"This is like Vegas-what happens here, stays here."
With that, Brittney Cappiello, MSPT, opens the floor at her Fitness Into Tomorrow (FIT) class at Williamstown (MA) Physical Therapy. Part group therapy, part exercise routine, the course aims to get women talking and moving to combat pelvic issues and incontinence-problems commonly suffered but rarely discussed.
From sneeze leaks to chronic urges, the taboo talks happen behind closed doors, but they're prompting participants to open up, even in public.
After a trial run, the program has spawned a waiting list of women wanting to speak up and work out. It's a different approach, but it may just be the ticket for incontinence relief.
Cappiello launched the FIT program with specific attention to women in their 30s or 40s. She had treated a number of patients in that demographic and found that, while many were already suffering from mild incontinence, few were taking steps to treat it. "A lot of women don't know you don't have to live with [incontinence]," she said.
Incontinence is a common problem both during and after pregnancy. Pelvic floor muscles are overstretched during the nine months leading to birth, and postural changes after delivery leave the bladder less supported-all of which contribute to incontinence.
The trouble is, few women are willing to admit they have a problem, so they stay tight-lipped in public and even at doctor's appointments. "It's not something they would talk about at a dinner party.and if they mention it to family members, it gets blown off as 'That's what happens when you're pregnant,'" Cappiello said.
Jennifer, one of the FIT participants, grew up with that mindset. "I just thought it was normal to have incontinence and bladder control problems," she said.
Jennifer experienced mild incontinence as well as back pain during her first pregnancy. When she was pregnant with her second child, the problems got more severe. Her doctor mentioned physical therapy, which brought her to Cappiello.
"I've learned so much about other things that could happen [in pelvic health] that I had never known," Jennifer said. "It's been very eye-opening."
When minor incontinence goes untreated, muscles remain weak and the condition can worsen. But another concern is the impact bladder control problems have on the psyche. Incontinence can cause women to give up activities they enjoy, which often results in depression.
"I know some clients who won't go to a restaurant or store unless they know where the bathroom is," Cappiello said. "It begins to dictate their life."
Fitness and Education
To combat the problem, as well as its stigma, Cappiello crafted a dual fitness and education program that would teach women about incontinence and offer exercises to restore bladder control. She recruited friends and clients in the target age range for a pilot class. Of the 12 who signed up, nine suffered some form of incontinence-a statistic that surprised the entire class.
"They were shocked," she said. "It was something they never told anybody, and something they didn't feel comfortable telling their doctor."
The PT begins each class with 30 to 40 minutes of discussion about a women's health topic, and she often relies on statistics to drive the chatter.
During a chat dedicated to incontinence, Cappiello revealed that one in 10 women have had surgery for incontinence or pelvic prolapse issues. A surprising number, but one that was proven within Cappiello's class: During their discussion, one of the 12 shared that she had undergone surgery for bladder problems.
"[Incontinence] is an issue, and people need that kind of setting to really tee off the conversation," said Maureen, a former athletic trainer and registered dietician who was part of the pilot. She encouraged Cappiello to start the FIT class, and wound up learning she had more incontinence issues than she realized.
Women feel comfortable sharing personal experiences with the group, mostly because there's no judgment. The "Vegas" clause also reinforces a sense of trust, especially when news travels fast in the small town. "It's a safe zone where you can talk about the fact you jumped on a trampoline with your son and peed your pants.and other women can say, 'Hey, that happened to me, too,'" Cappiello said.
Learning Control
In addition to discussion, each FIT session includes 50 minutes of challenging exercises. The goal is to strengthen the pelvic floor for better bladder control, but Cappiello does it through a whole-body approach.
The routine includes a variety of squats, lunges, core work and spine work, with different speeds and depths. "The pelvic floor has both fast- and slow-twitch fibers, so it responds well to speed and to slow endurance motions," Cappiello explained.
The exercises achieve what Cappiello called "3-D pelvic mobility," which she believes is more natural to the body than traditional Kegels. "Bladder control shouldn't be something you have to think about; it should be an unconscious thing," the PT said.
Two-year-olds learn bladder control without the use of Kegels, so Cappiello doesn't see a point in stressing their use in adults. As toddlers reach the potty-training years, they roll, squat and move much more than they did as infants. That, not pelvic clenches, is what ultimately helps them get control of their bladder, Cappiello noted. Besides, she added, women are rarely taught how to Kegel properly, so much of the medical advice telling them to do so goes to waste. FIT's full-body approach also makes the class more appealing to young participants.
As mothers in their 30s, the women have little time to exercise, so an action-packed routine makes the 50 minutes feel worthwhile. Plus, the changes are noticeable. "I hadn't tried to do any jumping around until the first class and realized that was an [incontinence] issue as well," Maureen said. ".it's a perfect stepping stone to see the work I need to do to continue with those improvements."
"The first week it's hard to tell [if there's improvement] because you're so unbelievably sore from it. But after the second class, it was just amazing," Jennifer said.
Some Added Effects
Cappiello considers the program a success, but she's even more pleased with its side effects. As the women became more comfortable talking in class, they also began to broach incontinence issues outside the clinic. "Knowing this class was coming and there was a resource in our community for women, I started talking about it more and more," Maureen said.
At work and among friends, mentions of the class raised a few eyebrows, but more so, piqued interest. Many women weren't aware they had a problem, or that a physical therapist could help fix it. Now, within the small town, a surprising number of women are coming out of the woodwork to sign up for the next FIT course-so many that there's now a waiting list.
"Any woman I've told [says], 'I have to take that class. When is she offering it next?'" Jennifer said. "Everybody is amazed it's not something you just have to deal with."
Teaching a class on such personal issues was a gamble, but Maureen commended Cappiello for playing it safe with a trial run. Physical therapists should also consider testing the waters before launching any new program.
"None of us plan something the first time and it's 100 percent on the mark," Maureen noted. "[A pilot] is a great way to very logically get the feedback you need for a successful class."
The next step is getting the medical community more involved in spreading the word to the public. With so many women already showing interest, there are likely even more who would benefit from the program.
Obstetricians and gynecologists could alert women to physical therapy options, as could nurses or lactation specialists, who may offer a less intimidating ear on bladder issues.
"I keep saying, 'The conversation's started,'" Maureen said.
Now, it's just a matter of keeping it going.
Cheryl McEvoy is a former assistant editor/web editor at ADVANCE.