Why Do I Pee When I Sneeze?
If you have ever been in or around a group of adult women, you know it is common to hear complaints of peeing with coughing and sneezing, or reports of avoiding jumping and running because of a fear of incontinence. Over the years, this has been normalized as something that just happens after you have children, or as you get older. The narrative is finally changing, thanks to recent uptick in exposure to pelvic floor PT. Although leakage is so common amongst adult women, it is NOT just a normal part of life following childbirth and aging. You don’t have to live with these symptoms!
Urinary incontinence (UI) affects a significant portion of the female (and male) population. There are three types of UI: stress urinary incontinence (SUI), urge urinary incontinence (UUI), or mixed urinary incontinence (MUI). SUI, what we’re talking about here, is leaking urine with “stressful” activities such as coughing, sneezing, jumping, running, lifting, etc. Leaking with these stressful activities is a result of increased pressure on the bladder and indicates a breakdown in the functioning of this system. UUI is leakage occurring when the urge to urinate is felt and often presents as leaking on the way to the restroom. This type of incontinence typically leads to peeing “just in case”, frequent stops to the restroom, and feeling anxious about being in a setting for too long without a restroom. Mixed UI, as I’m sure you guessed, is a combination of the two explained above.
So, what is really going on with stress incontinence? SUI can be a product of many factors. Typically, we see this occurring due to weakened and uncoordinated pelvic floor muscles and improperly managed intrabdominal pressure. It is important for the pelvic floor to be able to contract and relax appropriately in response to pressure changes within the abdomen. When you cough or sneeze, the pressure placed on your bladder increases and can cause your external sphincter (which is responsible for making sure urine doesn’t leak out) to briefly open to release a small amount of urine.
With aging, lifting, regular activity over time, pregnancy, and childbirth, the muscles of the pelvic floor can weaken and/or “forget” how to do what they’re supposed to do and when to do it. Does that mean you are doomed to suffer, having to wear a pad or pantyliner, or avoid activities all together? NO!
So, that leaves the question, what do we do?
1. The Knack. The knack refers to a method of controlling leakage by performing a pelvic floor muscle contraction prior to the “event”. For example, if you feel a sneeze coming on, you think about contracting the pelvic floor (think about squeezing in and up) prior to sneezing and holding it throughout the sneeze. While this is not a “fix”, it can help reduce symptoms while you do the other things listed below.
2. Learn how to breathe. We all suck at breathing. Focusing attention on diaphragmatic breathing (which is not the same as belly breathing) can help with ribcage mobility, core activation, and properly coordinated pelvic floor activity. All of these things help manage pressure in the abdomen and reduce leaking.
3. Address your posture and mobility. Improving mobility of the thorax, back, and hips not only allows for better posture and pelvic positioning, but also allows the pelvic floor and diaphragm to work throughout their range of motion. This is important when adding load or increased pressure. A strong pelvic floor is also a mobile and reactive one. Changing posture during “stressful” activities can also relieve symptoms of SUI.
4. Strengthen the core and pelvic floor. This is not just a Kegel prescription. Pelvic floor strengthening is much more complex than just a simple squeeze and relaxation. Strengthening these muscles includes coordinating breathe with activation and relaxation, as well as adding in functional tasks that incorporate the entire body.
5. SEE A PELVIC PT. If the above tips don’t resolve your symptoms and give you your life back, reach out to a pelvic floor therapist to get a more specific evaluation. Just like one diet doesn’t work for every body the same, one plan doesn’t treat all SUI with the same results. The best outcomes are when your condition is evaluated by a skilled pelvic floor physical therapist.
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