How to Stop Urine Leakage When Coughing: A Pelvic Floor Physical Therapist Explains
Urine leakage with coughing occurs when the pelvic floor muscles are too weak, have poor coordination or timing, or are unable to respond appropriately to increased intra-abdominal pressure. Pelvic floor physical therapy can help improve pelvic floor muscle strength, timing, and coordination, while also addressing contributing factors outside of the pelvic floor, such as hip, spine, or rib mobility and untreated constipation.
Pelvic floor physical therapists can help you find the root cause of urine leakage when coughing. It’s important to note that while urinary leakage is common, no amount of leakage is normal.
Why Does Urine Leak When You Cough?
Urinary leakage with coughing, also known as stress urinary incontinence, can affect up to 1 in 3 adults¹. As pelvic floor physical therapists, this is something we see frequently in our clinic.
While this is a common symptom, it’s important to understand that it is not normal and not something you simply have to live with. Leaking urine when you cough can happen to anyone, at any age or gender, and to people with or without a history of pregnancy.
Stress incontinence occurs when pressure builds inside the body and the pelvic floor muscles are either too weak, too tight, or poorly coordinated to provide the support needed to hold urine in.
What’s Actually Happening in Your Body When You Cough
Before you cough, your body goes through a series of quick, coordinated changes to generate the pressure needed for an effective cough. This pressure is called intra-abdominal pressure and occurs through:
A deep inhale
Closure of the glottis (throat)
Anticipatory muscle contractions of the core, back, and pelvic floor to stiffen the abdomen and spine
An increase in intra-abdominal pressure as air is trapped in the lungs and abdominal muscles contract
The pelvic floor is a group of muscles that should automatically respond to this increase in pressure by contracting to keep urine in. Leakage occurs when the pelvic floor doesn’t react quickly enough (a coordination issue) or when it isn’t strong enough to generate the support needed, resulting in urine loss.
Common Reasons You Leak Urine When Coughing
Understanding why you’re experiencing bladder leakage is key because not all leakage is caused by the same issue. As pelvic floor physical therapists, we assess the full picture to determine the root cause of stress incontinence so it can be properly addressed.
Leaking urine when you cough may be due to:
Pelvic floor muscle weakness
Reduced strength and/or endurance
Poor pelvic floor muscle timing or coordination
Muscles don’t turn on fast enough or at the right time
Overactive or tight pelvic floor muscles
Muscles can’t lengthen properly to contract
A tight pelvic floor is still a weak pelvic floor
How to Stop Urine Leakage When Coughing: What Actually Helps
Step 1: Improve pelvic floor muscle awareness and coordination
Most people aren’t familiar with their pelvic floor muscles. It’s usually not top of mind until something stops working. The first step in improving urinary leakage is learning how to connect with and become aware of your pelvic floor.
Try this exercise:
Wherever you are right now — sitting, standing, or lying down — close your eyes and take a deep breath in through your nose with your mouth closed. Notice what’s happening in your body. You may feel your ribs expand and your abdomen gently move outward.
Now bring your attention to your pelvic floor. As you inhale, you should feel the pelvic floor drop, lengthen, and open. As you exhale through an open mouth, gently squeeze and lift your pelvic floor as if you’re trying to stop the flow of urine, lifting it higher into the pelvis.
If this is difficult to feel, that’s okay. Awareness improves with time. This exercise may feel challenging if your pelvic floor is tight and unable to lengthen, or weak and unable to lift — both of which are important findings.
Step 2: Improve pelvic floor muscle strength and endurance
Before you jump into doing hundreds of Kegels, let me say this: as a pelvic floor physical therapist, prescribing isolated Kegels is something I rarely do.
So how do you strengthen the pelvic floor?
Research shows that performing certain exercises with a coordinated pelvic floor squeeze and lift can improve overall pelvic floor strength and muscle function better than an isolated kegel.
To improve pelvic floor strength and endurance, we often focus on:
Hip, spine, and rib mobility
The core and pelvic floor work more efficiently when the spine, rib cage, and hips are mobile.
Some of our favorite exercises include:
Cat/cow
Child’s pose
Thread the needle
Figure-four stretch or pigeon pose
Core and hip strengthening and stability
Some of our go-to exercises include:
Squats
Lunges
Bridges
Bear hovers
Planks
Step 3: Train the “knack” (pre-contracting the pelvic floor)
The knack is a pre-contraction of the pelvic floor muscles performed just before you cough or sneeze. This involves gently squeezing and lifting the pelvic floor before the cough happens.
Doing this helps support the urethra and bladder in anticipation of increased intra-abdominal pressure. The knack is a pelvic floor physical therapist’s quick tip to help reduce leakage while you’re building strength and endurance.
Over time, as your pelvic floor becomes stronger and more coordinated, we want these muscles to contract automatically in anticipation of pressure — without you having to think about it.
Step 4: Address more than just the pelvic floor
Leaking urine with coughing often isn’t caused by the pelvic floor alone. One common contributor I see in the clinic is bowel function.
Lingering constipation or incomplete bowel movements increase pressure within the pelvis, making it harder for the pelvic floor muscles to do their job effectively. Managing constipation and improving bowel regularity are important components of achieving full bladder control.
What Not to Do If You’re Leaking When Coughing
Do endless Kegels without an assessment
This may seem counterintuitive, but Kegels aren’t always the answer. I’ve seen patients worsen their leakage by doing too many pelvic floor contractions. An assessment is essential to determine whether Kegels are appropriate and whether they’re being done correctly.
Ignore symptoms and hope they go away
Urinary leakage is your body’s way of signaling that something is off. Leakage rarely resolves on its own and often worsens over time. Addressing the root issue sooner leads to better outcomes.
How Pelvic Floor Physical Therapy Helps Stop Leakage
Pelvic floor physical therapy provides:
A complete and comprehensive assessment to identify the root cause of leakage
Improved pelvic floor muscle awareness
Increased pelvic floor strength, endurance, and coordination using a whole-body approach
You Don’t Have to Live With Urine Leakage When Coughing
No amount of urinary leakage with coughing is normal, and help is available. Stress urinary incontinence is highly treatable, and many patients experience significant or complete symptom resolution.
Finding the root cause of leakage, improving pelvic floor awareness, and building strength, endurance, and timing are key components of bladder control. Pelvic physical therapists are specially trained to assess these factors and create a personalized treatment plan to help you stop leaking.
Work With Us
We would love to help you find the root cause of your stress incontinence and create a customized treatment plan to improve your bladder control.
If you’re local to Northwest Chicago, we are a pelvic health physical therapy clinic located in the Norwood Park neighborhood of Chicago, near Park Ridge, IL, and would be honored to support you.
If you have questions or would like us to give you a call, book a discovery call or submit a contact form today.
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