than directly ask about incontinence. The pelvic floor has a role in maintaining continence and is a muscle group that needs specific attention if clients have or are at risk of pelvic floor problems or incontinence.
Both your male and female clients can be screened to find out if they have any risk factors for pelvic floor issues or if they have any existing problems with incontinence. Screening forms were developed during the Pelvic Floor First campaign to assist fitness professionals with asking screening questions. Visit the resources section of this website to download these tools:
How can exercise affect the pelvic floor?
One of the roles of the pelvic floor is to respond quickly and strongly to increases in intra-abdominal pressure to prevent leakage of urine. When an exercise is too ‘strong’ for a client who has a pelvic floor or incontinence issue, then urine leakage may occur. This is more likely with high-impact or high-intensity exercises which place downwards pressure on the pelvic floor. Any resistance exercise which causes a client to breath hold can also place strain down on the pelvic floor and, for some clients, cause leakage.
Matching a client’s exercise load to their level of pelvic floor control can help to reduce the risk of this occurring.
The Pelvic Floor First factsheets and brochures outline risk factors and suggest modifications which you can use with your clients. This is particularly important for clients who may be more at risk, such as those who are pregnant, postnatal or postmenopausal.
Where can your clients be referred to?
Encourage clients to speak to their GP or refer to a continence health professional in your area if they reveal to you that they have an incontinence or pelvic floor problem.
There are physiotherapists trained in the treatment of incontinence and pelvic health and more information is available on this for your clients from the Chartered Society of Physiotherapy website:
For further information
Clients can be referred to Bladder & Bowel UK who offer helpline advice, information and signposting to services:
During World Continence Week, the World Federation for Incontinence and Pelvic Problems is hosting a series of information webinars:
About bowel incontinence: https://www.nhs.uk/conditions/bowel-incontinence/
https://www.pelvicfloorfirst.org.au/ has a range of resources designed to assist fitness professionals to educate their clients about pelvic floor issues and fitness.
Information source for UK stats used:
Where to next? Check out ‘Supporting your Pregnant Clients through Exercise’ with Dianne.
Dianne Edmonds is a physiotherapist with more than 25 years of experience with pregnancy, postnatal and pelvic floor education, treatment and fitness programmes. Dianne was the lead physiotherapist and project officer for the Pelvic Floor First project campaign, run by the Continence Foundation of Australia, and is a Pelvic Floor First ambassador. Dianne is the director and founder of The Pregnancy Centre and completed her Elite Personal Training course in 2013.