Why Do I Pee When I Sneeze?

Chances are if you've hung out with a group of moms for any length of time, you have heard a laugh/pee joke, a sneeze/pee joke, or shared some solidarity when someone mentioned wetting themselves while jumping on a trampoline. This issue is called stress urinary incontinence and it is super-duper common, especially among women who have had a baby, hence the term "mom bladder."

According to current statistics, about 15 million women in the U.S. experience this kind of incontinence. One in four to one in two women who exercise experience stress urinary incontinence, which can also be a huge barrier to exercise. I mean, lots of people don’t want to go to an exercise class or to the gym wearing a pad and they FOR SURE don’t want to explain to their trainer why they need to run to the bathroom after a few jumping jacks.

In this blog, I’m going to talk a little bit more about what stress urinary incontinence is, why you experience leaking during situations like the ones mentioned above, and where you can go to get help for leakage and other pelvic floor issues.

What exactly is stress urinary incontinence?
The #1 answer on Google says stress incontinence is leakage caused by physical activity, but anyone who has fully wet themselves after a sneeze can tell you that answer isn’t really accurate. Stress incontinence is leakage that can happen when the pressure in the core canister increases. This includes things such as laughing, sneezing, coughing, running, jumping, squat jumps, double unders, lifting something heavy (like a kiddo), even planks can cause leakage in some people. It can span from just a tiny bit of leakage to losing your full bladder. Many people will report leakage that just happens throughout the day as well, with what seems like no rhyme or reason.

Now that we’ve covered what stress urinary incontinence is, you may be wondering why it happens during activities that don’t seem all that significant. Like a simple cough or sneeze?

“Why do I pee when I ____?”

I hear women ask all the time why they pee on themselves. Lots of people reply that it’s just because they are a mom now or because they’re getting older and their tissues are weak. In my opinion, those answers are just doing people a disservice. In this section, I’m going to talk a little bit about how of the continence mechanism works. How do you actually hold your bladder?

Check out the photo over there. This is a top view of the pelvic floor. As you can see, our pelvic floor is basically the bottom of our bottom, it is what holds in your internal organs, bladder, urethra, and anal sphincter. It has a ton of other jobs, but we’ll just focus on this main one so I don’t go off on a tangent.

Check out the little hole where your urethra would go, you can see in this photo that it is surrounded my muscle and fascia. I want you to imagine the urethra like a hose. When you're trying to stop yourself from peeing, the pelvic floor will squeeze to “kink” the urethra- similar to when you step on a hose to stop the flow of water (then take your foot off when your husband unknowingly sticks his face at the other end to see whats up, HAAAA!). This stepping on a hose or “kinking” of the urethra stops the flow of urine… or does it?

Now, lots of people will read that and think, "Well, I just have to squeeze really hard, and that will help. Right?" Well, not really. We really only have a third of that control, the rest is an involuntary response. Sure some of it has to do with the muscles, other factors are the quality of the fascia and your brain reacting with your bladder. Many different factors contribute to the kinkage of that urethra and whether you maintain continence or not.

Let me give you a quick example- think about kids learning to potty train. In all respects, they should have strong pelvic floors right? They’ve never encountered many of the SUI risk factors, yet they struggle to maintain their bladder. Why? Because it’s involuntary and they have to learn bladder and bowel control. Pretty fascinating, right?

When you do something like laugh, jump, sneeze, or cough, you’re increasing the pressure in the core canister, which I have discussed in more detail in this blog. This puts more pressure on the pelvic floor and when the pelvic floor can’t withstand that pressure, the hose doesn’t “kink” or the urethra doesn’t close off, you get leakage.

Times like pregnancy, where the pressure demands on the core canister are greater, can increase the chances of leakage. Even when the baby comes out, the muscles and tissues of the core and pelvic floor have been under a huge amount of stress. This is why it is HELLA important to consider pressure changes in the core canister, on the abdominal wall and pelvic floor, during exercise and activity during these times.

Let me just take this a step further to clarify that pelvic floor strength is not the only factor at play here. There's a big difference between the person who will go to do one jumping jack or have one really large sneeze and immediately leak and the person who will leak a little bit 10, 20, or 30 jumping jacks out. While one person may be struggling more with strength, the other may struggle with endurance so it’s really important to know where to go to get a thorough evaluation of the pelvic floor when managing incontinence.

Where can you go to get help?

Alright, so here’s where I tell you the first step is to go see your doctor. Maybe you’ve done that before and they gave you a referral to a urogynecologist or shrugged their shoulders and said it was normal. This is one of the big reasons I’m furiously typing this as I fume about my own experience. I’m here to tell you there IS more you can do, so don’t be afraid to advocate for yourself. Ask for a referral to a pelvic floor physical therapist, who can give you an internal examination of pelvic floor strength and function, diastasis recti, and screen you for any possible pelvic floor dysfunctions. A trained therapist can individually assess your pelvic floor and help you understand more about your unique situation.

So many women I speak to don’t know where to go to find this kind of help. There are a few places you can go to search for a pelvic health practitioner near you, but one that I love is Pelvic Guru’s directory, where you can search for not just physical therapists but coaches trained in women’s health, doulas, midwives, sex therapists, and more.

If you're experiencing leakage that is a barrier to exercise for you, I would highly recommend a coach like me and many other coaches I know who understand the inner workings of the pelvic floor. These coaches can give you guidance and information while helping you get back to the activities you want to do without leakage, whether that's picking up your kiddo without leaking, or being able to do lots of double unders at a CrossFit competition.