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Female Urinary Incontinence: Helping clients move from caution to confidence

Kerry Ann Madden

While Urinary Incontinence occurs in both men and women, this post will address our female clients and how we can help improve their quality of life through our own knowledge and informed programming choices. 

The secret women hate to share

Ask your female friends… women will talk about “peeing their pants” but only with their peers. Often it is when one of them comments about a leak during double unders or while laughing hysterically at an episode of ‘Schitt’s Creek’. Most do this as a way to commiserate, if they even talk about it at all. This common place “Yea, that happens to me too” response leads to living with leaking as the status quo. 

According to the National Association For Continence, one in four women over the age of 18 experience episodes of urine leakage. The fact is that many women are reluctant to talk about these episodes. Instead, they opt to secretly plan their lives around the possibility of an accident. Over time, this problem can escalate from simply wearing a panty liner to hypervigilance over the location of the nearest bathroom. (Yes, there are apps for that!) Yet, on average, it takes  6.5 years to seek help for this problem. 

As fitness professionals, it is important to realize our clients may be reluctant to divulge information about their urinary incontinence (UI), whether out of embarrassment, denial or some other reason. That is why, when designing an appropriate fitness program, it is essential to take into consideration all the factors that possibly affect our client’s safety and wellbeing. 

Urinary incontinence causes

First, it might be helpful for you to know the many causes of UI, ranging from muscle imbalance and nerve damage to medications. While the most common causes are pregnancy, childbirth and menopause, incontinence factors can also include weight gain, and consuming dietary irritants, such as spicy foods, caffeine and alcohol.     There is also growing evidence that many female athletes in high impact sports are at a greater risk for developing UI. 

There are two distinct types of UI: Stress Incontinence and Urge Incontinence. A third category called Mixed includes women who experience both types.

  • Stress UI occurs during high impact movements  such as running, jumping and any increased demand on the intra abdominal pressure system. This can be caused by structural issues such as prolapsed organs and/or a hypermobile urethra. It can also be caused by suboptimal alignment and recruitment of muscles, dietary irritants or medications.
  • Urge UI occurs when the bladder reacts to an environmental trigger such as the awareness of a proximal bathroom or running water. The term “key in the lock syndrome” is often used to refer to this type as many women will feel an overwhelming urge or leak when they arrive home, ready to unlock their door.
  • Mixed UI occurs when both types are experienced.

Why we need pelvic health pioneers

Unfortunately, many women are told that they should make a regular practice of Kegel exercises to improve leakage issues. While this can be effective for strengthening some pelvic floor muscles, it is not a comprehensive approach and may actually be detrimental to the pelvic floor function in some women. Many well intentioned fitness professionals have created exercise programs reinforcing practices that are not founded in the latest research and application.

The good news is that there are medical doctors and physical therapists researching and developing ways to improve UI symptoms. Among these professionals are two specific specialists: urogynecologists and pelvic floor physical therapists. Along with these medical colleagues,  fitness professionals can become allies to help our clients address UI challenges they may face as part of their programs. 

Creating safe and empowering spaces 

To begin to open up dialog around this subject there are several steps you can take to create safe and empowering spaces for your female clients. 

    1. Educate yourself: Become knowledgeable about UI and the latest recommendations. Below are several resources I recommend. This is, by no means, an exhaustive list. There are also many excellent certification courses that focus on women’s health, including pelvic floor training guidance.
      1. Women’s Guide to Pelvic Health by Elizabeth E. Houser, MD and Stephanie Riley Hahn, PT,  
      2. The National Association for Continence
      3. The Pelvic Guru
      4. Julie Wiebe, PT
  • Start the conversation: Create a system within your facility that encourages women to share this information. One way would be to include a short question on your PARQ, such as, “ Do you experience urine leakage while exercising?”. Normalizing the conversation in a way you would with any muscle imbalance or pre existing condition can go a long way in providing women with the information they need to address the UI.
  • Refer out: When a client does experience UI it is important to first, refer them to a qualified medical professional. Creating a referral network of urogynecologists and pelvic floor physical therapists will allow you to continue to learn and have a strong allyship.

As awareness and information for Female Urinary Incontinence increases, we have an opportunity as MedFit Professionals to provide a higher level of understanding to our clients. Through our own education and networking we can destigmatize urinary leakage and improve our clients lives for the better.

Kerry Ann Madden has been helping people in the fitness industry for 10 years. She is a NASM Master CPT, Corrective Exercise Specialist and MedFit Network Professional Member. Prior to pursuing education and training in pelvic floor health, she had been known to pee her pants whilst jumping, doing heavy squats with 100lbs on her back, coughing, sneezing and laughing hysterically (but not all at the same time). She is the mom of two remarkable young women and partner of an amazingly supportive husband. 

MFN Contributing Author