Do you pee when you cough?
If you answered yes, it's likely you've got stress urinary incontinence (SUI). The good news is that you’re not on your own—Millions of people have some form of SUI. And because it’s often an embarrassing and taboo subject, there's probably a lot more people out there with bladder leaks who are yet to be diagnosed.
Both men and women can have SUI, although it tends to be more common in women with one-third of women in the UK experiencing SUI (1).
Your diagnosis of SUI doesn't have to be the end of your story. Did you know that strengthening your pelvic floor muscles can put an end to your bladder leaks?
In this blog post, we’re going to take a look at what causes you to pee when coughing and how to put an end to those pesky leaks.
Stress Incontinence
Stress incontinence is an unintentional urine leak caused by pressure or 'stress' on the bladder. It occurs when the pelvic floor muscles, which support the bladder and control urinary function, become weakened. This weakening can result from various factors such as childbirth, pregnancy, aging, menopause, obesity, chronic coughing, or pelvic surgery.
Types of incontinence
There are a few other types of stress urinary incontinence including:
Urge Incontinence: Also known as "overactive bladder," urge incontinence involves a sudden and intense urge to urinate, often leading to involuntary urine leakage before reaching the bathroom. It's typically caused by bladder muscle spasms or nerve damage, resulting in an overactive bladder.
Mixed Incontinence: Mixed incontinence is a combination of stress and urge incontinence, where individuals experience symptoms of both types. This can involve leakage during physical activities as well as sudden urges to urinate.
Overflow Incontinence: Occurs when the bladder doesn't empty completely, leading to frequent or constant dribbling of urine. It's often caused by an obstruction or blockage in the urinary tract, such as an enlarged prostate in men or a urinary tract infection.
What causes a weak bladder when coughing?
There are many different causes of urinary incontinence, and one of the most common causes is a weak pelvic floor. The pelvic floor muscle is the shape of a hammock that runs from the frontal pubic bone to the base of the spine and sits below the bladder, uterus, and bowel. The pelvic floor muscles give you the control you need when you have a wee or poo. But if the pelvic floor muscle is weak due to damage (more on this in a bit), when you cough it can’t provide enough support to keep the urethra closed. Therefore, when pressure is placed on it, that’s when you may leak (2).
If you find that you're coughing regularly, your pelvic muscles may weaken from the repetitive strain occurring when you cough, and this can cause bladder leaks. So stress urinary incontinence tends to be common with people with chronic chest conditions such as:
- Bronchiectasis
- Asthma
- Chronic obstructive pulmonary disease (COPD) (2)
However, there are other causes of stress incontinence and these include:
- Pregnancy
- Childbirth
- Being overweight
- Damage to the bladder during surgery. For example, a hysterectomy, or the removal of the prostate gland
- Neurological conditions
- Certain medicines
- Connective tissue disorders (3,4)
Although the above causes of SUI aren’t directly related to coughing, when you have SUI and you cough, laugh, or sneeze, you may find that you leak.
What happens when coughing
When you cough your tummy muscles contract, this then places pressure on your pelvic floor muscles and bladder. Because the pelvic floor muscles have contracted, this stops you from peeing and all this happens without you needing to think about it.
However, when you have a weak pelvic floor, it's thought that the prolonged and constant coughing places pressure on the pelvic floor muscles. This can weaken the muscles and, therefore, bladder leaks are more likely to happen (2).
What Causes Stress Incontinence?
- Pregnancy and childbirth increase pressure and stretch on pelvic floor muscles.
- Weight gain can strain pelvic floor muscles.
- Hormonal changes during pregnancy and menopause affect pelvic floor tissue strength.
- Chronic constipation or heavy lifting can also strain pelvic floor muscles.
Prevention
Prevention of bladder prolapse involves adopting healthy lifestyle habits. Firstly, quitting smoking is crucial as it reduces the risk of developing conditions that can weaken pelvic muscles. Additionally, maintaining a healthy weight or losing weight if necessary helps alleviate pressure on the pelvic floor, and reduces the likelihood of prolapse.
Engaging in regular pelvic floor exercises, especially during pregnancy and after childbirth, strengthens these muscles, providing better support for the bladder and surrounding organs.
Taking measures to prevent constipation, such as consuming a high-fiber diet and staying hydrated, reduces strain during bowel movements, which can contribute to pelvic floor weakness and prolapse. These preventive measures collectively contribute to maintaining pelvic floor health and minimizing the risk of bladder prolapse.
Diagnosis
One common diagnostic approach involves keeping a diary of urination habits. This diary can help identify patterns and triggers of urinary incontinence, providing valuable information for the healthcare provider to determine the underlying causes of the problem.
Additionally, a healthcare provider may conduct a physical examination of the abdomen and genitals. This examination allows for the assessment of pelvic nerve function and the identification of any physical abnormalities or signs of infection.
- Urinary pad test: You wear an absorbent pad(s) for 24 hours at home. Your provider weighs the pad after use to determine the volume of leaked urine.
- Bladder scan: A brief ultrasound in your healthcare provider’s office to make sure you are emptying your bladder when you pee.
- Ultrasound: A pelvic or abdominal ultrasound assesses the health of the bladder, kidneys and other organs.
In some cases, further diagnostic tests may be necessary to evaluate bladder function and identify underlying conditions. These tests may include:
- Urine Sample Analysis
- Urinalysis
- Neurological Examination
- Bladder Function Tests.
How to Stop Incontinence When Coughing
There are a few options to stop bladder leaks when coughing. Let's dive into three of them below.
1. Kegel Exercises
Practicing Kegel exercises or pelvic floor exercises daily can reduce your bladder leaks by strengthening your pelvic floor and is probably the first treatment your doctor will recommend. You can do Kegels on their own or using Kegel weights, or internal devices, such as an electrical probe.
Using vaginal weights can be uncomfortable and may cause problems. For example, you may find that the weights get stuck, cause tearing, or poor cleaning of the device can lead to infections. Also, if you use the weights too much, you may find that your muscles become too tight which can lead to pain during sex (5).
Doing Kegel exercises can be tricky because it’s easy to squeeze your tummy or thigh muscles rather than your pelvic floor. They can also be time-consuming, and let’s face it, we’d all rather be doing something other than Kegels.
2. Muscle-strengthening techniques
Muscle-strengthening techniques, such as vaginal cones, biofeedback, and electrical stimulation, offer effective options for managing stress incontinence. Vaginal cones, small devices inserted into the vagina, improve pelvic floor strength over time, reducing symptoms through targeted muscle training.
Biofeedback provides real-time feedback on muscle activity, enhancing coordination and control. Electrical stimulation uses low-voltage currents to strengthen muscles and alleviate urinary urgency and frequency associated with stress incontinence.
3. Controlled coughing and techniques.
Controlled coughing and the airway clearance technique can help reduce the amount of leakage when you cough. How do you do this? Simply sit upright with a straight spine before you cough. This technique can help you to clear your airway, as research has shown that your pelvic floor works best in this position.
There’s also a technique called ‘The Knack’. To do this, tighten and lift your pelvic floor muscles before you cough to protect your pelvic muscles from weakening (2).
4. Lifestyle changes
There are a few lifestyle changes you may want to make to stop your leaks when coughing, such as:
- Losing weight, this reduces the pressure that's placed on your pelvic floor muscles when you cough
- Cutting out caffeine and alcohol
- Avoid foods like artificial sweeteners, carbonated beverages, chocolate, citrus fruits and tomatoes, spicy foods
- Stopping or cutting down on smoking (6)
4. Medications
Medications for pelvic floor issues, like duloxetine (Cymbalta) for stress incontinence, can strengthen muscles but may have side effects and long-term risks. Botox injections can alleviate urge incontinence by relaxing bladder muscles. However, both options should be carefully considered with a healthcare provider due to potential complications.
5.Surgical Options:
Surgical interventions for pelvic floor issues include repairing weakened muscles or tissues. Procedures such as pelvic organ prolapse repair or sling surgeries address urinary incontinence. Stress incontinence treatments for women may involve vaginal estrogen therapy, insertable vaginal pessaries, urethral injections, or sling surgeries, each targeting different aspects of pelvic floor support to reduce urine leakage.
Future Complications From SUI’s
Stress incontinence can lead to complications such as skin irritation, infections, sleep disturbances, and mental health issues. It can also limit activities and impact intimacy. Seeking prompt treatment is essential to mitigate these effects and improve quality of life.
Control bladder leaks when coughing with INNOVO
The number one way to control your bladder leaks when coughing is to strengthen your pelvic floor muscles. Choosing to strengthen your pelvic floor can be time-consuming, and using internal devices can be dangerous. INNOVO helps you to do your pelvic floor exercises perfectly by doing them for you (all 180 of them). In fact, they’re so effective that research shows that 87% of INNOVO users were defined as dry, or almost dry, after 12 weeks (7).
Find out how INNOVO can put an end to your bladder leaks and how you can get back to coughing leak-free
Sources
- Bladder & Bowel Community. Stress Urinary Incontinence (SUI). Published September 2021.
- Guy’s and St Thomas’ NHS. Chronic Coughing and Urinary Incontinence. Reviewed April 2016.
- NHS. Urinary Incontinence Causes. November 2019
- Mayo Clinic. Stress Incontinence. March 2020.
- Medline. Kegel Exercises. Review October 2021.
- Medical News Today. Is Urine Leakage While Coughing Normal. September 2017.
- R. Dmochowski – Novel external electrical muscle stimulation device for the treatment of female stress urinary incontinence: randomized controlled noninferiority trial versus intravaginal electrical stimulation. ICS Conference 2018.