Why some people leak urine when they sneeze (and what they can do about it)

In this post from SIU Medicine's Pelvic Wellness Series, we'd like to talk about a common concern that affects women and even some men: stress urinary incontinence, perhaps better recognized as "peeing a little when I sneeze."

Is this something you struggle with? If so, keep reading to learn more about why it happens and what can be done about it. 

Why do I pee when I sneeze? 

If you unintentionally leak urine when you sneeze, laugh, jump, cough, pick something up or exercise, you might have stress incontinence. It's the most common kind of urinary incontinence, ahead of urge incontinence (the sudden and urgent need to urinate, often before you can reach the bathroom) and mixed incontinence (a combination of stress plus urge incontinence).

Stress incontinence begins when pressure inside the abdominal cavity increases, which consequently puts excess pressure on the bladder and downward pressure on the pelvic floor muscles (which attach to your pelvic bones and form the bottom of your “core”). Under normal conditions, the pelvic floor muscles can withstand this change in pressure and prevent urine from exiting the bladder through the urethra. However, if the pelvic floor muscles are weak or stretched out, they won't be able to properly support the bladder nor control the urethra, which can allow urine to uncontrollably leak out.

Several factors can cause pelvic muscle weakness and laxity and increase the risk of stress urinary incontinence, including:

• Pregnancy and childbirth 
• Hormonal changes associated with menopause
• Chronic coughing (often due to smoking or asthma)
• Obesity or overweight
• Surgery or trauma in the pelvic area

The frequency of these factors helps explain why as many as 1 in 4 women develop a pelvic floor disorder at some point in their lives. And while not everyone with a pelvic floor disorder has stress incontinence, the presence of stress incontinence almost always indicates some kind of problem with the pelvic floor musculature.

Men can experience stress incontinence, too. In men, stress incontinence often develops after surgery for prostate cancer or prostate enlargement, which can weaken the muscle (urinary sphincter) that controls the release of urine.

Other issues people may notice if they have stress incontinence

In addition to the accidental loss of urine during activities that increase pressure on the pelvic floor, people with stress incontinence may also report: 

• Pain during urination
• Increased urinary frequency
• Increased urinary urgency (particularly if they have mixed incontinence) 
• Emotional distress
• Social withdrawal 
• Changes in lifestyle habits associated with their symptoms (e.g., avoiding certain activities known to cause leakage, purposefully going to the bathroom more often in an attempt to prevent leakage) 

Why it's important to talk about stress incontinence 

While it might be frequently used for comedy in popular culture and mentioned in commercials advertising feminine hygiene products, unintentionally leaking urine isn't a laughing matter. For one thing, if the underlying cause of stress incontinence isn't addressed, complications like urinary tract infections and skin irritation can develop.

In addition, stress incontinence is routinely associated with emotional distress and impaired quality of life. Many women feel embarrassed and ashamed about their symptoms, and may even feel reluctant to speak with a health care provider about their concerns, despite the fact that there are many effective treatment options available.

Some strategies that women use to try to compensate for stress incontinence—such as going to the bathroom before their bladder actually feels full—may actually teach the bladder to signal the need to go even when there's not a lot of urine present. This can worsen issues like urinary frequency. 

Finding relief from stress incontinence

So, what does this all mean for you if you have stress incontinence? Ask a trusted health care provider for help!

There are a variety of interventions and techniques that can alleviate symptoms and restore the strength and function of your pelvic floor muscles, which can prevent symptoms from coming back. Some techniques backed by research include:

• Pelvic floor strengthening exercises
• Pelvic floor physical therapy
• Weight loss
• Pessary (a comfortable, silicone vaginal insert that helps stop leaks and can be worn daily or just as needed)
• Urethral bulking agents (minimally invasive procedure)
• Surgery (urethral sling procedure)

Connect with a provider today 

If you have stress incontinence, you don't need to struggle alone. Find a provider at SIU Medicine and explore your treatment options now.