What is Urinary Incontinence?
There are several different types of urinary incontinence, with different causes.
1. Stress incontinence refers to leakage that occurs due to excessive intra-abdominal pressure and the stress it puts on the pelvic floor. This leakage usually happens during activities like running, jumping, sneezing, coughing, laughing, lifting heavy weights, etc.
2. Urge incontinence is a sense of urgency around needing to urinate and/or involuntary leakage that is caused by overactive bladder tissue
3. Mixed urinary incontinence is leakage of urine caused by a combination of stress and urge urinary incontinence
4. Overflow incontinence happens when your bladder is overly full, usually because the tissue making up the bladder is compressed or under-active
5. Functional incontinence is leakage that occurs when there are physical or environmental barriers to toileting
Stress Incontinence
Lets look at a typical scenario I often hear from ladies:
A lady comes to me having had an intense cough. She found herself having a coughing fit and completely losing control of her bladder, soaking her knickers. She is peri-menopausal and has had children. (Note, it is more common for women who have given birth to have pelvic floor dysfunction, BUT it can affect anyone, even those who haven’t had children.)
Stress urinary incontinence (SUI) can cause embarrassment & depression, especially as it isn’t always predictable.
If you relate to the above ‘scenario, please have a read as it is good to understand more about it and what you can do to help yourself. You shouldn’t have to be afraid to cough or sneeze.
Causes of Urine Leakage When Coughing or Sneezing
The physiological reason behind urine leakage when coughing or sneezing is basically due to the increase in intra-abdominal pressure caused by the force of the sneeze or cough.
Intra-abdominal pressure – imagine the whole core system (including the pelvic floor and diaphragm) as a balloon. Imagine squeezing the top of the balloon. The bottom of the balloon bulges out and down in response to the pressure from the top.
Ideally, the pelvic floor resists some of that downward pressure while also lengthening to accommodate it. Except a sneeze is much faster. If the pelvic floor muscles are unable to counteract the force of the sneeze, leaking happens.
Both pelvic floor muscle weakness/laxity and excessive tension can lead to not being able to counteract the increase in intra-abdominal pressure that happens when you cough or sneeze.
If your pelvic floor muscles are too lax/weak, there’s not enough force generated by the muscles to counteract the sneeze.
If you have overactive/tight pelvic floor muscles, they can be so tense that they can not contract further to withstand the load.
Factors that can contribute to a tight/overactive pelvic floor muscles include:
• Stress and trauma
• Bladder or bowel dysfunction (e.g., IBD)
• Hypermobility–this can cause you to grip your pelvic floor muscles in an attempt to find more stability
• Movement patterns and habits, including high-impact sports
Factors contributing to the weakening of pelvic floor muscles include:
• Pregnancy and childbirth
• Pelvic organ prolapse
• Weakening of tissue due to age, especially the drop in oestrogen levels during perimenopause
Symptoms and Diagnosis
When is it important to see a doctor or better, a women’s health physio when it comes to incontinence?
It depends on frequency. If you’re noticing leakage regularly, especially if you have chronic conditions like allergies that may lead to frequent sneezing and coughing I would definitely see a Dr and get a referral or get in touch with me and I can advise who to see/best options for you.
Your doctor may perform an internal exam, including bladder function tests.
If you’re only noticing it occasionally (e.g., jumping on a trampoline once a year), or if you notice it when you get sick but don’t end up having issues once you’re better, working on your breathing technique & overall core function is probably enough. Keep an eye on it & how often you get issues.
How to Stop Urine Leaking When Coughing or Sneezing
In order to stop the leaking, there are a few things you can do to help the bladder.
• Reduce consumption of bladder irritants such as caffeine and alcohol
• Learn breathing techniques (like Hypopressives) and movement patterns that help you better manage intra-abdominal pressure. I teach lateral breath work and help women exercise whilst thinking about how to breathe to avoid more pressure on the pelvic floor.
• I also teach hypopressives which can really help the symptoms.
• Focus on the root cause of the issue: fill out my health screening form and I can say if it sounds like you are tighter in the pelvic floor. Otherwise, ask me for a woman’s health physio/osteo who can do an internal physical examination.
• Higher body weight is correlated with an increase in the likelihood of stress urinary incontinence, but you can learn to manage intra-abdominal pressure at any size
• Smoking is also correlated with an increase in SUI
• Other interventions include vaginal pessaries or urethral inserts
Tips for Managing Sudden Episodes of Urine Leakage
What do you do the next time you sneeze?
- 1st – make sure you aren’t trying to hold back the sneeze or cough – open your mouth when coughing or sneezing.
Keeping your mouth open allows you to disperse some of the force. - 2nd – notice what happens in your pelvic floor when you sneeze or cough – do you feel downward pressure?
Can you find some internal resistance to that downward pressure? For some people, it can be helpful to think about performing a kegel contraction , ie what I say is try to hold a fart & wee as you are about to cough/sneeze but then relax afterwards.
Long-term Strategies
- Talk about it – don’t be ashamed, as more women than you think will be going through what you are.
- Your body isn’t broken; it just needs a little help to function well.
- Maintaining your core function as you age and as your life stages shift is key to preventing SUI long-term.
FAQ
1. Who is most likely to experience urine leakage when coughing or sneezing?
Stress urinary incontinence, which involves leakage during activities such as coughing, sneezing, or exercising, is more common in women, particularly those who have had multiple pregnancies, given birth vaginally, or experienced hormonal changes due to menopause.
2. How effective are pelvic floor exercises in treating urine leakage when coughing or sneezing?
Pelvic floor exercises are often effective in treating stress urinary incontinence by strengthening the muscles that support the bladder and urethra. With regular practice, these exercises can improve bladder control and reduce episodes of urine leakage during coughing or sneezing.
3. What are some non-surgical treatments for stress incontinence?
Non-surgical treatments for stress urinary incontinence may include seeing a women’s health physio, come and see me to learn how to manage it with lateral breathwork or hypopressives, lifestyle modifications, bladder training techniques and the use of vaginal pessaries or urethral inserts.
4. Is surgery a viable option for treating urine leakage? If so, what does it involve?
Surgery may be considered for stress urinary incontinence when nothing else has worked. These surgeries aim to provide additional support to the structures that control urine flow and reduce leakage.
5. How can I talk to my doctor about urine leakage without feeling embarrassed?
You can prepare for the conversation by writing down your symptoms and concerns beforehand, choosing a private setting for the discussion, and reminding yourself that seeking help is a proactive step towards improving your health and quality of life. Your doctor can offer guidance, support, and personalized treatment options to address your specific needs.
If you want to chat just get in touch with me and I can offer support or advise where to start.
