Peeing While Coughing: How To Solve It
Many people notice a small urine leak when they cough, sneeze, laugh, or exercise.
This condition is called stress urinary incontinence (SUI).
It is common but also treatable with quality pelvic floor physical therapy.
Stress urinary incontinence affects 17–45% of adult women.
Up to 37% of females experience it at some point in their lives.
Your body is not “failing.” It’s communicating that the pressure system and pelvic floor coordination need support.
In this blog, you will learn more about why you pee when you cough and what can be done about it.
Why Do I Pee When I Cough?
Leakage when coughing is more complex than just having a “weak pelvic floor”. When you cough the pressure inside your trunk and abdomen rapidly increases. Your bladder sits inside the abdominal cavity and rests on top of the pelvic floor muscles. When there is increased pressure on the bladder and pelvic floor, the pressure moves downwards. If you do not have good pressure management which is influenced by posture, breathing, and muscle tone you may be more prone to urinary leakage. There is also a natural reflex that should occur when you cough where the pelvic floor and urethral sphincter contract against the pressure, but sometimes this reflex is lost and needs to be retrained.
Since there are many factors that affect leakage with coughing, it is important that you are individually assessed for which parts may affect your symptoms. You could be doing kegels all day but if you do not have the appropriate resting tone and coordination, you can still have leakage.
What Is Stress Urinary Incontinence?
Stress urinary incontinence is involuntary urinary leakage during a moment of physical exertion or pressure on the bladder. Examples of this can be during coughing, sneezing, jumping, or lifting. It is important to be evaluated and distinguish what type of urinary incontinence you have as there can be different types and causes such as urge incontinence.
Stress incontinence is usually a result of poor pressure management. You can have a strong pelvic floor, but if the forces above are too strong or the pressure is disproportionately placed on your pelvic floor and bladder, leakage will be likely even if you kegel. This is why it is important to have your posture, breathing, and core strategies assessed when trying to address the root cause of stress urinary incontinence.
Common Causes of Leaking When Coughing
Pelvic floor weakness/tightness: Many people assume if they are leaking that they have weak pelvic floors. This leads to over doing kegels as a treatment. The reality is tight muscles can be weak and oftentimes trying to tighten or strengthen alone is not enough or can make matters worse.
Poor coordination: Sometimes the reflex of the pelvic floor lifting during a cough is lost and needs to be retrained.
Pregnancy and postpartum changes: The pelvic floor muscles can be both lengthened and get more tight (relatively strained) during pregnancy which can contribute to urinary leakage. There is also increased pressure on the pelvic floor during this time.
High impact exercise: If you are someone who does constant heavy lifting with improper mechanics, pressure management, or breathing strategies this can contribute to leakage.
Constipation: If you have struggled with constipation most of your life or even just recently when urinary symptoms started, this can also contribute to leakage. Stool sitting in the rectum for longer periods than normal can increase pressure on the bladder and pelvic floor, and straining to eliminate a bowel movement can also strain the pelvic floor muscles.
Chronic coughing: If you have a chronic cough, whether it be from an illness or something else, this can also contribute to consistent pressure on the bladder and pelvic floor that can make the environment more prone to leakage.
Hormonal changes: During the menopause transition, estrogen decreases and this causes the pelvic floor to lose some elasticity which can contribute to leakage.
Why Kegels Alone Do Not Fix Stress Incontinence
Many people are told to "just do kegels”. Kegels in isolation are rarely the answer, and even if they can help most people perform them incorrectly. Pelvic floor contractions require proper breath coordination and isolation of the pelvic floor without compensatory patterns. The best way to screen for this is to get feedback from a trained pelvic floor physical therapist.
The reason kegels are rarely the answer is because most people already have overactive pelvic floor muscles. When muscles are already tight, they have a hard time contracting or generating force. Most people benefit from first learning how to effectively relax the pelvic floor muscles so they can sit at a better resting length in order to generate tension and power when needed with the right timing and coordination. Proper pelvic floor training generally takes 2-3 months with guidance and consistent practice to create sustainable change. When working with a qualified pelvic floor specialist, it is important that the whole pressure system is addressed including the diaphragm, abdominal, and pelvic floor alongside considerations for the nervous system in motor learning. At Bodyful, you can expect this holistic and thorough approach.
How Pelvic Floor Physical Therapy Helps
The benefit of working with a pelvic floor physical therapist is that we can assess pelvic floor strength, muscle tone, reflex timing, breathing mechanics, pressure management, nervous system regulation, and movement patterns. We are experts in motor training, patient education, and manual therapy.
Treatment at Bodyful may include pelvic floor muscle training, relaxation training, breathing mechanics, core coordination, coughing strategies, nervous system regulation, and functional movement retraining.
Studies have shown that pelvic floor training can reduce bladder neck mobility and improve urethral support during coughing, which in turn improves symptoms. You can read more by looking at this study here.
Somatic Approaches to Healing Pelvic Floor Dysfunction and Leakage with Coughing
One way Bodyful is unique is that we can bring a somatic approach to pelvic health and learning. If you are someone who values body awareness, nervous system regulation, and trauma informed care then we may be the right fit for you.
A somatic approach recognizes that pelvic floor function is deeply connected to breathing, posture, emotions, beliefs, images, and the nervous system. We aim to create a container that can hold the complexities of healing and learning within a realm of safety and curiosity.
5 Simple Ways to Address Peeing While Coughing
The Knack: There is a reflex called “the knack” where your pelvic floor is supposed to lift gently before coughing or sneezing. Sometimes you have to retrain this by consciously lifting the pelvic floor when you have leakage.
Diaphragmatic Breathing: Oftentimes tight muscles are not strong which is why there can be leakage. Try diaphragmatic breathing to reduce tension in the pelvic floor.
Posture: When you cough or sneeze, notice if you round your back and tuck your ribcage in. If you do, this can sometimes create more pressure down. Try keeping your ribcage stacked over your pelvis.
Reduce Constipation: Constipation can contribute to leakage because if there is stool sitting in the rectum it can create more pressure on the bladder. Straining for bowel movements can also strain the pelvic floor.
Relax Your Butt: If your butt muscles are gripping, your pelvic floor is most likely tight as well. See if you can notice this habit throughout the day and try to interrupt it when possible.
When You Should See a Pelvic Floor Physical Therapist
If you exhibit any of these symptoms you shoulder consider seeing a pelvic floor specialist:
leaking with coughing, sneezing, laughing
leaking during exercise
postpartum leakage
needing pads for workouts
pelvic heaviness
pelvic pain with leakage
Bladder leaks are common, but they are not something you have to live with. Quality pelvic floor PT can help.
Work With a Pelvic Floor Physical Therapist in Oakland
If you experience peeing while coughing, sneezing, or exercising, pelvic floor physical therapy can help identify the root cause and create a ersonalized treatment plan.
At Bodyful Physical Therapy, we use:
somatic pelvic therapy
nervous system regulation
movement retraining
postural and breathing retraining
skilled manual therapy and visceral fascial mobilization
specific core retraining for pressure management
