Why You Leak When You Cough or Sneeze

I sat next to a very congested man on the train this morning which, in addition to making me Google where to get a flu shot (don't forget!), served as a very literal reminder that we’re entering one of the sneeziest, leakiest times of year. But what is it about coughing and sneezing that causes bladder leaks? And other than crossing her legs and praying for spring, what’s a leaker to do during cold and flu season? Our pelvic health expert, Lindsey Vestal, explains that stress incontinence is the short explanation for winter leaks, but the longer version has to do with intra-abdominal pressure.

Why coughing and sneezing cause bladder leaks

First, just so we’re clear: Research *has* shown that mental stress can up your odds of leaking, but the “stress” in “stress incontinence” refers to physiological stress (meaning it’s in your bod, not your brain).

Every single time you breathe (it happens ~20,000 times a day!), your diaphragm expands and literally pushes everything beneath it towards your pelvic floor. That sounds pretty stressful already, but your pelvic floor muscles always rise to the occasion by keeping your insides buoyed and protected. This whole pressure system concept might seem abstract, but Lindsey explains that you can witness it for yourself with every rise and fall of your chest and stomach. What you’re really seeing is your diaphragm expanding and contracting, triggering your pelvic floor to respond.

So, if you leak when you sneeze or cough (or laugh or jump), it means your pelvic floor muscles aren’t strong enough to withstand the pressure that’s being created by your diaphragm when you breathe. 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: forceful sneezing or coughing), how many times in a row you cough or sneeze, or how long you’ve been enduring that dreaded winter cold or flu.

Getting well is always step one in taking care of yourself, but there are also a few different ways to deal with stress-related leaks when they happen.

Keep crossing your legs

Lindsey says squeezing your thighs is actually a useful tactic for keeping leaks at bay. She says that, when you find yourself clenching your muscles, “all of those impulses are absolutely correct, because your body is trying to counteract internal pressure.” It makes sense: The reason you’re leaking is likely that your pelvic floor muscles are weakened and/or just plain tired, so backing up their efforts by contracting your thigh muscles actually *can* prevent leaking. That said, crossing your legs isn’t the only solution.

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 little leaks. Whether it’s keeping a pair of spare undies in your bag or in your desk at work, or investing in some leak-proof underwear to withstand winter leaks, it can be helpful to give yourself a little piece of mind.

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 bod. Start your search here.

How do you survive cold, flu, and leak season? Share your tips in the comments.


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