ASK DR NOVOA – I sometimes leak a little bit of urine when I sneeze or cough. Is this normal?


What you are describing is Stress urinary incontinence (SUI) which is the accidental leakage of urine when you cough, laugh or sneeze. It is the most common form of urinary incontinence in women.
SUI occurs when your bladder neck sphincter, which acts like a valve to the bladder, allows for a loss of urine due to excessive pressure placed on it from pressure on the bladder. As a result, the sphincter opens slightly and allows a small amount of urine to leak out.

This means you can leak urine when you: (1)cough, laugh or sneeze (2) exercise (particularly jumping) (3) lift or do any movement that puts pressure on the bladder (4) have sex or an orgasm.

In severe cases even walking or getting up out of bed or a chair can cause leaking. You may also notice that SUI is worse during the week before your period.

It is estimated that 4% of all women suffer from this problem, but it increases to one in three between the ages of 35 and 60.

Stress urinary incontinence is rare in men, and is usually a result of injury or prostate surgery.

SUI is due to weakness in the sphincter muscle and the pelvic floor muscles that support the pelvis and abdomen. The following conditions have been linked to SUI.

  • Pregnancy: due to carry the extra weight of a baby and having a baby and uterus rest on the bladder.

  • Childbirth: Vaginal deliveries have a higher risk of causing SUI. The more deliveries and larger babies, the higher the risk.

  • Being overweight: Extra weight puts more pressure on the abdomen and bladder.

  • Hysterectomy: a hysterectomy is an operation where the uterus is removed. This operation can cause damage to the pelvic floor and associated nerves of the bladder.

  • Smoking: a chronic cough from smoking puts more pressure on the bladder.

  • Menopause: After menopause, estrogen levels decrease which may affect the strength of the bladder neck and uretrhra. Also, postmenopausal women are more likely to be overweight and have had a hysterectomy.

  • Inherited weakness of the pelvic floor muscles, although this is rare.

  • Medication can affect the pelvic floor. Examples are alpha-blockers used to treat high blood pressure, some antidepressants and sedatives, and some muscle-relaxant drugs.

Stress urinary incontinence is generally managed by non-drug methods such as:

  • lifestyle changes to reduce pressure on your bladder (stopping smoking, losing weight and watching fluid intake).

  • pelvic floor exercises – Kegel exercises, with or without vaginal cones/biofeedback

If these treatments don’t work, your doctor may recommend surgery such as:

  • bladder neck suspension or sling

  • collagen injections around the urethra (periurethral bulking injections)

  • implantation of an artificial urinary sphincter or sacral nerve stimulator

  • tension-free vaginal tape (TVT)

The key to determining whether or not there is a problem is if it bothers you. Although occasional “accidents” can and do occur, if it becomes a problem to you, then seek medical attention from your Gynecologist.

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Filed under Blog, Gynecology, Questions of the Day

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