This is is one of the most common questions we hear. Unfortunately, some people don’t ask because have been led to believe that it is normal and/or there’s nothing that can be done about it. This question is so important because it opens the door to learn more about your body and the opportunity to improve your wellbeing and quality of life at any age.

Is urinary leakage with activity normal?

Urinary leakage with activity or cough is, in fact, common–but not normal. It would be similar to asking “I need reading glasses now to see the small print; is that normal?” It is common for eyesight to change, especially as we get older, but it is NOT something that we consider a normal state or expect people to just “live with.” Similarly, leakage of urine with activity, coughing or laughing is common in women (as many as one in four or more as we age), but it is most certainly not something that you just have to live with.

Why does urinary leakage happen?

Urine leakage that is caused by a sudden increase in abdominal pressure, such as occurs with a cough or strenuous exercise, is called ‘stress urinary incontinence.’ Normally urine only leaves the body when you are purposefully emptying your bladder. With stress urinary incontinence, urine leaves the bladder unexpectedly at the time of a cough, sneeze, laugh, jump, etc. This happens because the strength of the bladder outlet – the urethra, is weaker and no longer is able to keep the outlet closed during the increase in pressure on the bladder. This is not normal and it indicates a weakness of the ‘door.’ This weakness can progress over time, making the leakage more and more common.

Weakening of the urethra can be caused by loss of strength of the supporting muscles known as the pelvic floor muscles. These are the same ones that you squeeze when trying to keep urine from passing. Another cause of weakness of the bladder ‘door’ is a loss of strength of the connective tissue which supports the urethra and lower bladder. This connective tissue acts like a strong hammock that keeps the urethra and bladder in the best position. When the pelvic floor muscles become weak or the hammock support loses its strength, stress leakage can occur.

What are the treatments for stress urinary incontinence?

First of all, whether to do something or nothing is up to the person experiencing the leakage. For some, an infrequent small leak of urine is not bothersome and does not feel worth the effort of intervening. It does indicate that the door is weak, and some people may wish to be proactive and try to avoid any worsening of the problem.

Preventative strategies could include strengthening the muscles of the pelvic floor with Kegel exercises. They could also include avoiding unnecessary strain to the pelvic floor support tissues (the hammock). Most people are not aware that certain daily life habits can breakdown supportive tissue to the pelvic organs and the urethra little by little over time. Examples of this are frequent bouts of constipation with straining, a chronic deep cough that puts frequent pressure against the pelvic support system or heavy or improper lifting techniques. All of these generate stress and strain on the connective tissue and can cause further loss of support. Thus, treating constipation or a chronic cough, avoiding unusually heavy lifting and learning how to lift correctly are all things that can prevent further loss of support to the urethra.

In some cases, the leakage is bothersome enough that a person will ask their doctor about it–or even schedule an appointment with a specialist (often called a urogynecologist or female pelvic medicine and reconstructive surgery specialist) to talk about the issue. Multiple options exist for treating bothersome urinary incontinence, including formal pelvic floor exercises with a trained physical therapist, as well as nonsurgical and surgical treatments for stress urinary incontinence that provide support to the urethra to prevent leakage. Before deciding on a treatment, you should feel well-informed about the risks and benefits of all of the options in order to make the best choice for you.

If it is bothering you, talk to your doctor about it. Do not manage stress urinary incontinence by avoiding healthy activities like running or jumping in order to stay dry. This deprives you of the important vigorous activity that the rest of your body needs and is so important to general health and wellbeing. Just know that while leakage is common, is not a normal state and should be treated if it limits you from doing the things you want to be doing.