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Why do I leak urine when I cough, sneeze, or run?

Updated: Nov 22, 2023

Roughly 10 million adults will experience some form of urinary incontinence in their lives. 50-60% of cases will be stress urinary incontinence.

What is stress urinary incontinence (SUI)?

Stress urinary incontinence is when we leak urine under high pressure conditions such as laughing, coughing, sneezing, or performing physical activity that requires bracing our abdomen.

While not all SUI is caused by pregnancy or postpartum pelvic floor dysfunction, a large percentage of those who have been pregnant and / or given birth may experience SUI. It is more common than you think! Just because it is common, however, does not mean it is normal.

Our pelvic floor plays a key role in keeping us continent, however any damage to the muscles in the pelvic floor may compromise our ability to stay leak-free. Damage can often occur during pregnancy as well as during vaginal birth, with weakness increasing up to 50% in healthy women postpartum. This is often due to the significant stress placed upon the pelvic floor musculature that can either over-stretch, tear, or damage the innervation to the muscle.

When we sneeze, for example, and our abdominal pressure greatly increases, our pelvic floor must contract and resist that pressure quickly. If the muscle is unable to maintain a pressure sufficient to stop the urethra from opening, we leak urine unintentionally.

Great, so what do I do about it?

Interventions range from physical therapy and medications, to surgery. Physical therapy (PT) is the most conservative based intervention for SUI. PT mainly addresses, but is not limited to, pelvic floor muscle training (PFMT). These days, the results from surgery aren't recognized to be extremely successful, so it is worth your time and effort to pursue conservative interventions first.

Interventions your Pelvic-Floor PT may do with you are:

  • Education on how to consciously contract the pelvic floor before and during increases in abdominal pressure

  • Regular strength training for structural support of the pelvic floor

  • Core strengthening and stability that indirectly trains the pelvic floor

  • Manual or biofeedback techniques to assist with learned contraction

  • Dry needling with electrical stimulation to help improve innervation and control of the muscles

  • Address environmental factors that may be contributing to SUI

  • Provide a long-term program and following up to assess success over time

What if I have SUI and I haven’t been pregnant?

Not all SUI is caused from pregnancy! There are various reasons or environmental factors that may contribute to or cause your SUI. Any scenario in which the pelvic floor muscles and fascia are compromised in their ability to support your organs and provide a barrier against internal pressure may cause incontinence.

The most common reason why someone experiences SUI, whether having been pregnant or not, is due to muscle tension being unable to support high pressure demands with the fast twitch muscles. If you're chronically stressed, for example, and squeezing your pelvic floor subconsciously all the time, your muscles may tighten to the point where the cannot tolerate the demand placed on them.

Too Long, Didn’t Read (TLDR)

Stress urinary incontinence occurs when the internal pressure on the bladder is greater than the pressure created by the pelvic floor to prevent voiding before desired. This can happen with sneezing, coughing, running, or other physical activity that requires abdominal bracing like weightlifting. Prevalence of SUI increases with pregnancy and postpartum due to the damage the pelvic floor may receive during these phases of life. A great intervention and non-invasive treatment option is pelvic-floor physical therapy.

If you believe you may be suffering from SUI, no matter what the cause, and would like to see what PT can do for you, book a consultation to get advice and recommendations on your specific needs.


About the Author:

Caroline Gamwell, DPT is a Doctor of Physical Therapy, specializing in Pelvic Floor and Women's Health. She is the founder of Worth It PT based in Denver, Colorado, a clinic whose focus is to help others achieve their health and wellness goals through a higher quality of healthcare.

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