You are three minutes into your class. Music is pumping, everyone is getting warm, and you call the next move. Jump squats, thirty seconds, here we go.

Somewhere near the back, a woman steps to the side and does something else. She does not look up. She does not tell you why, and she is not going to, because there are twenty-nine other people in the room and a conversation about bladder leakage is not one anybody starts in a Tuesday morning workout.

Then, a few weeks later, she stops coming.

When Pelvic Floor Symptoms Stop Women Moving

Australian research published in the British Journal of Sports Medicine found that among women experiencing pelvic floor symptoms, one in two had stopped sport or exercise because of them.

Read that again, because the important word is stopped. Not switched to something gentler, not moved to a different class. Stopped.

However the symptoms were challenging her, stopping will cause more issues. Strength, bone loading, balance, sleep, mood, and the fact that showing up to the same workout every week is often the most reliable social connection in her week. That is a lot to lose, and once the routine is gone it is remarkably hard to start again.

This week, Continence Health Australia has built its Women’s Health Week campaign around the line keep Moving with Confidence. I am one of the original Pelvic Floor First ambassadors and I am currently on the Pelvic Floor First Exercise Professional Advisory Group. I think that Moving with Confidence is the right phrase, and I want to talk about the part that is hardest to discuss.

There is no shortage of good pelvic floor information for exercise professionals. The problem is that almost all of it assumes a personal training relationship. Screen the client, ask the questions, adjust the programme for the individual, review it next week.

Now put that in a group class. You cannot screen. You cannot ask. You cannot modify person by person, and you certainly cannot single anyone out. Most women do group fitness, which means the advice that exists is not written for group fitness workouts.

So the important question is “what can I build into the class so that she never has to tell me anything”.

Give Them Options Without Asking Them Why

Here is the shift, and it is small enough to deliver this in your next class.

Offer two versions of the movement, and offer them as equals. “Jump, or keep a foot down and drive the arms” Both are the exercise but they provide a choice. Compare that with “if you have any pelvic floor issues, do this version”, which turns a choice into a public declaration, and guarantees that the person who needs it will do the other one.

Your Cueing Matters More Than You Think

Then look hard at your habitual cues, because a few of them may be negatively impacting your participants.

“Squeeze your pelvic floor before you lift” is the one to look at first. It sounds protective, and for a person whose pelvic floor is already overactive rather than weak, adding more tension is precisely the wrong direction. “Brace your core” and “suck it in” have the same problem. And “you shouldn’t be lifting heavy” or “don’t jump” are not modifications at all, they are just doors closing.

What works better is honest and much simpler. “Keep breathing through the whole movement”. “Let everything relax and soften between efforts”. “Stand tall and let your ribs move”. “Here are two versions, take the one you can control”.

Notice that not one of those requires you to know anything about the person in front of you. That is the point.

And What If Someone Does Tell You?

Occasionally, somebody will tell you. Usually sideways, usually while packing up, usually with a laugh in front of it.

The single most useful thing you can do in that moment is not flinch and not fix. You are not diagnosing and you are not treating, and pretending otherwise helps nobody. What you can do is say that it is common and that they can contact the National Continence Helpline, 1800 33 00 66. It is free, it is confidential, and it is answered by nurse continence specialists, Monday to Friday from 8am to 8pm. No appointment, no referral, and no cost. From there she can be directed on to a pelvic health physiotherapist or another service if that is what she needs, which means you do not have to work out what she needs.

You See Her Every Week

One more thought:

Pregnancy is a life stage. Menopause is a life stage. A woman passes through each one once, and the resources built for those moments reach her once.

An instructor is not a life stage. An instructor is a channel. You stand in front of women in every stage at once, in the same room, every week, for years. You see her more often than any health professional does, which makes you the earliest place a change can be noticed, and the last place it should be met with “you probably shouldn’t do that any more”.

She Shouldn’t Have to Put Her Hand Up

You do not need to become a pelvic floor expert to do this well. You need two versions of the movement, a handful of effective cues, and a room where nobody has to put her hand up.

Because moving well today helps you keep doing the things you love tomorrow, and for all the seasons to come.

Marietta Mehanni is an original Pelvic Floor First ambassador and a member of the Pelvic Floor First Exercise Professional Advisory Group. Continence Health Australia’s Women’s Health Week resources are available at continence.org.au/womens-health-week.