Why do I pee a little when I cough or sneeze?

If you’re a mom or mom-to-be, chances are you’ve been warned about “peezing”. You’ve likely been told that once you have a baby, you’re probably going to pee a little every time you cough or sneeze. It’s just the cost of giving birth, right?

No matter how many babies you have delivered, or how you delivered them, peeing every time you cough or sneeze is not normal or something you have to live with.

Loss of urine with coughing or sneezing is also known as stress urinary incontinence (SUI). And yes, it is definitely common in postpartum women. But that does not mean it is normal.

I do want to make a quick note that in this blog post, I am going to be primarily talking about postpartum women with stress urinary incontinence. The reason for this is that it has become very normalized among this population, and there are many people and products out there that promote the idea that SUI is to be expected once you deliver a baby. However, everyone has a pelvic floor, and any person can experience SUI. Therefore, if you pee when you cough or sneeze but have never been pregnant or never delivered a baby, the information shared in this blog post absolutely applies to you, too.

Stress Urinary Incontinence – What is it and why does it happen?

Stress urinary incontinence (SUI) is when you leak urine during activities that increase pressure in your core or during physical exertion. If leaking happens during physical exertion such as running or jumping, there is a chance that your foot, ankle, and/or hip may also be involved and need to be addressed to reduce leaking. If leaking happens during coughing, sneezing, or laughing, that typically means there is a pressure management issue.

When the pressure in our abdomen increases, our pelvic floor muscles need to respond to the increase in pressure and support our pelvic organs. This means the pelvic floor absorbs the force of the pressure while supporting the bladder to prevent loss of urine. If the pelvic floor muscles are unable to respond appropriately, we may leak.

So what is going on with my pelvic floor muscles if I am experiencing SUI with coughing or sneezing?

There are a few different things that may be happening with your pelvic floor muscles, which is why it is so important to work with a pelvic floor therapist to determine how to best address leaking. Here are a few reasons why leaking happens.

1) Your pelvic floor muscles are weak and/or uncoordinated. Your pelvic floor muscles can become weak or uncoordinated for a number of reasons. If your muscles are weak, just doing kegels is not the answer. It is important to re-train your pelvic floor to work in tandem with your diaphragm and core muscles, and to active to support your pelvic organs during coughing, sneezing, and other activities that place pressure on your pelvic floor.

2) Your pelvic floor muscles are “tight” or guarded. Just like other muscles in your body, your pelvic floor muscles need to be able to move through their full range of motion. Also like other muscles in your body, they can become shortened or guarded. If the muscles are restricted, they are unable to absorb force well during an increase in abdominal pressure (picture jumping on a trampoline vs a slab of concrete).

How do I stop “peezing”?

The answer to this question, like so many of the questions I answer in my blog posts, is: it depends. This is where it is important to have an individualized assessment to determine why you are leaking and what the best steps are to reduce leaking.

However, here are a few quick tips for you if you’re experiencing SUI with coughing, sneezing, or laughing.

1) Work on diaphragmatic breathing. Improving diaphragmatic breathing is important to help improve pelvic floor function. Your diaphragm and pelvic floor work in tandem. When you inhale, your diaphragm descends (pulling air into your lungs) as your pelvic floor muscles lengthen. When you exhale, your pelvic floor muscles naturally lift as your diaphragm ascends. Here is a quick video to help you work on diaphragmatic breathing.

2) Work on functional core strengthening exercises. Your pelvic floor muscles also coordinate with your deep transversus abdominis muscle (TA). Strengthening your TA, as well as the rest of your core, will help to improve pelvic floor function. Check out the video below on TA bracing.

3) Try the “knack” technique. A simple technique you can start trying right away is known as the “knack”. When you feel a cough or sneeze coming on, do a small kegel (think of stopping urine and gas without squeezing your glutes) and lower TA brace. Keep the pelvic floor and TA engaged during your cough/sneeze. This is a great technique to use in the moment, but the long term goal of therapy is for your muscles to learn how to respond appropriately on their own.

Interested in learning more? Check out my FREE PDF download, “Yes, You Can Run, Jump, and Lift Without Peeing Your Pants” by clicking here.

If you have questions, please reach out to me directly at alexis@absolutekineticspt.com.

Blog post written by Dr. Alexis Hutchison, PT, DPT, OCS