Is it normal to… pee when I sneeze?

So, you’re wondering if it’s unusual to experience urinary leakage when you sneeze. If you’re asking yourself this question, you’ve come to the right place. You do not have to live with urinary leakage — while this is common, it is not normal! You should go and speak to your doctor about this. But first, let’s chat about it.

Incontinence is not normal

Many women think it’s normal to experience urinary leakage after giving birth. In fact, you may have heard from friends or family members that after childbirth, this is just a fact of life for women as you age. However, this is simply not true.

Stress urinary incontinence (SUI) is when you have loss of urine that you can’t control with a physical activity like coughing, sneezing, lifting, laughing, exercise, etc. This happens because the muscles that tighten  or contract to prevent urine loss (pelvic floor muscles) become weak or the bladder neck is damaged.

SUI is very common in women, but it is not normal. It can have a negative impact on your quality of life and can affect women of all ages. SUI may keep you from social activities or prevent you from engaging in exercise. Furthermore, if you have mild leakage now, this is a great time to intervene with conservative measures as it may worsen over time.

Where to go for help

There are doctors, nurse practitioners, nurses and other healthcare experts who specialize in caring for women with these exact issues. A urogynecologist is a physician who specializes in these types of issues that women face throughout their lives. It can seem embarrassing to talk about, but I’ll bet after you get the conversation started, it will be a lot easier than you think.

In my office, the new patient paperwork alone includes a lot of ice breaker questions to facilitate talking about all pelvic floor disorders. This includes things like urinary leakage, prolapse or dropped bladder, fecal or bowel incontinence, overactive bladder, pelvic pain and more.

Strengthening your pelvic floor muscles

There are lots of things we can do to help that don’t involve surgery. For example, strengthening the muscles of the pelvic floor that help prevent urine loss is an effective way to improve or eliminate SUI. Pelvic floor strengthening has been shown to improve SUI in up to 75% of women. Some coaching on how to properly perform a Kegel exercise can help you perform pelvic floor exercises at home. We also offer pelvic floor therapy in the office with biofeedback and electrical stimulation to improve success in a non-invasive way. This gives you the tools you need to be able to exercise more effectively at home. Learn more about pelvic floor therapy here.

In addition, maintaining a healthy body weight, quitting smoking and decreasing constipation can all play a role in decreasing SUI. Finally, there are incontinence devices that can be placed in the vagina (like a pessary) that can help prevent loss of urine. Some women even find that wearing a tampon while exercising can make a difference.

The mainstay of conservative management is often pelvic floor exercises and therapy in the office. A lot of women see improvement early on. It is very common for women to come in and say that they have been working on Kegel exercises at home for months (or even years) but, upon exam in the office, they are unable to contract the muscles properly.

Let’s talk about surgical options

Now, some women try conservative measures, but others feel it affects their quality of life enough that they would like to have a procedure or surgery. That is OK, too. There are many options. The most common surgery across the world is a midurethral sling, which is an outpatient, 15 to 20-minute procedure. After being introduced in the 1990s, the midurethral sling has become the true gold standard surgical treatment. There are also urethral bulking injections and a sling can be made out of your own tissue (although this is a more invasive procedure). Talk to your doctor about whether a surgical option makes sense for you.

What if you’re not quite done having kids?

This is another question that I hear a lot: I think I want to have another child. Should I wait to do something about this urine leakage? This is a conversation that you should have with your urogynecologist. In general, you can always work on the conservative options that we have discussed.

However, studies of women who have had surgery and then gone on to bear children indicate that the pregnancy or delivery does not seem to have a negative impact on the durability of surgery for leakage. This means that a surgery (like a sling) can hold up after delivery and you may not need to wait until you are done having children before doing something about this. In the end, this needs to be an individualized discussion between you and your doctor.

So, to sum it up, the answer is no — it’s not normal to pee when you sneeze. Or cough. Or exercise. If you’re dealing with stress urinary incontinence, find a pelvic specialist today.