# Perceptions of a 'Pelvic-Floor Friendly' Group Exercise Class in Women with Urinary Incontinence
## 3 Results and Discussion
### Instructor Characteristics
#### 3.2.3 Additional Support to Help Women Manage UI During PA  
Pelvic Health Advice in the PA Environment  
Given the topic area and the aims of the PA intervention, a pelvic floor physiotherapist was present during both the intervention exercise class and focus group to help guide and support participants. Their presence also allowed the researcher to explore women's perceptions of having specialist pelvic floor help available in the PA environment. Participants were overwhelmingly enthused by being given clear and easy-to-understand PFE instructions. Many of the women had not sought help for their UI but all had sought guidance from various sources regarding UI management and/or performing effective PFE--though some commented that they felt they may not have been performing them correctly. Those who had sought help for their UI and received PFE instruction from a physiotherapist appeared to have little confidence that they had understood the instruction correctly and one suggested she would have appreciated the opportunity for quicker help-seeking:  
_\"I've been in physio for appointments, two by phone... but if [the PA instructor] had that kind of decree or something, I could have gotten all that [information] far easier, instead of waiting half a year. I mean, I waited half a year to be given exactly the same exercises 'hold for 10...\"_  
Studies suggest less than approximately 40% of adults with UI report their symptoms to a health professional [109], however a 2022 survey conducted by the Royal College of Obstetricians and Gynaecologists found 53% of UK women with pelvic floor dysfunction, had not discussed it with a medical professional and 69% of all their participants had not discussed pelvic floor health with any NHS healthcare provider [110]. Women's reasons for not seeking help for UI have been commonly reported as being due to embarrassment or shame [111], the assumption UI is a normal part of ageing [83], or that there are no treatment options available [84]. Bringing pelvic health guidance into the PA environment may present an early opportunity to promote effective PFEs and signpost treatment options. Several participants felt having the physio present also gave them confidence the workout catered to them, though they also felt having a physio present at every exercise class was not necessary but having a pelvic floor endorsed PA instructor should be standard, particularly to provide PFE guidance and whether exercises performed are safe regarding their specific condition: _\"...and what's safe as well, so you don't make anything worse. That's what scares me\"_. Several participants agreed they felt put off exercising for fear of making their UI condition worse but those with pelvic dysfunction in addition to UI, such as prolapse, seemed most concerned, though there appears no evidence in the literature to corroborate this is a widely held perception. In consideration of pelvic health advice being available where women exercise, [PERSON] [112] suggests mixing group PFE training with home PFE training is more effective than home training alone and recommends including PFEsin group exercise classes as it may motivate women to become more physically active overall. Therefore, adding PFE instruction to group PA classes may not only help women's confidence in performing PFEs correctly, it may also encourage women to perform PFE's regularly and re-engage or continue to engage in group PA in general. In addition, given that [PERSON] et al. [84] reported women did not know of any treatment options available for UI, and the women in the current study were unaware of any options other than pad-use to help manage their UI during PA, having access to easy pelvic floor physiotherapy referral or guidance may help women to remain physically active for longer, by helping them avoid UI onset or withdrawal from PA once UI manifests.