Do you pee a little when you laugh?  What about when you sneeze, cough, or bend over?  And, I hate to ask, but do you always wear panty liners all day or carry extra underwear “just in case” you have an accident? Well, peeing while laughing, sneezing, coughing, or doing certain exercises or activities is very common among women.  The medical term for this is stress incontinence.  And, stress incontinence occurs because of weakened or stretched out pelvic floor muscles and tissues. 

Stress incontinence can be embarrassing.  In fact, sometimes it is smelly because of the urine leakage and pads.  As a result, you may avoid certain activities and isolate yourself from friends and social situations.  And, here’s another interesting thing.  Men also suffer from stress incontinence and weak bladder muscles.  Of course, the causes in men are different than in women.  However, you can imagine the secrecy and embarrassment that they also go through.

So, let’s talk about peeing while laughing and those other moments.  And, there’s no need to be embarrassed.  It’s just you, me, and a terrific group of sisters. 

Strong Pelvic Muscles Prevent Stress Incontinence

Now, hang in here with me for a brief anatomy lesson on the pelvic muscles and how they affect stress incontinence. Pelvic floor muscles are the layer of muscles that support the pelvic organs.  In women, the pelvic organs are the uterus, bladder, and bowel.  And, for men, they are the bladder and the bowel.  Strong pelvic muscles give us control over when we go to the bathroom.  In other words, they help us control when we pee, poop, and pass gas.

So, you don’t want to miss this part.  Strong pelvic muscles are also needed for sexual function.  In men, it is important for erectile function and ejaculation.  And, in women, they are needed for arousal and orgasms.  Let me put this another way.  If you’re peeing while laughing, then you’re probably also not having strong orgasms.  Additionally, it might mean that you’re avoiding sex because you also might pee while you’re having sex. 

The pelvic floor muscles stretch like a mini trampoline in two directions.  They stretch front and back from your tailbone to the pubic bone and from side to side from one sitting bone to the other.  The pelvic floor muscles have holes for the urethra (peeing), vagina (sex and childbirth), and anus (pooping).  Additionally, these muscles support the baby during pregnancy and assist in birthing.  Furthermore, the pelvic muscles work with the core muscles of the abdomen and back to stabilize and support the spine. 

In extreme cases, weak pelvic muscles and ligaments can cause uterine prolapse, which is a rare cause of stress incontinence.  A uterine prolapse occurs when the uterus descends toward or into the vagina.  And, unfortunately, in some cases, the uterus protrudes from the vaginal opening.

Weak Pelvic Muscles Cause Stress Incontinence

Weakened and loose pelvic floor muscles put extra stress on the bladder.  As a result, this causes peeing while laughing, sneezing, coughing, etc. So, what causes weak pelvic muscles?  The most common reasons are:

• Pregnancy
• Pregnancy with multiple children (twins, triplets, etc.)
• Vaginal childbirth
• Multiple vaginal childbirths 
• Chronic constipation and straining on the toilet
• Heavy lifting
• Muscle strain
• Obesity
• Other conditions associated with aging

The bottom line is that these conditions may cause your bladder to drop because your pelvic floor muscles cannot properly support it.  Additionally, the muscles that close the urethra loosens, which means that you can’t control your pee when you laugh, sneeze, cough, etc.

Change Your Eating and Drinking Habits to Prevent Stress Incontinence

Several foods and drinks can irritate your bladder or act as a diuretic (which makes you pee more often).  Generally, spicy foods ( e.g. hot peppers and hot sauce) and citrus fruits may contribute to stress incontinence. 

However, for most people, the biggest improvements in stress incontinence may be seen by eliminating beverages that contain caffeine (e.g., tea, coffee, and carbonated sodas with cola).  Additionally, you will also need to reduce or eliminate alcohol, which acts as a natural diuretic.

Reduce Your Fluid Intake to Prevent Stress Incontinence

So, in addition to reducing your caffeine and alcohol intake, you may need to reduce how much fluid you drink to prevent and treat stress incontinence.  Now, let me break this down for you.  You need to drink 8-10 cups of water daily to stay hydrated and meet your body functions.  However, if you drink more fluid than that, you may need to reduce your fluid intake.  So, this means reducing your intake of juices, teas, coffee, etc., before you reduce your water intake. 

Additionally, you may need to reduce how much liquid you have in the evening and at bedtime to prevent too much peeing at night or even wetting the bed.  So, if you’re really thirsty in the evening, suck on a few ice chips.

Make Other Lifestyle Changes for Stress Incontinence

So, there are other lifestyle changes that can improve stress incontinence.  These include losing weight if you’re overweight or obese, quitting tobacco use, and preventing constipation.

Weighing too much puts extra on your bladder and pelvic floor muscles. However, even moderate weight loss may significantly improve your symptoms.  You can also learn how to set SMART weight loss goals to help manage your weight. 

If you smoker, this is another reason to quit.  So, nicotine and other chemicals in tobacco irritate the bladder and increase the urgency to pee.  And, if you drink and smoke, you not only increase your risk for certain cancers, you also increase your risk for stress incontinence.  Enough said.

Believe it or not, constipation contributes to stress incontinence.  Straining to poop increases abdominal pressure and stimulates nerves near the rectum.  As a result, it  increases urinary frequency.  So, eat more fruits, vegetables, and whole grain foods to prevent constipation.  In some cases, you may need to use a stool softener.   

And by the way, if you have a chronic cough, have it evaluated by your doctor.  Asthma, allergies, or medication side effects are common causes of a chronic cough.

Strengthen Pelvic Muscles with Kegel Exercises

Although you cannot see your pelvic muscles, you can train them like any other muscles.  And, by far, Kegel exercises are the most common pelvic floor exercises.  Women use Kegel exercises to tighten their pelvic and vaginal muscles to improve their sex life.  And, the good news is that women also use Kegel exercises as a non-surgical way to prevent and treat stress incontinence. 

And, I’m not stopping here.  Women can do Kegel exercises during pregnancy to prevent loose pelvic floor muscles and to strengthen these muscles for the birthing process.   Furthermore, older women can be proactive in keeping their vaginal and pelvic floor muscles healthy and tight with Kegel exercises. 

How to Do Kegel Exercises to Prevent Stress Incontinence

• Locate your pelvic muscles. To find your pelvic floor muscles, stop peeing in midstream. Did you stop the flow?  Yeah!!! You’ve found your pelvic muscles.  Now, empty your bladder, flush, and move to a new location to practice these exercises.  Always practice these exercises on an empty bladder.
• Tighten and release.  Tighten your pelvic floor muscles for 5 seconds. Then, relax them for 5 seconds.  Now, repeat the tightening and relaxing 5 times.  Do not hold your breath, and breathe normally. Take it slowly your first few days. However, you want to work up to tightening and releasing for 10 seconds at a time.
• Stay focused.  Now, this is important.  Do not tighten the muscles in your butt, abs, or thighs when you do these exercises.  Focus on isolating, tightening, and releasing only your pelvic muscles. 
• Repeat three times a day. Do three sets of 10-15 repetitions three times a day.
• Do Kegel exercises anywhere. Well, the great thing about these exercises is that nobody knows you are doing them.  So, go ahead and do them at the stop light, at your desk at work, or while waiting in the grocery line.  The possibilities are endless. 

Consider Using a Kegel Training Device

Now, I’m going to take this up a notch.  You may also want to try Kegel exercises with a pelvic
floor muscle exerciser.  These digital devices are inserted into the vagina and provide feedback on your progress and whether you’re doing the Kegel exercises correctly.  Ahh, the joys of technology.

I know what you’re thinking, so I will go ahead and say it. Yes, you may get some extra tingles down there.  But, is that really a problem or an added benefit?

Seek Medical Treatment for Stress Incontinence

Now, I am calling you out on this.  While peeing while laughing, sneezing, and coughing is common, it is not normal.  And, it should not be your “new normal.”  Here is the thing, and, I want you to answer honestly.  Have you been to the doctor for this issue?  If not, why not? 

So, ladies, let’s pull the panty liners off and admit that peeing while laughing is a medical problem.  And, if you’ve tried all the things discussed above, then, you also need to consider some other options for stress incontinence.  These medical options will work alongside with your lifestyle changes and Kegel exercises.

Ask Your Doctor about Using a Pessary for Stress Incontinence

Lifestyle changes, training your bladder, and daily Kegel exercises work for most women with stress incontinence.  However, if these are not effective, your gynecologist or urologist may also recommend a pessary.   So, using a pessary is a non-surgical, effective way to treat stress incontinence. It is a soft flexible device that is inserted into the vagina.  And, the great thing is that pessaries come in different shapes and sizes, which ensures the best fit for you.  

Furthermore, many pessaries can be used during intercourse.  So, be sure to ask your doctor about this. Other questions to ask your doctor about a vaginal pessary include:

• Am I a good candidate for it?
• How will it improve my stress incontinence?
• Is it comfortable and easy to use?
• What are the advantages and disadvantages of using it?
• Will it prevent my need for corrective surgery?
• How will it affect my sex life? 
• Will it increase my risk for urinary tract infections or vaginal infections?
• How will I know if the vaginal pessary slips out of place?

Consider Prescription Medication for Stress Incontinence

Depending on your case, your doctor might recommend medication to treat stress incontinence.  Medications are usually used for mild to moderate cases to:

• Relax bladder muscles
• Reduce bladder contractions and leakage
• Strengthen pelvic floor muscles

Collagen injections is another option for stress incontinence.  For this procedure, collagen (or another bulking agent) is injected around the urethra to narrow it.  And, the narrowing can help stop leakage and, eventually, stress incontinence.  Multiple treatments are needed over time.

Ask Your Doctor about Surgery for Stress Incontinence

If your stress incontinence doesn’t respond to any of the above treatment that are less-invasive, you may need a surgical procedure.   More than likely, this involves placing a sling to support the urethra.  However, this is the last option when other treatments have failed. 

Now, It’s Your Turn

Well, I hope you feel more educated about stress incontinence and why you pee when you laugh, sneeze, or cough.          

I really encourage you to:

1. Make an appointment to talk to your doctor about stress incontinence
2. Modify your food and beverage choices
3. Make other lifestyle changes
4. Start doing Kegel exercises every day 

We look forward to hearing about your experience in the comment section of this blog.  You can also join the conversation on the Keep It Tight Sisters Facebook Group.

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