Why Do I Leak Urine When Coughing?

It is not uncommon, especially in older adults, to leak urine on coughing. This in medical term is called stress incontinence. Involuntarily leaking of urinecan happen with any activity like laughing, sneezing, or lifting some people. This is common in the elderly as their control over the bladder loses with time and age. There have also been cases where young adults have also complained or stress incontinence. This condition can be very embarrassing and impact the quality of life significantly. People may not wish to go out in public or attend any ceremony or function for fear of leaking urine. However, there are not many people that report this to a physician and hence stress incontinence is a condition which is quite under reported^{[1, 2]}.

In a rough estimate around 420 million people above the age of 20 have stress incontinence of some form, including leaking urine when coughing. There are around 12 million Americans who have stress incontinence. This is seen more in nursing home residents than others by about 50%. There are about 25% of female who report stress incontinence to some degree and among these around 7-30% people are in the age bracket of 20 to 39 years^{[1, 2]}.

Some of the conditions that have been seen to be associated with stress incontinence include pregnancy, diabetes, childbirth, and obesity. In males, stress incontinence is seen to be associated more in people who have undergone prostate surgery. As stated, stress incontinence is leakage of urine with any activity. This article highlights some of the causes and what to do for leaking urine when coughing^{[1, 2]}.

The reason why a person leaks urine involuntarily is because the pelvic muscles and tissues which support the bladder and control the urinary sphincter become weak. This results in the muscles and tissues no longer being able to support the bladder the way they should and thus the urine starts leaking. These muscles are called as pelvic floor muscles^[2].

There can be numerous reasons as to why these muscles become damaged or weak but the causes are typically different from that of females than they are for males. For females pregnancy and childbirth are the most common cause of damage to the pelvic floor muscles resulting in stress incontinence. For males, it is a surgical procedure on the prostate gland that is the most common cause^[2].

There are also certain risk factors for stress incontinence that include gender. Being a female is one of the biggest risk factor for a condition like leaking urine when coughing. A study done on stress incontinence mentions that around 12% of females between the age bracket of 20 and 45 and around 22% of females in the age bracket of 45 and 60 are at risk for stress incontinence. The increased risk in females is primarily due to pregnancy and childbirth. Females who have delivered children are 8 times more likely to develop stress incontinence than other females. The increased risk is also for females who have delivered their babies vaginally^[2].

For males, it is the prostate surgery which is the biggest risk factor for leaking urine when coughing. Other risk factors include age of being above 70 years. Obesity also is a well-known risk factor in males for stress incontinence. People despite of their gender with a past history of any pelvic surgery are at an increased risk for having stress incontinence. People with overactive bladder, chronic constipation, pelvic organ prolapse, and chronic low back pain also are at increased risk for developing stress incontinence^[2].

Some people especially young adults damage their pelvic muscles as a result of intense training for sprinting, running, or contact sports which causes them to leak urine when coughing^[2].

Stress Incontinence of any type including leaking urine when coughing is quite common and there are quite a few treatments available for this condition including lifestyle modifications, devices, and even surgery^[2].

Lifestyle Modifications: People with stress incontinence are advised to eat a balanced diet and if they are overweight to lose weight in healthful manner. Nicotine is a big no-no for people with stress incontinence as it makes the condition worse. It is important for people with this condition to time their intake of fluids and measure how much they drink to prevent any untoward incidences in public places^[2].

Physical Therapy: Doing exercises to strengthen the pelvic muscles are quite effective in preventing episodes of leaking urine when coughing. The most prominent exercise advised by therapists for stress incontinence is the Kegel exercise. This exercise is quite easy to do and can be done independently or under the supervision of a therapist^[2].

The Kegel exercise involves use of the pelvic muscles and holding them so that they become strong enough to hold urine. This should be done as often as possible for best results^[2].

Bladder Training: This is also quite an effective way to treat stress incontinence. This involves setting a time and voiding at regular intervals. This helps the bladder to release urine only when sitting on the toilet^[2].

Devices: Aside from lifestyle modifications and exercises, there are also certain devices that can be used to prevent leaking urine when coughing. These devices are only to be used when the other measures are found to be ineffective. This is only for females. A vaginal pessary is the most effective device for stress incontinence. It supports the bladder such that the urine does not leak when the bladder is under stress such as when coughing^[2].

Surgery: This is left as a last resort when all other conservative measures fail to give the desired results. The surgery allows the bladder sphincter to close and open properly so that urine does not leak. For this a sling is used and is placed around the bladder to support it. This procedure is effective in both males and females^[2].

In conclusion, leaking urine when coughing is a form of a medical condition called stress incontinence. It is one of those conditions that is often underreported and many people do not seek professional help for it. However, it is always advised for people who have stress incontinence to speak to a healthcare provider and get treated as no getting treated may aggravate the problem even more and even increase the risk for infection^{[1, 2]}.

In many cases, stress incontinence can be managed just by making some lifestyle modifications as outlined above and doing pelvic muscle strengthening exercises daily. However there are also other treatments in the form of devices for females and even surgery in severe cases to treat stress incontinence and prevent leaking urine when coughing^{[1, 2]}.

References: