Leaking When You Cough, Laugh, or Sneeze? Here’s What You Can Do
Let’s start with the basics.
Leaking when you cough, laugh, or sneeze are examples of stress urinary incontinence. This leakage occurs when we are unable to control increased pressure on our pelvic floor and is also commonly seen with impact activities such as jumping and running.
While leakage is COMMON, IT IS NOT NORMAL and is certainly not something you should “just live with” at any age. Oh, and crossing your legs is not an acceptable solution!
To better understand leakage, we must understand how our abdominal cavity functions as a pressure system.
Our abdominal cavity is composed of 4 muscle groups that we call the anticipatory core. Every time we move, these 4 muscle groups fire before any movement occurs to provide a stable base for movement.
Imagine your anticipatory core is like a soda can. The top of the can is your diaphragm. The front wall of the can is your transverse abdominis, the 4th and deepest abdominal layer which wraps around you like a wide belt. The back wall of the can is made up of the muscles that line and support your spine. The bottom of the can is your pelvic floor muscles.
This imaginary can is your abdominal cavity and you use your core every time you breathe to manage the pressure within this space.
As you INHALE, your diaphragm contracts DOWN allowing your lungs to fill. To accommodate this increase in pressure in your abdominal cavity, your pelvic floor muscles should RELAX and descend and your abdominal muscles SHOULD move OUT and away from your spine to expand the abdominal cavity.
As you EXHALE, the diaphragm naturally rises UPWARD as the lungs release air, and the abdominals and pelvic floor muscles should move back to their resting position.
For men, poor control of this pressure system leads to hernias as this is typically the weakest area in their abdominal cavity. For women, our three orifices, or openings, on the bottom of our pelvic floor (urethra, vagina, anus) are our most susceptible regions leading to urinary leakage. However, for the same reasons, it is also very common for women to experience leakage of gas and stool.
While most would think that stress incontinence is caused only by weak pelvic floor muscles, it is also very common among populations with tight pelvic floors such as gymnasts due to the lack of shock absorption of these tense muscles. A tight pelvic floor does not mean a strong or coordinated pelvic floor.
So what do we do about it?
We need to begin by reconnecting with the pelvic floor. Sure, you can do a pelvic floor contraction(kegel), but can you relax and lengthen your pelvic floor? Work on coordinating your inhales with pelvic floor relaxation and exhales with pelvic floor contractions. I recommend practicing 5 breaths, 5 times per day in different positions (on your back, sitting, standing, walking). These breaths are great to practice at a stop light or while washing dishes!
Use your pelvic floor contraction when you need it. Yes, you should contract your pelvic floor with coughing, laughing, and sneezing to prevent leakage. While at first you will need to mentally focus on contracting your pelvic floor before coughing, laughing, or sneezing, the goal is that your body internalizes this pattern and it will become innate over time.
DO NOT LIVE WITH IT! Leakage is COMMON but NOT NORMAL. Please speak with your doctor and seek out a pelvic health physical therapist who can help you regain control of these muscles.
Meghan Krill, PT, DPT is the owner of Flora Physical Therapy, a holistic pelvic health physical therapy practice, in downtown Fairfield. She completed her undergraduate degree at the University of Notre Dame and received her Doctor of Physical Therapy degree from Columbia University. Meghan has continued her education completing coursework in pelvic floor pain and dysfunction, prenatal and postpartum care, and nutrition through the Herman and Wallace Pelvic Rehabilitation Institute as well as various other pelvic health organizations. From menstrual cycles to menopause, she loves helping patients find solutions to their aches and pain through an integrative and individualized approach. She hopes to empower all women to tackle their issues “Like a Girl.”