Why does coughing or sneezing make me leak?

January 5, 2024 | Author: Sarah Graham, PT, MPT, PRPC

Do you leak when you cough, sneeze, jump, or laugh? Has everything changed since having kids? Perhaps your mom told you it was just a normal part of aging, or worse, your doctor dismissed it as such? While it is a common issue, stress incontinence is not normal. You can live a life that does not have to include pantiliners or pads, and you might not even need that bladder lift! Exercise and physical therapy are here to help.


What IS stress incontinence, and WHY do I have it?

The definition of stress incontinence is the involuntary leakage of urine during activities that exert pressure on the bladder. Weak or damaged pelvic floor muscles, often a consequence of pregnancy, childbirth, trauma, aging, or illness, are common contributors that cause stress incontinence. Statistics show that 50% of women in the U.S. encounter incontinence at some point in their lives. Let’s delve into why this happens:


During pregnancy, the pelvic floor is under a lot of stress as the baby grows and then moves from the pelvic region to the abdominal area, protruding VERY far out in front. All the extra pressure on the bladder, coupled with the growing baby, can cause the pelvic floor to be under more stress, and if those muscles aren’t strong enough, leaking can occur.


Post-pregnancy is a whole other ball game! In the case of a vaginal birth, the pelvic floor undergoes necessary dilation to stretch and lengthen to allow for the birth. Leaking is very common if there are complications, such as prolonged pushing or tearing of the perineum and pelvic floor muscles.


Aging and leaking can often go hand in hand. As muscles throughout the body weaken due to lack of training or use, coupled with chronic conditions like persistent coughing or extended bed rest, the pelvic floor becomes more susceptible to weakness and leakage. Just as strengthening the arm and leg muscles helps with functional movement, strengthening the pelvic floor can help with incontinence and leaking.


Illness can also be a huge factor that impacts leaking and continence. Chronic coughing can cause the pelvic floor to move downward, and, after time, weakness and leaking can occur. Just being in bed for extended periods can weaken the muscles of the pelvic floor, hips, and glutes, which also increases the risks of leaking.


What does my pelvic floor DO?

With all this information, there has to be a bright side, right? Absolutely! The good news is that with pelvic floor strengthening, as well as retraining of the muscles, proper breathing techniques, and strengthening of the hips, core, and glutes, your symptoms can improve significantly.

Now, we get to talk about the pelvic floor muscles and their function in aiding continence. The pelvic floor works like a sling at the base of the core muscles, keeping everything “up and in” where it belongs. The pelvic floor has three layers, and the primary function of those muscles is support, sphincter control, truck/core fixation, and providing muscle tone for the vaginal and rectal canals. If the pelvic floor muscles begin to weaken, organ prolapse, leaking, and sexual dysfunction can occur. The muscles are 70% slow twitch – which means they have endurance-like properties and work to support the organs. They are also 30% fast twitch fibers– which means they can contract to stop leaking with rapid sphincter closure (like with a jump or sneeze).

The other part of this puzzle is where the bladder sits in the pelvis. It sits behind the pubic bone, and when it becomes full, will move up and into the abdominal cavity (just a bit). The uterus, and large and small intestines for that matter, sit posterior (behind) and superior (above) to the bladder, filling up a lot of that abdominal space. So, ensuring the mobility of the abdominal fascia and the bladder is incredibly important. Factors like abdominal surgeries, C-section scars, or fascial restrictions can impede the bladder’s full expansion, leading to an increased frequency of leaks.


How can pelvic floor therapy help me STOP leaking?

So, how can pelvic floor physical therapy help? I am glad you asked! Pelvic floor physical therapy focuses on mobility training and strengthening the pelvic floor, hips, glutes, and core. Physical therapy interventions include biofeedback, bladder retraining, strengthening, and lengthening of the pelvic floor and hip/glute/core muscles. It’s also important to note that pelvic floor therapy goes beyond just “Kegels.” Your therapist will tailor exercises based on an individual assessment, and they will be able to determine if Kegels are an appropriate exercise for you. However, if your muscles are already tight, this is one of the worst things you can do for your pelvic floor. A well-trained pelvic floor physical therapist can assess your specific needs and candidacy for therapy.


If you have any questions about stress incontinence, or if you’re curious to see if you are a good candidate for pelvic floor therapy, give us a call or send us a message today!

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