Why You Leak When You Cough or Sneeze

Medically reviewed by Dr. Jennifer Conti, MD

For many people, leaking is more of a nuisance than it is a huge disruption of their day-to-day. For those same people, that can all change at the start of cold and flu season or allergy season. Coughing, sneezing, jumping, laughing, and many other seemingly small physical exertions are common leak triggers for people with stress incontinence. To be clear, research *has* shown that stress and anxiety can up your odds of leaking, but stress incontinence refers to physiological stress (meaning your body, not your mind).

But what is it that causes incontinence when coughing or sneezing? And other than crossing your legs or running to the nearest bathroom, what’s a leaker to do? Lindsey Vestal, owner of The Functional Pelvis and all-around pelvic health expert, explains why stress incontinence is a thing, and what you can do to manage leaks when they’re triggered.

Causes of stress incontinence

Every person has unique triggers when it comes to stress incontinence, but Lindsey says all of them are rooted in your intra-abdominal pressure system. Every single time you breathe (approximately 20,000 times a day!), your diaphragm expands, putting pressure on everything that sits beneath it in your body. Theoretically, your pelvic floor muscles should always rise to the occasion by keeping your insides buoyed and protected.

If you leak when you sneeze or cough, it means your pelvic floor muscles aren’t strong enough to consistently withstand the pressure from your diaphragm. This pressure system also explains why you might not *always* leak when you cough or sneeze. Stress incontinence can depend on the intensity of your breath (ex: a serious coughing fit, instead of a small cough to clear your throat), how many times in a row you cough or sneeze, or how long you’ve been enduring triggers. No matter the intensity, there are a few different ways to deal with stress incontinence when it happens.

Keep crossing your legs

For many people who leak, crossing your legs is an almost automatic response to feeling a coughing or sneezing fit coming on. It turns out that this is actually a useful tactic for preventing leaks. Lindsey says that, if you’re leaking because your pelvic floor muscles are weakened or tired, backing up their efforts by contracting your thigh muscles actually *can* prevent or reduce leaking.

Have a backup plan

The moment before a sneeze happens can feel like a year, but it’s still never enough time to get yourself to the bathroom or cross your legs in time if you’re prone to bladder leaks. Whether it’s keeping a pair of spare undies in your bag, or investing in some pee-proof undies, it can be helpful to give yourself a sense of security and an action plan when leaks do catch you off guard.

Strengthen your pelvic floor

It’s as good a time as any to reiterate that Kegels are *not* the end-all solution to leaks, but stress incontinence is a case where Kegels and other strength-focused pelvic floor exercises are a good solution. Because your muscles have been overworked and weakened — whether that’s because of pregnancy, childbirth, hormone fluctuations during perimenopause, or a chronic cough or cold — they need to get a workout to rebuild their strength and flexibility. As a first step, find a pelvic health PT who can build an individualized plan for your body. Start your search here.

You might also ask your healthcare provider about cute little vaginal devices called pessaries, which are safe, removable vaginal rings/cubes that can work miracles on some types of pelvic organ prolapse and urinary leakage. Another similar alternative is the Impressa device from Poise, which fits inside the vagina like a tampon, but does some targeted bladder support work to prevent leakage during times where you might normally be triggered (i.e. your morning run or your trampoline jam sesh).

How do you handle stress incontinence and leak triggers? Share your tips in the comments.

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