And if so, shouldn’t everyone involved with exercise prescription be screening for those most at risk?

The short answer is YES.

In 2009 the Continence Foundation of Australia organised a stake-holders forum with experts from the health and fitness sectors to explore the link between exercise and pelvic floor dysfunction.

During the forum, renowned professionals voiced their concerns regarding the alarming numbers of exercising men and women presenting with coexisting symptoms such as incontinence and pelvic organ prolapse.

While we all agree the increasing health push to exercise is a move in the right direction - and hence the popularity of fitness- based classes such as Pilates, pump and boot camp are on the rise - there are however many individuals commencing new programmes, that are left dealing with some not-so-pleasant side-effects.

You probably have several clients or patients right now doing programmes designed to increase their fitness, strength and aid weight loss.  But I wonder how many of these programmes include pelvic floor training? And how many of your clients have pelvic floor problems they haven’t even told you about? Studies reveal that up to 80% of people suffering with pelvic floor problems do so without seeking advice from a professional.

As health and fitness professionals, our clients expect that we are exercise specialists and that their programmes will have positive outcomes.  But could your well-meaning exercises be putting clients at risk of prolapse or incontinence?

Unfortunately in many cases the answer is YES.

So, who exactly is at risk?

Women who:

• Are pregnant or have ever had a baby
• Are pre- or post-menopausal
• Have symptoms of  prolapse (a sagging down of pelvic organs, commonly after childbirth or around menopause)
• Those who have had a hysterectomy or other gynaecological surgery

Anyone who:

• Is overweight (BMI >25)
• Lifts heavy weights – either in the gym, as part of a job, or who lifts children in the home
• Strains on the toilet because of constipation
• Coughs a lot (e.g. with asthma, smoker’s cough or hay-fever)
• Has a history of back pain
• Has suffered trauma or injury to the pelvic area (e.g. radiotherapy, a fall)
• Has had abdominal surgery
• Is an elite athlete (e.g. a runner, gymnast or trampolinist)

A man who:

• Has a prostate problem (where the prostate gland disrupts the urine flow)
• Has had a prostate operation (and where urinary incontinence followed)

Answering  ‘Yes’ to any of these questions puts one at risk of developing pelvic floor dysfunction and this should always be considered this when designing a programme.

Industry surveys carried out in 2011 have shown that many fitness professionals only ask about previous surgery and pregnancy history in their pre-exercise screening.   If this is the case, then chances are many New Zealanders may be doing potentially harmful forms of exercise.

If however, you always perform a thorough screening of all your clients, then you will have identified the above risk factors and discussed these with the client.  And of course you will then design a pelvic floor safe programme; ensuring that their exercise won’t place them at risk of worsening or developing any of the following:

• Leaking urine with exercise or lifting
• Toilet urgency or frequency or leaking before you can get there
• Accidental passing of wind while exercising, coughing etc.
• Prolapse (in women) – pelvic pressure, bulging, dragging or discomfort
• Pelvic pain or painful sex during or after intercourse

So, if any of your patients/clients/friends/relatives experience any of the last five symptoms, then you should suggest that they speak to their doctor or a continence professional.  These symptoms are common but they should never be considered “normal”. Many of these symptoms can be effectively treated, and in many cases cured.

With  an estimated  1.1 million (25%) of people in New Zealand aged 15 years or over, already suffering either urinary or faecal incontinence, or both – the likelihood is that you already have several clients suffering in silence.

Then surely all exercise professionals should be asking appropriate screening questions to ensure their workouts are safe?   Surely all health professionals should be help give their patients pelvic floor exercises and advise them on safe exercise practice?  We believe the answer should be YES.

If you would like to become part of the solution, not the problem…Then join us on the upcoming Exercise and the Pelvic Floor workshop and we’ll teach you a new way to look at exercise…After analysing the functions and dysfunctions of the pelvic floor, we’ll cover how to recognise symptoms of pelvic floor problems and practice using a screening tool to improve your confidence identifying and talking about the risks.  We’ll practise how to teach core and pelvic floor exercises and then analyse a variety of common gym exercises, discussing which exercises could be harmful and how to modify them to keep things pelvic floor safe.