Why do i leak when i run/jump/cough/sneeze? Stress Urinary Incontinence explained

Stress urinary incontinence (SUI) is a common condition that affects many individuals, particularly women, resulting in involuntary leakage of urine during moments of physical exertion, such as coughing, sneezing, laughing, or exercising. Although it can significantly impact quality of life, there are effective management strategies available. This blog will discuss the signs and symptoms of SUI, possible causes, and various treatment options, particularly emphasising conservative approaches that we offer at Eureka Health.

Signs and Symptoms of Stress Urinary Incontinence

The primary symptom of SUI is the involuntary leakage of urine during activities that increase intra-abdominal pressure (IAP). Common triggers include:

• Coughing or Sneezing: Unexpected leakage occurs frequently with these actions.

• Laughing: The physical exertion of laughter can lead to urine leakage.

• Exercising: Activities such as running, jumping, or other high-impact exercises often exacerbate symptoms.

• Heavy Lifting: Lifting heavy objects can lead to involuntary urine loss.

• Sex: leaking urine with penetration or orgasm.

Additionally, individuals may experience feelings of embarrassment, frustration, and anxiety regarding their condition, which can impact their social interactions and emotional well-being. Many of these symptoms are quite common but shouldn’t be normalised and ignored. There are often many strategies to help.

Possible Causes of Stress Urinary Incontinence

Put simply, we need the pressure keeping your urethra closed, to be stronger than the pressure in and around your bladder. We describe this as requiring your Maximum Urethral Close Pressure (MUCP) to be greater than the Intravesical Pressure (IVP). If the scales are out of balance for these two elements, then we leak.

SUI can arise from various factors, including:

1. Weakness of Pelvic Floor Muscles: These muscles support the bladder and urethra, and weakening can lead to incontinence. Specifically the External Urethral Sphincter (EUS) plays a big role in controlling our Urethral Close Pressure (UCP).

2. Hormonal Changes: Fluctuations of oestrogen and progesterone, especially during pregnancy and menopause, but also at different times in your monthly cycle can play a role.

3. Childbirth: Vaginal childbirth can stretch or damage fascia and muscles around your pelvic floor, increasing the likelihood of SUI.

4. Obesity: Excess body weight increases pressure on the bladder and pelvic floor, increasing your IVP.

5. Aging: Changes in muscle tone and tissue elasticity with age can contribute to SUI.

Common Treatment Options for Stress Urinary Incontinence

1. Conservative Treatment Options:

   a. Pelvic Floor Muscle Training (PFMT): This involves exercises that strengthen the pelvic floor muscles, enhancing their support for the bladder. Women’s health clinicians often guide individuals through these exercises, making them a highly effective treatment for SUI. Research has shown that PFMT can significantly reduce urinary leakage episodes and improve overall bladder control (Dumoulin et al., 2018).

   b. Addressing Intra-Abdominal Pressure (IAP): Techniques to decrease IAP during physical activity can greatly benefit those with SUI. This might involve training in proper body mechanics and breath control to minimise undue pressure on the bladder. A study published in Neurourology and Urodynamics suggests that minimising IAP through proper alignment and movement strategies can reduce the incidence of urinary leakage during high-impact activities (Bo et al., 2020).

   c. Single-Leg Strengthening: Enhancing single-leg strength can improve overall pelvic stability and support during dynamic activities. Exercises that focus on leg and core strength can help in managing SUI symptoms. Research by Morkved et al. (2017) indicated that weight-bearing exercises combined with pelvic floor training lead to significant improvements in SUI symptoms.

2. Comprehensive Approaches: In addressing SUI, it is essential to consider a holistic or biopsychosocial approach, which factors in the individual’s physical, emotional, and social well-being. Engaging with a women’s health clinician who adopts this whole-person perspective can provide tailored strategies that consider all aspects of health. This is why our Initial Pelvic Health appointment goes for an hour and includes all of your medical history. We truly believe that it is all connected.

   Effective management may include lifestyle modifications such as weight management, dietary changes, and psychological support, which can address anxiety and stress, related to incontinence. Research has shown that individuals who receive holistic care may experience better outcomes and improved quality of life (Hernández et al., 2021).

3. Behavioural Interventions: These involve lifestyle changes such as bladder training, controlling constipation, dietary adjustments to minimise irritants (like caffeine and alcohol), and fluid management to help control symptoms better.

If the above interventions aren’t helpful for your symptoms, next steps might involve a pessary or a specialist consultation to discuss surgical options.

Conclusion

Stress urinary incontinence is a common yet often overlooked issue that can impact daily life and self-esteem. By understanding the signs, symptoms, and causes, individuals can take proactive steps toward management. Conservative treatments, such as pelvic floor muscle training, addressing intra-abdominal pressure, and improving single-leg strength, offer effective options for managing SUI. Additionally, adopting a biopsychosocial approach ensures that care is comprehensive, addressing not only the physical symptoms but also the emotional and social implications.

If you are experiencing symptoms of SUI, it is important to reach out to a healthcare provider or a women’s health clinician. With the right support and treatment plan, it is possible to regain control and improve your quality of life. To book a pelvic health consultation, click here; we have physios and osteos trained in women’s pelvic health.

References

• Bø, K., Hilde, G., & Fagen, K. (2020). Effects of Pelvic Floor Muscle Training and Increasing Intra-Abdominal Pressure on Urinary Incontinence: A randomized controlled trial. Neurourology and Urodynamics, 39(2), 898-904.

• Dumoulin, C., Hay-Smith, J. C., & Hunskaar, S. (2018). Pelvic floor muscle training versus no treatment for urinary incontinence in women. Cochrane Database of Systematic Reviews, 2018(12).

• Hernández, A., Ruiz, S., & Martinez, P. (2021). A holistic approach to understanding the burden of urinary incontinence: The biopsychosocial model. Acta Urologica Hispánica, 1(1), 37-45.

• Mørkved, S., Bø, K., & Schei, B. (2017). Single-leg exercises and pelvic floor muscle training for women with stress urinary incontinence: A randomized controlled trial. Physical Therapy, 97(1), 74-83.

If you are struggling with SUI, reach out for support from a healthcare professional to explore your treatment options. With commitment and the right guidance, it is possible to manage and overcome this condition.