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Why Do I Pee When I Cough: Stress Incontinence Explained

Dr. Michelle Frank

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June 7, 2023
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Older woman worrying about stress incontinence

The sudden leak of urine when you cough, laugh, or sneeze can be quite stressful – especially during a social setting with no loo in sight. 

Peeing when coughing occurs due to stress incontinence. Situations of high physical stress put pressure on a weakened urinary sphincter and pelvic floor which can no longer retain urine, resulting in episodes of urine leaks.

This article will explore why you pee when you cough, in what ways you can improve your sphincter control, and how to avoid potential risk factors that increase your chances of developing stress incontinence.

Why Do I Pee When I Cough?

A primary reason why stress incontinence occurs is due to the weakness in your pelvic floor muscles and the urinary sphincter supporting your urinary bladder.

Stress incontinence affects about 4%–30% of adults. The usual factors weakening your pelvic floor include working out, surgery, lifting heavy objects, pregnancy, and childbirth. The prevalence of urinary incontinence is almost three times higher among women compared to men1. Additionally, stress incontinence is more frequently observed among older adults2, since pelvic floor muscles experience various forces of strain over time. 

In an ideal situation, you should be able to hold in your pee during a stressful situation such as coughing. However, due to long-term weakness, often due to the changes with age, this becomes a little difficult, and stress incontinence results.

What Are My Risk Factors For Stress Incontinence? 

Several factors contribute to stress incontinence along with advanced age and the female sex.

Pregnancy and Childbirth

A primary reason why women are more likely to experience stress incontinence is because of their lifetime risk factors, which include hormonal fluctuations, pregnancy, and childbirth

A study of 750 pregnant women recorded almost 40% of their participants experiencing stress incontinence during their pregnancies3. Another study conducted among Swedish women recorded 21% of their respondents experiencing stress incontinence a year postpartum, with a higher risk among those who also had stress incontinence during pregnancy4.

Pregnancy and childbirth, especially vaginal delivery5, places significant strain on the pelvic floor. While the body attempts to go back to its pre-pregnancy state during the first few postpartum months, there is often a lingering weakness within the pelvic floor.

Surgery

Surgery is another risk factor associated with pelvic floor weakness. 

It is reported as the most common reason men may experience stress incontinence. Surgeries associated with the prostate are linked with urinary incontinence in men6 as are enlargement or swelling (prostatitis) of the prostate.

Similarly, pelvic surgery, such as a hysterectomy, among women can also work as a risk factor for pelvic weakness leading to stress incontinence.

Lifestyle Factors

An additional stress factor is being overweight or obese. Carrying around extra weight places strain on the pelvic floor. On the other hand, vigorous workouts or occupations involving heavy lifting can also contribute to pelvic weakness as it results in repeated strain on the pelvic muscles. 

Similarly, having prolonged constipation, which might frequently require putting repeated pressure on the pelvic muscles, can work as a risk factor for stress incontinence7.

Chronic Cough

Some studies have highlighted a chronic cough as a primary link to urinary incontinence, especially among women8. Old age, repeated bouts of infection exacerbating a cough, and the severity of the cough were documented as possible reasons for a chronic cough leading to incontinence9.

How Do I Know If I Have Stress Incontinence?

Peeing when coughing or during other situations of stress, such as laughing, sneezing, or even lifting weights, is the primary sign you might have stress incontinence.

A key indication of stress incontinence, and not other forms of urinary incontinence, is that a small amount of urine leaks while coughing. If you observe larger amounts of urine leaking or the frequent urge to empty your bladder it can be another medical condition that might require looking into. 

Additionally, you may also notice that you do not always pee when you cough. As the condition progresses as pelvic weakness increases, it can occur more frequently. 

Eventually, stress incontinence can start interrupting your daily quality of life. You will also start avoiding activities, such as working out or attending social activities, which can aggravate your stress incontinence. 

When you notice yourself leaking urine frequently under stressful conditions, it would be ideal to contact your healthcare provider.

Your doctor is likely to conduct a series of tests to ensure that the cause of your stress incontinence is due to pelvic floor weakness. Some of these tests include regular blood work to check for diabetes or infection, urine analysis, urinary stress test, measuring bladder pressure and residual volumes, and a cystoscopy (where a camera is used to look inside your bladder) if required.

How Is Stress Incontinence Treated?

While stress incontinence can be distressing, it is treatable, frequently without the use of medications.

Pelvic Floor Training

The primary way in which you will regain bladder control is by improving your pelvic muscle strength. One of the simple ways to do this is through the regular practice of Kegel exercises10. While many resort to practicing Kegels after a diagnosis of stress incontinence, regular pelvic floor strengthening exercises can be used preventatively to help minimize your risk of stress urinary incontinence11.

To initiate the appropriate practice of pelvic floor muscle training, you will be recommended to visit a physical therapist. They will guide you through breathing techniques, which muscles to exercise, and also how many times to practice Kegels during the day. Such introductory sessions are important for, as with any other muscle in the body, overtraining or regularly practicing the exercise in the wrong way can result in injury and pain.

Changes to Your Lifestyle

In addition to regularly practicing your Kegel exercises, your doctor will also suggest a few lifestyle changes. One of the first things to do would be to monitor your fluid consumption. While you should not limit your water consumption throughout the day, pay attention to additional caffeine or carbonated fluid intake. These can often irritate the bladder and increase the frequency of urine leaks.

Another lifestyle change would be to regularly empty your bladder and avoid waiting until the last minute. This can help with training your bladder to urinate at specified times and also prevent accidents during the day.

Also, work on increasing your fiber content to reduce your risk of constipation.

If you are overweight or obese, consider a healthier lifestyle which can provide several benefits, one of which can be reduced strain on your pelvic floor muscles.

Alternative Therapies

There are no specific medications that are generally used to manage stress incontinence. However, there are some additional therapeutic avenues,  such as electrical stimulation12, urethral inserts13, vaginal pessaries14, and vaginal cone therapy15 have shown some indications for relief with urinary stress incontinence.

Surgery

Surgery is usually considered a last option if physical therapy and alternative forms of therapy provide no relief from symptoms.

There is a 13.6% risk of requiring surgery for relief from stress incontinence16. This risk increases with age since pelvic muscles can weaken significantly with time. A review of the literature has highlighted the retropubic midurethral sling (MUS), transobturator MUS, traditional sling, and open colposuspension surguries as providing the best results for women with stress incontinence compared to other procedures17.

Are There Any Complications to Stress Incontinence?

When detected early, stress incontinence can be managed with simpler therapeutic strategies. As you have read above, with regular practice of Kegel exercises, you can reduce your likelihood of peeing when you cough.

One of the primary complications of stress incontinence is the decline in your quality of life. With simple gestures such as laughing, sneezing, or coughing, the sensation of leaking urine can cause significant distress. It can also result in quitting activities such as exercising. In some cases, the frequent use of pads and adult diapers can cause significant anxiety which can limit outdoor activity as well.

Stress incontinence can sometimes feel like it is triggering your urgency to urinate. However, this can be a sign of mixed urinary incontinence. Studies have indicated that urge to urinate incontinence episodes can frequently come right after a stress incontinence situation, which can both be distressing and require the use of different treatment strategies18.

Conclusion

While peeing when coughing can seem like a unique concern, it is actually quite common. Several treatment methods can be adopted to reduce the frequency of stress incontinence. As soon as you feel you have urinary incontinence it would be ideal to check in with your doctor. Ruling out conditions such as infections, diabetes, and other traumatic injuries leading to incontinence is crucial to be able to adequately manage symptoms of stress incontinence. 

Stress incontinence can be embarrassing and difficult to discuss with the people in your life. Consider reaching out to support groups or forums both for voicing your concerns and finding support.

  1. Milsom, I., & Gyhagen, M. (2019). The prevalence of urinary incontinence. Climacteric: the journal of the International Menopause Society, 22(3), 217–222. https://doi.org/10.1080/13697137.2018.1543263[]
  2. Jonsson Funk, M., Levin, P. J., & Wu, J. M. (2012). Trends in the surgical management of stress urinary incontinence. Obstetrics and Gynecology, 119(4), 845–851. https://doi.org/10.1097/AOG.0b013e31824b2e3e[]
  3. Dinç A. (2018). Prevalence of Urinary Incontinence During Pregnancy and Associated Risk Factors. Lower urinary tract symptoms, 10(3), 303–307. https://doi.org/10.1111/luts.12182[]
  4. Jansson, M. H., Franzén, K., Tegerstedt, G., Hiyoshi, A., & Nilsson, K. (2021). Stress and urgency urinary incontinence one year after a first birth-prevalence and risk factors. A prospective cohort study. Acta Obstetricia et Gynecologica Scandinavica, 100(12), 2193–2201. https://doi.org/10.1111/aogs.14275[]
  5. Fakhrizal, E., Priyatini, T., Santoso, B. I., Junizaf, J., Moegni, F., Djusad, S., ... & Maryuni, S. W. (2016). Prevalence and risk factors of persistent stress urinary incontinence at three months postpartum in Indonesian women. Medical Journal of Indonesia, 25(3), 163-170.[]
  6. Börgermann, C., Kaufmann, A., Sperling, H., Stöhrer, M., & Rübben, H. (2010). The treatment of stress incontinence in men: part 2 of a series of articles on incontinence. Deutsches Ärzteblatt international, 107(27), 484–491. https://doi.org/10.3238/arztebl.2010.0484[]
  7. Maeda, T., Tomita, M., Nakazawa, A., Sakai, G., Funakoshi, S., Komatsuda, A., Ito, Y., Nagata, H., Tsukada, N., & Nakamura, S. (2017). Female Functional Constipation Is Associated with Overactive Bladder Symptoms and Urinary Incontinence. BioMed research international, 2017, 2138073. https://doi.org/10.1155/2017/2138073[]
  8. Zoglmann, R., Nguyen, T., Engberts, M., Vaessen, D., Patberg, N., & Van den Berg, J. (2015). Do patients with stress incontinence cough or do cough patients suffer from urinary incontinence? 1.13 Clinical Problems - Other. Annual Congress 2015. https://doi.org/10.1183/13993003.congress-2015.pa713[]
  9. Yang, C., Feng, Z., Chen, Z., Xu, D., Li, Y., Lai, K., & Yi, F. (2022). The risk factors for urinary incontinence in female adults with chronic cough. BMC pulmonary medicine, 22(1), 276. https://doi.org/10.1186/s12890-022-02069-w[]
  10. Harvey M. A. (2003). Pelvic floor exercises during and after pregnancy: a systematic review of their role in preventing pelvic floor dysfunction. Journal of Obstetrics and Gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC, 25(6), 487–498. https://doi.org/10.1016/s1701-2163(16)30310-3[]
  11. Cross, D., Kirshbaum, M. N., Wikander, L., Tan, J. B., Moss, S., & Gahreman, D. (2023). Does a Kegel Exercise Program Prior to Resistance Training Reduce the Risk of Stress Urinary Incontinence? International journal of environmental research and public health, 20(2), 1481. https://doi.org/10.3390/ijerph20021481[]
  12. Sarmento, A. L. C., Sá, B. S., Vasconcelos, A. G., Arcanjo, D. D. R., Durazzo, A., Lucarini, M., Leite, J. R. S. A., Sousa, H. A., & Kückelhaus, S. A. S. (2022). Perspectives on the Therapeutic Effects of Pelvic Floor Electrical Stimulation: A Systematic Review. International journal of environmental research and public health, 19(21), 14035. https://doi.org/10.3390/ijerph192114035[]
  13. Sirls, L. T., Foote, J. E., Kaufman, J. M., Lightner, D. J., Miller, J. L., Moseley, W. G., Nygaard, I. E., & Steidle, C. P. (2002). Long-term results of the FemSoft urethral insert for the management of female stress urinary incontinence. International urogynecology journal and pelvic floor dysfunction, 13(2), 88–95. https://doi.org/10.1007/s001920200021[]
  14. Al-Shaikh, G., Syed, S., Osman, S., Bogis, A., & Al-Badr, A. (2018). Pessary use in stress urinary incontinence: a review of advantages, complications, patient satisfaction, and quality of life. International Journal of Women's Health, 10, 195–201. https://doi.org/10.2147/IJWH.S152616[]
  15. Herbison, G. P., & Dean, N. (2013). Weighted vaginal cones for urinary incontinence. The Cochrane database of systematic reviews, 2013(7), CD002114. https://doi.org/10.1002/14651858.CD002114.pub2[]
  16. Wu, J. M., Matthews, C. A., Conover, M. M., Pate, V., & Jonsson Funk, M. (2014). Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstetrics and Gynecology, 123(6), 1201–1206. https://doi.org/10.1097/AOG.0000000000000286[]
  17. Imamura, M., Hudson, J., Wallace, S. A., MacLennan, G., Shimonovich, M., Omar, M. I., Javanbakht, M., Moloney, E., Becker, F., Ternent, L., Montgomery, I., Mackie, P., Saraswat, L., Monga, A., Vale, L., Craig, D., & Brazzelli, M. (2019). Surgical interventions for women with stress urinary incontinence: systematic review and network meta-analysis of randomized controlled trials. BMJ (Clinical research ed.), 365, l1842. https://doi.org/10.1136/bmj.l1842[]
  18. Minassian, V. A., Yan, X. S., Pitcavage, J., & Stewart, W. F. (2016). Mixed Incontinence Masked as Stress Induced Urgency Urinary Incontinence. The Journal of Urology, 196(4), 1190–1195. https://doi.org/10.1016/j.juro.2016.04.084[]

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