Updated: Sep 11
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. We pelvic floor therapists have a saying—while leaking during a cough or sneeze is very common, it is definitely not "normal". Thankfully, there are some simple exercises and strategies that can help. But I'm getting ahead of myself—first we have to understand why we leak in the first place.
What causes bladder leakage
It all comes down to physics. (I know, I can hear the groans from here, but bear with me...) 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.
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
Exercises to help stop leakage
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.
Pelvic floor muscle contraction, aka, "kegel"—for increasing your core strength, specifically the pelvic floor muscles
Tummy pull-in—for increasing your core strength, specifically the transversus abdominis
"Knack"—for perfecting the timing
Teaching someone how to do a pelvic floor muscle contraction correctly is a whole separate discussion. For now, see this resource for the "how" of a kegel, and if you struggle with doing it correctly, talk with your healthcare practitioner or make an appointment with me. For our purposes in this article, we are going to focus on the "how much" of kegels. Your goal is to be able to quickly and powerfully lift up at your pelvic floor, to help close off the urethra during a sneeze and prevent any leakage.
Contract your pelvic floor muscles quickly and hold for 3 seconds, then relax for 5 seconds; repeat for 10-15 repetitions.
Contract your pelvic floor muscles and hold for 10 seconds (or as long up to 10 that you can manage), relax for 10 seconds, and repeat for 10 repetitions. Remember to continue to breathe throughout this exercise—no breath holding!
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 relax and sag. (You can do it! It's important.)
Then, draw your lower tummy inward and hold for a count of 10 seconds (or as long up to 10 that you can manage); 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 relax and sag again, for 10 seconds. Repeat for 10 repetitions.
This exercise helps to work on the timing of your core contraction as you sneeze.
Sit up tall in chair, feet on floor.
Do kegel (pelvic floor muscle contraction); hold the contraction as you clear your throat.
Repeat 10 times.
The goal of this exercise is to practice pre-tightening the pelvic floor muscles quickly, prior to the pressure from above such as with a sneeze or clearing your throat. You should feel balanced at your pelvic floor—no downward pressure.
Consistency is key. While it may take up to 4-6 weeks to see a significant jump in strength and drop in leakage, you may see improvement in as little as 2 weeks. So stick with it!
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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.
As the saying goes, there is no better time than the present, so what are you waiting for?
Power up your pelvis and conquer your physics!
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About the Author:
Angela is the owner of My Pelvic Therapy, PLLC and a licensed physical therapist. Prior to starting her telehealth private practice, she worked as a senior physical therapist for 17 years at Advocate Lutheran General Hospital in Park Ridge, IL, specializing in helping both women and men overcome their pelvic floor challenges. She received her physical therapy degree from Duke University, biology degree from University of Illinois, and is a lifelong learner of all things PT.
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