Leak When You Sneeze? How to Conquer Stress Incontinence

Updated: Apr 4

Milk carton leaking—learn how to stop leaking with sneezes! — Learn How to Stop Leaking When You Sneeze!

Think you're alone leaking with sneezes? Think again! According to the NIDDK, almost half of all women leak urine at some point in their lives. Leaking with things like coughing, sneezing, laughing, or exercising is called stress incontinence. We pelvic floor therapists have a saying—while stress incontinence is very COMMON, it is definitely NOT NORMAL. Thankfully, there are some simple exercises and strategies that can help. Let's take a look at why we leak in the first place.

What causes stress incontinence?

It all comes down to physics. The basics of leaking with a sneeze are actually pretty simple: the sneezing pressure from above is too strong a force for the protective core pressure from below to match, and you leak.

Pictorial description with arrows of leakage happening when sneeze is more powerful than core strength, and of being dry when sneeze and core pressures are equal. — The Physics of Sneezing

Let's drill down further. What two major factors affect this physics problem?

Timing—how quickly can your core muscles pull their defenses together to push upward against the impending sneeze?
Power—how powerfully can your core push back against the sneeze? Your core for our purposes here includes the pelvic floor muscles, as well as the abdominals.

So let's break down our simple physics problem even further. Here are three possible scenarios that can lead to leaking with a sneeze:

Good timing, but not enough power (our scenario described above)
Enough power, but delayed timing
Not enough power and poor timing

Pictorial description with arrows of leakage happening when sneeze is more powerful than core strength, when core power is strong enough but contracts too late, and when core power is both too weak and contracts too late, and so leakage occurs. — Three Scenarios of Leaking with a Sneeze

Exercises to help stop stress incontinence

Now that you understand better why you may be leaking, let's talk about 3 simple exercises you can try at home to conquer the physics of sneezing.

Kegels (pelvic floor muscle contractions)—for increasing pelvic floor muscle strength
Tummy tuck—for increasing the strength of the deepest layer of abdominals (transversus abdominis), which help increase the power of the pelvic floor
"Knack"—for perfecting the timing of the abdominals and pelvic floor during coughing and sneezing

Kegel

Your goal is to be able to quickly and powerfully lift up at your pelvic floor, to help close off the urethra during a cough or sneeze to prevent any leakage.

Lie in a comfortable position on your back. If you are currently pregnant, be sure you are supported in a partially upright position with pillows under your head and shoulders. Now bend your knees and place your feet on the floor/bed.
Long Kegels: Contract your pelvic floor muscles up and in, as if you are stopping your urine stream, and hold the contraction for up to 10 seconds; then relax for 10 seconds. Repeat for 10 repetitions, 1-2 times per day.
Short Kegels: Quickly contract your pelvic floor muscles up and in and hold for 1-2 seconds, then fully relax for 1-2 seconds. Repeat for up to 30 repetitions, 1-2 times per day.

It is important to do both these short- and long-hold kegels for maximum benefit. Remember to breathe throughout!

Tummy tuck

This exercise targets the transversus abdominis, the deepest of your four abdominal muscle layers and one of the pelvic floor's most powerful allies.

For this exercise, start by sitting in good, tall posture with your feet firmly on the floor. Remember to focus and move your tummy, not your spine during this exercise.

First, let your tummy fully relax
Then, draw your lower tummy inward and hold for a count of up to 10 seconds; if you are able, pull up and in with your pelvic floor muscles at the same time. Keep breathing throughout the exercise.
Relax and let tummy muscles fully relax again, for up to 10 seconds.
Repeat for 10 repetitions, once per day

The "Knack"

This exercise helps to work on the timing of your core contraction as you cough or sneeze.

Sit up tall in chair, feet on floor.
Do Kegel (pelvic floor muscle contraction); hold the contraction as you clear your throat. (As you get better at this exercise, you can do Kegel AND pull in tummy.)
Relax.
Repeat 10 times.

The goal of this exercise is to practice pre-tightening the pelvic floor muscles quickly, prior to feeling the pressure from above as you clear your throat. You should feel balanced at your pelvic floor—no downward pressure.

Consistency is key. You may see improvement in stress incontinence as little as 2 weeks. Keep it up for 6 weeks to see a significant jump in strength and the biggest drop in leakage. Stick with it by making your exercises your new routine!

There is no better time than the present, so what are you waiting for?

Conquer your physics—start exercising and stop leaking!

Remember: it is important to check with your healthcare practitioner BEFORE starting any new exercise program. Certain exercises, such as Kegels, are not indicated for everyone. If you have just had a baby, your physician/healthcare provider will tell you when it is safe to return to exercise. If you are unsure that you are doing these exercises correctly or have any pain, stop and discuss with your healthcare practitioner, or schedule a virtual appointment with me.

About the Author:

Angela is a licensed physical therapist and owner of My Pelvic Therapy, an innovative virtual physical therapy practice designed to provide discreet, at-home solutions for women navigating common pelvic floor problems such as bladder leakage, pelvic organ prolapse, and discomfort during intimacy. She received her physical therapy degree from Duke University, biology degree from University of Illinois, and has been a pelvic health specialist for over 20 years.

You can contact Angela at angela@mypelvictherapy.com. You can also find her on LinkedIn , Instagram, and Facebook.