Some of your clients might suffer quietly from incontinence. It’s an issue about which clients often hesitate to speak and it affects more people than we realize. Tactfully bringing up this condition so you can work with it during exercise programming efforts will set you apart as a fitness professional.

An individual may present with one, or both, of the major forms of urinary incontinence: stress urinary incontinence and urgency incontinence. “[Both types] can exist simultaneously in the same person,” says Deepak Kapoor, M.D., president  Advanced Urology Centers of New York (AUCNY).

Since each variety has its own list of potential etiology, these conditions need to be addressed differently. Stress incontinence comes about from “…leakage with coughing, laughing, sneezing, or anything that increases pressure in the belly,” says Dr. Kimberly Ferrante,Clinical Assistant Professor in the Departments of OG/GYN/Urology at NYU Langone Medical Center.

Common Causes

There are a plethora of reasons why one’s pelvic muscles become weak, paving the way for stress urinary incontinence:

  • Chronic coughing or sneezing: Any condition/lifestyle habit that causes chronic coughing or sneezing, such as smoking or persistent allergies, can over time lead to leakage.
  • Obesity: The body of an overweight individual places increased pressure on the bladder. “The more pressure you put on the urethral sphincter, which squeezes and holds urine in, the more likely you are to leak,” says Dr. Ferrante.
  • Hormonal deficiency: Estrogen is known to help maintain strength in the muscles surrounding the bladder and urethra. Post-menopausal clients often present with stress urinary incontinence; a dip in circulating estrogen levels causes thinning and weakening of the vaginal tissues.
  • Age: Along with weaker vaginal muscles, the bladder muscles themselves can weaken with age.
  • Hysterectomy: Clients who have undergone a hysterectomy, or any surgeries of the female reproductive system, may notice a residual weakness in the surrounding tissues.
  • Pregnancy: Throughout the final trimester of pregnancy, hormones and extra weight place added stress on the uterus. Pushing during a vaginal delivery can negatively affect muscles supporting the bladder and urethra. Prolapse has also been known to occur, and any or all of these can result in incontinence.

Understanding Urgency

Unlike stress incontinence, urgency incontinence is a symptom of a potentially larger issue, according to Dr. Kapoor. If it presents with other symptoms, such as frequent or excessive urination, urgency can be an indication of an overworked bladder. Knowing a client’s health history makes a trainer understand requests for frequent bathroom breaks, and spares a client any potential embarrassment. Here are some of the more common contributing factors:

  • Metabolic disorders: High glucose levels signal the body to produce more urine, as is often the case with clients whose diabetes is not being well managed. Diabetes can also cause nerve damage, leading to signaling problems, a common cause of incontinence.
  • Neurological conditions: Dr. Kapoor reports that approximately 5% of Multiple Sclerosis cases are diagnosed by urinary difficulties.
  • Frequent bouts of constipation: Constipation can sometimes impact the nerves in the bladder, once again interfering with the signaling and causing urgency-incontinence.

Pelvic Anatomy

In an effort to support the pelvis and bladder, and constrict the bladder opening during movement, pelvic floor muscles work in opposition to an impact or an imposing load. If pelvic muscle strength is insufficient to counter impact forces, a leak or trickle of urine may result. Thinking in terms of applying pressure on a water balloon that has not been tied properly, it is easy to visualize the outcome.

Pelvic muscles also work in tandem with those of the core, supporting the abdominals and diaphragm. Exercises such as those encountered during Pilates workouts, mat or Reformer, do a wonderful job of core strengthening, and over time may help to maintain such strength once the initial weakness in the pelvic floor has been properly addressed.

Could Exercise Be at Fault?

In addition to the aforementioned reasons, weakness in a female’s pelvic floor muscles may be the result of a congenital malformation or other comorbid condition. However, another more unfortunate option is that the high-intensity exercises themselves may have weakened the pelvic floor.

Activities that involve jumping/landing/foot strikes, such as volleyball or gymnastics, have a tendency to increase the pressure on the pelvic floor muscles. This may lead to urinary incontinence, especially when coupled with pre-existing factors such as weak core muscles or back pain.

Engaging in heavy weightlifting may also exacerbate problems, most often when such training is done improperly. As we have no doubt observed on many occasions, some clients unwittingly hold their breath while lifting greater loads; this increases abdominal pressure, placing an unwelcome strain on muscles located in the pelvic floor.

One way to help clients avoid this scenario is by suggesting they sit when executing certain moves, such as a military press. When doing standing exercises such as squats, encourage clients to position their legs no further apart than shoulder width.

Safer Moves For Runners

In addition to making changes in a client’s stance during resistance training, there are minor tweaks we can make in clients’ aerobic exercise patterns that help alleviate and even prevent urinary incontinence.

Runners can increase their cadence (number of foot strikes per minute) and shorten each stride to reduce impact. Running posture, too, plays a definitive role. Simply leaning forward slightly offers the bladder better support by the pelvic bones. Inappropriate height/weight ratios also can lead to problems, since carrying extra pounds increases the impact felt with each foot strike.

If such a client expresses an interest in becoming a dedicated runner or is considering a 5K or half-marathon, a trainer can explain how safely shedding a few pounds prior to fully embarking upon a serious program can lead to his becoming a more effective runner. In the interim, there are other training/cardio options you can offer, such as swimming, cycling, powerwalking and low-impact water aerobics.

Too Much Of a Good Thing

Women’s Health experts Meagan Peeters-Gebler PT, DPT, CSCS, CMTPT, and Brianna Droessler-Aschliman PT, DPT, CMTPT are proponents of pelvic floor strengthening moves. However, they also offer a bit of cautionary advice. While it is true that a variety of exercise routines involve engaging and tightly clenching the pelvic floor/abdominal muscles, contracting these muscles too tightly and for an extended durationcan lead to the very problems trainers are trying to correct or avoid.

“We have this mentality that more is better,” Peeters-Gebler says, “and that gripping and never letting go makes muscles stronger. Women need to learn how to do exercises properly – including Kegels – by first and foremost engaging the pelvic floor and abdominal muscles, and then learning to relax them. An overactive pelvic floor can cause problems just like a weak one can.”

As with most aspects of fitness, balance is the key to minimizing the inconvenience of urinary incontinence. By showing clients alternatives to more traditional exercise movements, we can help them not only combat but prevent incontinence from interfering with their active lifestyles. Once mastered, clients can perform strengthening moves in between training sessions, enabling them to make the most of time spent with you, their trusted professional.

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Cathleen Kronemer

Cathleen Kronemer is an NFPT CEC writer and a member of the NFPT Certification Council Board. Cathleen is an AFAA-Certified Group Exercise Instructor, NSCA-Certified Personal Trainer, ACE-Certified Health Coach, former competitive bodybuilder and freelance writer. She is employed at the Jewish Community Center in St. Louis, MO. Cathleen has been involved in the fitness industry for over three decades. Feel free to contact her at She welcomes your feedback and your comments!