What is Happening?
When you cough or sneeze, your body experiences a sudden increase in abdominal pressure. This pressure pushes down on your bladder and the structures that keep urine contained. Normally, a system of muscles and tissues prevents leakage during such moments.
The pelvic floor muscles form a sling-like support at the base of the pelvis, holding the bladder, bowel, and in women, the uterus in place. These muscles, along with two urethral sphincters, control urine flow. When functioning effectively, these muscles tighten to keep the urethra closed against sudden pressure, preventing urine from escaping.
However, if this system is weakened, the increased pressure from a cough or sneeze can temporarily overcome the urethral closure. This leads to involuntary urine leakage, known as stress urinary incontinence (SUI).
Why This Happens
Many factors can contribute to the weakening of the pelvic floor muscles or increase the likelihood of stress urinary incontinence. Childbirth, particularly vaginal deliveries, can stretch and damage the pelvic floor muscles and nerves. The risk may increase with multiple births, assisted deliveries, or a large baby.
Aging also plays a role, as pelvic floor muscles can naturally weaken over time. In women, hormonal changes associated with menopause, such as lower estrogen levels, can affect the elasticity of tissues supporting the bladder and urethra. Excess weight, or obesity, consistently increases pressure on the pelvic floor, leading to muscle weakness and a higher risk of leakage.
Chronic coughing, often seen in individuals who smoke or have conditions like asthma or allergies, repeatedly stresses the pelvic floor. Activities involving high impact, such as running or jumping, and heavy lifting can also exert significant downward pressure, potentially leading to or worsening SUI. Certain surgical procedures, like prostatectomy in men, can affect the muscles and nerves involved in urinary control. Genetic factors may also influence an individual’s susceptibility to urinary incontinence.
Everyday Approaches to Management
Several non-medical strategies can help manage and reduce the symptoms of stress urinary incontinence. Pelvic floor exercises, commonly known as Kegels, are a primary approach to strengthen these supportive muscles. To perform a Kegel correctly, tighten the muscles as if stopping the flow of urine or holding back gas, feeling a lifting sensation. Focus on engaging only the pelvic floor muscles, avoiding the abdominal, thigh, or buttock muscles, and breathe normally. Regular practice is important for effectiveness.
Lifestyle adjustments can also make a difference. Managing body weight can reduce chronic pressure on the pelvic floor. Avoiding bladder irritants like caffeine and alcohol might lessen bladder urgency and leakage for some. For those with chronic cough, addressing the underlying cause, such as quitting smoking, can reduce repeated stress on the pelvic floor.
Behavioral techniques offer immediate relief during activities that trigger leakage. “The Knack” involves consciously contracting the pelvic floor muscles immediately before a cough, sneeze, or lift. This pre-emptive squeeze helps increase urethral pressure and provide upward support, counteracting the downward force. Practicing good posture can also reduce abdominal pressure on the bladder.
When to Consider Professional Help
While everyday approaches can provide significant improvement, it is important to recognize when professional medical advice is beneficial. If leakage is frequent, interferes with daily activities, or causes distress, consulting a healthcare professional is a sensible next step. Urinary incontinence is a common and treatable condition, and seeking help can lead to effective management.
A doctor can assess your symptoms, conduct a physical examination, and may suggest tests to determine the specific type and cause of your incontinence. These evaluations might include keeping a bladder diary or specialized tests that measure bladder function. Based on the assessment, a healthcare provider might recommend a referral to a pelvic floor physical therapist, who can provide personalized guidance and exercises.
Additional professional treatment options exist, ranging from medical devices like pessaries, which support the urethra, to certain medications that help improve urethral tone. For cases where conservative measures are not sufficient, minimally invasive procedures or surgical options may be considered. Openly discussing symptoms with a doctor is a step towards finding suitable solutions and improving quality of life.