Is it Normal to Pee When You Sneeze?

So you had a baby… congrats! Isn’t it amazing what your body was able to do? You grew a child! You literally grew a few tiny cells to a full blown 6, 7, 8… maybe even 10lb sweet baby. How beautiful. But perhaps now you are experiencing some things that aren’t so beautiful? Maybe your friend says something hilarious; or your hay fever has you sneezing; or you cough after taking a sip of water and…oops…a little pee comes out. Yikes. But that’s normal after having a baby, right? FALSE! Peeing when you sneeze, cough or laugh is common, but it is NOT normal.

What is the pelvic floor?

So let’s start with a little anatomy lesson. Your pelvic floor is a group of muscles that hold the bladder and rectum in place. Think of your pelvic floor as a hammock. It lies on the bottom of your core supporting all your internal organs, and perhaps, a growing baby. The pelvic floor is made up of muscles, and therefore it can be stretched and/or strengthened.

Pelvic floor during pregnancy and postpartum

So now let’s think about pregnancy. For months you grow a baby in your uterus that sits on the pelvic floor. And the combined weight of the baby, the placenta, and extra fluid places quiet a bit of extra weight on these pelvic floor muscles. This causes the pelvic floor to stretch out and the muscles that close the urethra (where the pee comes out) to become weak.

What is normal?

As previously mentioned the pelvic floor is a group of muscles that supports our bladder and rectum. When they are strong and functioning properly we are able to contract and relax them in order to control when we go to the bathroom. Normal pelvic floor function means you should be able to run, jump, etc. without unexpected urine leakage.

What is not normal?

Urinary leakage in women (especially postpartum) is common, but not normal. You shouldn’t leak urine just like you shouldn’t need glasses for “normal” function. When we cough, laugh, sneeze, run, or jump there is increased pressure inside the core and excessive stress is placed on the pelvic floor. This can cause an involuntary leakage of urine and is referred to as stress incontinence.

Stress incontinence

Stress incontinence occurs when the muscles and connective tissue that surround the urethra become weak, which is common after pregnancy. When extra stress is placed upon the pelvic floor these muscles are unable to appropriately contract in order to keep the urethra closed. If left untreated the muscles can continue to get weaker making leakage more common.

Aging and weakness

New moms are not the only women to suffer from pelvic floor weakness and stress urinary incontinence. As we age our muscles and connective tissue can also get progressively weak. Again this can lead to unexpected urine leakage during times when the pelvic floor is unable to withstand extra pressure placed upon on it. Other signs of pelvic floor weakness or dysfunction include trouble having a bowl movement, low back pain, and pain with sex.

How can we fix it?

So what can be done if you believe you have pelvic floor problems? Start with talking to your doctor. Every pregnancy is different and every woman is different so you should always speak with the appropriate medical professional regarding your unique case.

Exercise:

Just like with any muscle, the best way to make it function properly is to make it strength and length. And one of the most common exercises for specifically strengthening the pelvic floor is a kegel. A kegel is a contraction of your pelvic floor muscles. Many describe a kegel as stopping the flow of urine while peeing. Personally my favorite cue for performing a kegel is to imagine drinking through a straw with your vagina. Go ahead and laugh but I bet you’re doing it right now.

But pelvic floor is not just about kegels. The body is a chain and the pelvic floor does not function solo. There are many other muscle groups that need to be considered if you are suffering from incontinence (refer to my “Pop- Can” core post). Some of these muscle groups include your core and your pelvic stabilizers.

Physical Therapy:

If you are peeing when you cough, sneeze, laugh etc. the best thing you can do is seek a referral for women’s health physical therapy. Depending on where you live in the U.S. you may need an script (order) from your doctor.

Physical therapists who specialize in the pelvic floor are are able to evaluate and treat your unique symptoms. No two pregnancies and no two women are the exact same. The muscles that are weak or too tight will not be the same for every woman.

Why do women in the U.S. think it is normal?

So why do so many women think it’s normal to pee after having a baby? The answer is because there is a significant lack of knowledge and discussion about pelvic floor function. Did you know in France women are required to go to a pelvic floor therapist at 6 weeks postpartum and each woman has on average 10 pelvic floor therapy appointments? In the U.S. we have one postpartum visit with our OB, and pelvic floor function is not readily discussed. Hopefully, that can change.

What’s next?

This post just scratches the surface about pelvic floor function and dysfunction. And while this might be longest post I have written to date I wanted to try and keep it fairly short and sweet for now. We could dive much deeper into pelvic floor function, treatment, and prevention but I will save that for another day. Feel free to leave a comment or send me a message with any questions you might have about pelvic floor therapy. Let’s open up about pelvic floor function! 

–Monica