WHAT YOU MUST KNOW ABOUT PELVIC HEALTH: YOUR ULTIMATE GUIDE
TO WORKING WITH PREGNANT AND POSTPARTUM CLIENTS
When and How to Screen Clients for Pelvic
Floor Dysfunction
DAY
1
Awareness of pelvic floor anatomy and function is vital when working with
women in the gym. As a coach, you may not need to know intricate details,
nor are you required to have an in-depth understanding of how pelvic
dysfunctions are treated.
However, to become a trusted and responsible leader in your field and
provide the best service and support to your clients you must know how
the pelvic floor can be affected by pregnancy, birth, aging, nutrition,
hormones and exercise.
Phase
Factors That May Affect Pelvic Floor Function
PHASE 1
Development of functional reserve
during an individual’s growth
• Individual genetics
• Nutrition (including the impact of eating disorders)
• Environment (e.g., what sports did they play, etc.)
PHASE 2
Pregnancy and childbirth
• Pregnancy
• Pelvic floor structure (pelvic size and shape)
• Strength and flexibility of connective tissue
• Size of baby
• Mechanism of delivery (position of baby during
delivery)
• Obstetrical interventions (e.g., forceps delivery)
• Third- or fourth-degree perineal tears
• Management of second stage labor (10 cm dilated
through birth)
PHASE 3
Lifestyle and age-related changes
• Chronic constipation (affecting load on pelvic floor by
stress and strain over time)
• Obesity (associated with increased rates of pelvic
floor dysfunction)
• Scurvy (affects connective tissue integrity)
• Steroid treatments (accelerate connective tissue
reserve)
• Diabetes (affecting peripheral, and motor and sensory
nerves)
• Occupations that involve heavy lifting
• Conditions that elicit heavy coughing (may result in a
type of “repetitive motion” trauma)
• Menopause (change in estrogen levels affect collagen
breakdown and detrusor function)
• Gynecological surgery
To learn more about training pregnant and postpartum women: girlsgonestrong.com/cppc
P1
Day 1: When and How to Screen Clients for Pelvic Floor Dysfunction
Equally important is knowing how to screen clients for pelvic floor dysfunctions, being able to consider pelvic floor adaptations in pregnancy and
the postnatal period when creating exercise programs, and knowing when
and to whom you should refer a client when there is cause for concern.
When to Screen for Pelvic Floor Dysfunction
Before a new client starts an exercise program, it’s a good idea to screen
for pelvic floor dysfunction. You may decide to screen your client again at
a later date if circumstances change or if she mentions symptoms. Ideally,
all women participating in an exercise program with a coach should be
screened before starting.
It’s also wise to screen clients for pelvic floor dysfunction when there’s a
new situation, such as becoming pregnant, returning to exercise after giving birth (recently postpartum), or returning to exercise after surgery.
How to Screen for Pelvic Floor Dysfunction
When you’re assessing new clients before they start a training program,
we recommend including a pelvic floor screen. The Pelvic Floor First
Screening Tool from the Continence Foundation of Australia is easy to use
and will help you determine when a client may need a referral to a pelvic
health physiotherapist. It can also help guide conversations about pelvic
floor health and inform how you design a client’s training program.
If your client is pregnant, use:
11. The Physical Activity Readiness Medical Examination for Pregnancy
(PARmed-X for Pregnancy) form from the Canadian Society of
Exercise Physiology (to make sure she has medical clearance and is
safe to exercise).
2.
 Download the PARmed-X for Pregnancy here
To learn more about training pregnant and postpartum women: girlsgonestrong.com/cppc
P2
Day 1: When and How to Screen Clients for Pelvic Floor Dysfunction
22. The Pelvic Floor Screening Checklist adapted from the Continence
Foundation of Australia.
 Download the Pelvic Floor Screening Checklist here
3.
If your client is postpartum*, use:
11. The Postpartum Physical Activity Readiness Questionnaire (P-PAR-Q)
form we created for our Pre- & Postnatal Coaching Certification
students. This form includes pelvic floor screening within the
questionnaire.
 Download the Postpartum PAR-Q here
*There is no universally agreed-upon timeline to determine at what point
in postpartum you should stop administering the P-PAR-Q. Technically once
a woman has a baby, she is considered postpartum forever, but over time
the P-PAR-Q can become less relevant for some women. We recommend
using the P-PAR-Q with women who have given birth anytime in the last
three years.
Otherwise, you can administer your standard PAR-Q and the Pelvic Floor
First Screening Checklist we provide in the second bonus resource. If your
client has many risk factors for pelvic floor dysfunction, you can always
administer the P-PAR-Q later to learn more about her specific pregnancy
and birth experiences.
How you choose to perform the pelvic floor screening will depend on
many factors:
•
Your relationship with the client
•
How comfortable you are with discussing the topic
•
Where you undertake the screening process (a busy gym floor versus
a private room)
•
How much time you have available
To learn more about training pregnant and postpartum women: girlsgonestrong.com/cppc
P3
Day 1: When and How to Screen Clients for Pelvic Floor Dysfunction
If a client is attending a group class or you don’t have an opportunity
to spend a lot of one-on-one time with her, it is perfectly reasonable to
hand over a paper screening form and ask her to fill it in. If she answers
“yes” to any of the questions, you need to be able to provide her some
guidance on where she should go from there. We recommend that you
have some business cards or a list of pelvic health providers that you can
recommend to her. If there are no pelvic health physiotherapists in close
proximity, ask her to follow up with her GP or OB/GYN.
If the circumstances allow and you feel comfortable doing so, you can
verbally ask the client the questions on the form. This can allow you the
opportunity to ask follow up questions and better gauge your client’s
concerns on these matters. Having this conversation can also mean that
you can discuss why pelvic health is important to long term health and
the types of treatments that are available.
Signs of Optimal Pelvic Floor Function
Urinating six to eight times per day
Signs of Pelvic Floor Dysfunction
Increased frequency of urination
(over six to eight times per day)
No leaking of urine
Can hold bladder and bowels to get to the
toilet
No discomfort with intercourse or
penetration
Leaking urine when coughing, sneezing,
laughing, exercising or otherwise exerting
oneself
Can’t make it to the toilet in time
Pain with intercourse or penetration
No lumbar or pelvic pain
Feeling of heaviness in the perineum
Emptying bladder and bowel with ease
No difficulty using a tampon
Feeling of things “coming out” or “falling out”
of the vagina
Difficulty inserting a tampon
To learn more about training pregnant and postpartum women: girlsgonestrong.com/cppc
P4
Day 1: When and How to Screen Clients for Pelvic Floor Dysfunction
Although a client’s responses to a questionnaire, along with a core
assessment, can give you some insight as to whether or not pelvic floor
dysfunction is present, you probably won’t know if she’s doing a pelvic
floor muscle contraction effectively. This is where collaboration with a
pelvic health physiotherapist is essential.
When these muscles contract, they should feel like they’re drawing upward, not pushing downward. Some women bear down rather than
drawing up when attempting to contract the pelvic floor muscles. If your
client isn’t sure, encourage her to see a pelvic health physiotherapist who
can perform internal work (if possible).
Teach your client to administer a self-test.
Your client can also test her pelvic floor muscles at home. If she is open
to talking about it, and you feel comfortable recommending that she test
her pelvic floor muscles herself, here are two quick tests she can try at
home to see if her pelvic floor muscles are moving properly.
If she doesn’t want to or can’t get to a pelvic health physiotherapist, these
tests may be of some value to her. Give the following cues to try at home
when she has some privacy:
14. “While standing in the shower, Insert one or two fingers into your
vagina (about three-quarters of the finger length deep). Focus on
drawing the pelvic floor muscles together and lifting them up toward
your head. You should feel a squeeze and a lift around your fingers.”
25. “Sit on your hand and feel the pressure of the perineum on your
hand. Focus on doing a pelvic floor contraction and feel the lift of the
perineum up and away from your hand. As you relax the muscles,
feel them descend back toward the hand.”
To learn more about training pregnant and postpartum women: girlsgonestrong.com/cppc
P5
Day 1: When and How to Screen Clients for Pelvic Floor Dysfunction
If your client has a physioball (also known as a stability ball or a
Swiss ball), doing these exercises sitting on the ball may help her feel
the perineum lifting away from the ball.
These two quick self-tests are useful to give your clients a basic idea if
the pelvic floor is contracting and elevating only. If she does these tests
and does not feel much movement, or she feels the pelvic floor moving
the opposite way to expected (i.e. downwards when contracting), then
she could see a pelvic health physio for further evaluation.
Most health and fitness professionals do not discuss pelvic health with
their clients. With a good understanding of the pelvic floor and its
response to exercise, you can help your clients achieve better outcomes.
By completing this free course, you are taking the first steps toward
joining a revolution in the fitness industry — a revolution in which the
discussion of pelvic health is common (not “weird” or “gross” or even
unusual) and is integral to a client’s training program.
When you are equipped to discuss, demystify, and incorporate pelvic
floor health in your training programs, you will help countless women
seek treatment early, stay active, enjoy great sex, and ultimately, enhance
their quality of life.
How to Find a Pelvic Health Physiotherapist In Your Area
(for Yourself or Your Client)
 Click here for a FREE download to help you find a pelvic health
physio in your area (and to learn more about how to help clients who
don’t have a physio in their area).
To learn more about training pregnant and postpartum women: girlsgonestrong.com/cppc
P6