Why Do I Pee When I Cough?

TEAM KNIX / YOUR BODY

Peeing a little bit when you cough, or laugh, or during exercise is not unheard of. This kind of urinary incontinence in women can affect us for four main reasons:

  1. You already needed to pee and your ability to ‘hold it in’ is compromised when you have a sudden physical exertion. In this case, making sure you heed the need to pee in a timely fashion should take care of the problem.
  2. You’re experiencing temporary incontinence. This can be caused by many things, which we’ll dive deeper into in the next section.
  3. However, if this is less a one-off accident and more a pattern that happens, you might be experiencing a form of incontinence called “stress incontinence”.
  4. You have “mixed incontinence”, which is a combination of stress incontinence and urge incontinence. Urge incontinence usually manifests as a sudden urge to urinate, which may result in urine leakage.

What Would Cause *Temporary* Incontinence?

Urinary incontinence can be brought on temporarily for a number of reasons. Most of the causes of temporary urinary incontinence in women are not too medically concerning.

Causes of temporary urinary incontinence include eating hot and spicy foods, or drinking too much. If this applies to you, it should pass in a relatively short time and it shouldn’t cause any stress—aside from maybe encouraging a little more restraint next time you’re eating or drinking!

Temporary urinary incontinence can also be a side effect of certain medications. Your doctor or pharmacist will usually caution you if this is the case with a medication you’ve been prescribed. If it gets too much, you can work with your doctor to explore alternative treatments.

One cause of temporary incontinence that does warrant a visit to your doctors is a urinary tract infection (UTI). Other symptoms of a UTI include a burning sensation when you pee or blood in the urine.


Stress Urinary Incontinence SUI Explained

It might surprise you to know there are different kinds of incontinence. You can read about all 5 types of urinary incontinence here.

But if you are peeing when you cough and it’s a more persistent (every day or thereabouts) experience than temporary incontinence can explain, it’s likely you have stress urinary incontinence

Stress urinary incontinence has nothing to do with emotional stress, but is about physical exertion. This can be the obvious physical exertion of doing exercise. But it can also include bodily functions and involuntary reactions like coughing, sneezing, even laughing, which cause an involuntary release of urine.

In fact it stress incontinence occurs during any of the following:

  • Coughing or sneezing
  • Laughing
  • Bending over
  • Lifting heavy objects
  • Exercise
  • Have sex

When you cough, for example, there’s a lot of exertion: Your abdominal muscles, diaphragm and intercostal muscles push the air out of your lungs and your vocal chords, your throat and even eyelids muscles play a role. In other words, your body is working! With all that bodily stress, weaker muscles can “falter” in those moments and that can cause  a small amount of urine  to leak.

But why would the muscles in your urethra and bladder be weakened? Well, the pelvic floor muscles are just like any other muscle: They can be injured or damaged. And they can also be weak if not exercised.

Causes of Stress Incontinence in Women

Damage to the pelvic floor muscles or the muscles of the bladder and urethra can happen to women due to childbirth or trauma from surgery (e.g. hysterectomy).

And weakened muscles can happen because of aging (menopause) and lack of exercise. This is one of the reasons why pelvic floor exercises (exercising the pelvic floor muscles) come up so often in relation to urinary incontinence.

Additional factors that increase the risk of stress incontinence include:

  • Age
  • Being overweight
  • Smoking
  • Family history
  • Other diseases (e.g. diabetes, MS, Parkinson’s Disease)
  • Having been through pregnancy and childbirth
  • Having undergone certain pelvic surgeries (e.g. hysterectomy)
  • Dementia 

Lifestyle Changes You Can Make to Manage Stress Incontinence

50% of people who experience incontinence do not seek help. But whether incontinence is temporary or persistent, there are lifestyle changes you can make to manage and have excellent quality of life while living with incontinence.

  • Reduce risk factors: If you want another reason to quit smoking, reduce alcohol consumption or maintain a healthy weight, here it is. Of course, you can do these things for myriad medical reasons and while they don’t come with guaranteed health outcomes, the risk of many diseases and conditions will be lessened.
  • Do Kegel exercises / pelvic floor muscle training: These exercises strengthen the weakened pelvic muscles, which support the bladder, uterus, small intestine and rectum. There’s no reason to wait to start doing pelvic muscle exercises. But they may help even if started at a later stage.
  • Try products like leakproof underwear: Experiencing incontinence can cause a great deal of embarrassment. It even prevents some people from participating in events and outings, leading to isolation, depression and shame. While you explore treatment options with your doctor, you can also explore products to help you stay active and social. Leakproof underwear comes with different absorbency levels, that can hold up to 8 tsp of pee.

While lifestyle changes are easy to make, we don’t at all suggest those changes replace medical advice. 

When to Seek Medical Advice for Stress Incontinence

It is never a good idea to use “Dr Google” to self-diagnose, so we definitely recommend booking some time to discuss your experience of incontinence with your healthcare provider. They will be able to confirm you do indeed have stress incontinence, or if it could be mixed urinary incontinence.

They’ll also want to conduct a complete pelvic examination and study your medical history to better understand possible causes that might point to certain treatment options. While it’s great to go into the doctor’s office informed, let them be the ones to draw conclusions on a firm diagnosis.

When you do make the time to talk to your doctor, it always helps to be prepared. Write down the questions you want to ask and anticipate the questions they might ask you!

These are some of the questions your doctor may ask about your experiences of urinary incontinence:

  • How long have you been experiencing these symptoms?
  • Have your symptoms been continuous or occasional, have they worsened over time?
  • How often do you need to urinate?
  • When (time of day or night) do you leak urine?
  • Is it difficult for you to empty your bladder?
  • Have you noticed any blood in your urine?
  • General lifestyle questions: Smoking, diet, alcohol and caffeine consumption etc.

And here are some questions you might ask your doctor:

  • What type of incontinence do I have?
  • What is causing my urinary incontinence
  • What tests should I expect?
  • Should I make lifestyle changes, like:
    • Bladder diary
    • Kegel exercises
    • Timed bathroom breaks
    • Diet changes, etc.
  • What treatment(s) do you suggest for me and why?
  • Without treatment, what will happen?
  • What are the side effects or risks associated with this treatment plan?

Incontinence is not an easy thing to experience, but there are treatment options and lifestyle changes that can make it easier to live with incontinence. 

Stress Incontinence Treatments You Might Explore with Your Doctor

As you explore treatments for stress incontinence with your doctor, some combination of the following may be discussed.

Pelvic Floor Muscle Exercises & Biofeedback

Kegel exercises are something you can do yourself as part of general health and fitness but your doctor may recommend them too. They can also teach you how Kegel exercises strengthen your pelvic floor muscles and sphincter, as well as how to do them. Just like any exercise regime, Kegels require consistent practice to have any effect.

Biofeedback can also be used along with Kegel exercises to increase effectiveness. This involves the use of pressure sensors or electrical stimulation to reinforce certain muscle contractions.


Fluid Consumption & Bladder Training

Your healthcare professional may also recommend making changes to the fluids you consume, and when you consume them. Of course, it’s important to stay hydrated. But they may suggest cutting back on caffeinated, carbonated beverages and/or alcohol. If these simple changes have an effect, it will be a personal decision whether to make more permanent dietary changes.

In addition to curtailing certain beverages, your doctor may advise bladder training. This involves taking bathroom breaks at regularly timed intervals. By ensuring your bladder is emptied frequently, you minimize the chances of leakages. Over time, the time between breaks can be increased. This course of action might be especially effective for those with mixed incontinence.

Devices

Devices that can be used to control stress incontinence include vaginal pessaries and urethral inserts.

  • Vaginal Pessary: This is a soft, removable device that is inserted in the vagina. It supports areas that are affected by pelvic organ prolapse (POP).
  • Urethral Insert: A small tampon-like disposable device inserted into the urethra acts as a barrier to prevent leakage, while still allowing you to pee.

Surgery

Finally, under certain circumstances, you may need surgery. Your doctor might  explore surgery options for stress incontinence. These will usually help strengthen the bladder neck or improve closure of the sphincter. Surgery often offers a more long term solution to involuntary urine leaks.  However, as with any surgery, there are risks to explore and you might want to try  exploring other options before you undergo surgery.