Table 2 Coping strategies for exercising with pelvic floor symptoms

Toileting

Emptying the bladder multiple times during or prior to exercise

Ensuring that run/walk routes were always near a toilet

Sourcing facility with good access to toilets, i.e. changing to a smaller gym where the toilet is closer to the class

“Well I'm usually pretty careful. If I was going to a live yoga class, if I had to travel a distance to get to the yoga class, I go to the toilet before I get on the mat.” (P11)

“I think being so accessible to the bathroom, that's the main thing for me. I think being kept at kind of small class groups, it makes it more comfortable to not think that I'm hogging the toilet or anything.” (P23)

Containment

Wearing and frequently changing pads/underwear

Taking a change of clothes for exercise in case of accidental leakage

“So, you're quietly going to the toilet, change your underwear again, you take three pair of underwear and a plastic bag and what not. You buy those special little wipes that you can buy to clean up on each time. But I was sort of hyper aware because I was in a hot and sweaty environment” (P3)

Concerns about clothing/uniforms

Being conscious of clothing/uniform selection for sport/exercise

Stopping sports when uniforms do not allow for concealment of pads or leakage e.g. short, light-weight, cut-away or light-coloured outfits made women fearful that leakage could be seen and made it difficult to wear pads or continence underwear

Choosing to wear dark clothing that can hide leakage

Feeling of distress when sports (like martial arts) required white uniforms where leakage is more visible

“It bothers me because I have to wear black tights. I'd like to wear some lovely coloured tights that women can wear, but I just can't.” (P24)

“For some women where pads don't hold it, then they're going to need that extra support because they're likely to have more of an issue of leakage at a sport setting. Especially netball ones. They're quite short.” (P14)

Intake restrictions

Restricting fluid intake before and during sport/exercise to avoid a full bladder

Balancing adequate hydration with avoiding leakage. Concerns about dehydration particularly in hot climates

Women with anal incontinence also carefully considered the timing of the intake of food and medications to avoid provoking bowel leakage

“I deliberately don't drink, which is probably a bit of a thing, … before I'm going to go for a run.” (P13)

“I think for me mostly it's like urine incontinence, especially after a hard run. I know if I'm pushing myself or if the weather is particularly hot. I notice the impacts then, especially through summer, where you're trying to stay hydrated, but at the same time being mindful of… Well, I need to make sure that I balance this out too and not wet myself while I'm running” (P19)

“You have to put a lot more thought into it. You have to make sure you're either wearing the right kind of undies or you've got enough pads and yeah, how long you'll be out for and if you pad will hold if you've had too much water. So you're either dehydrated or peeing yourself” (P15)