Does sneezing make you worry about what else might come out? What about laughing, coughing, running, jumping, or lifting? If any of these normal activities leave you running to the bathroom or stocking up on pads, I’d like to offer you some different options. Contrary to what you may have heard, none of these are things you need to put up with. They are NOT the cost of motherhood. There ARE answers.
The cost of being a mother
All of these varieties of unintended pee are referred to as stress incontinence. There are difference kinds of incontinence, but stress incontinence is the form most likely to affect postpartum women. (Here’s a systematic review and meta-analysis if you’re interested.)
Stress incontinence occurs because of the mechanical nature of these activities. There is more pressure than the muscles can handle, therefore, leaks occur. It seems reasonable that the answer should be to strengthen the muscles that hold the pee in, but it’s often not that simple.
Pregnancy, delivery, and postpartum can affect multiple parts of the body, only one of which is the pelvic floor. For some women, considering the pelvic floor alone is enough, but often, a whole body approach is necessary.
The role of the pelvic floor
The pelvic floor is a group of muscles that closes the bottom of the pelvis. It usually gets credit for its roles related to pee, poop, sex, or having babies, but actually, it does a lot of other cool stuff, too. If you’re interested, you can read more about those things here.
For now, let’s cover three distinct roles of the pelvic floor:
- A squeeze of the sphincters to stop pee and poop.
- A lift of the muscles surrounding the sphincters to support internal organs.
- A contribution to pressure regulation within the abdomen and pelvis.
This last role provides stability to the hips and spine pretty much every time you move. Under ideal conditions, the pelvic floor and the diaphragm should move down together on an inhale and up together on an exhale. This movement is not unlike the motion of a piston in an engine, and both the inhale and the exhale create stability by generating pressure.
When this pressure is too much or directed in certain ways, it can become problematic. In addition to the diaphragm, lots of other muscles can influence the effectiveness of the pelvic floor, including the abs, hips, feet, and upper body.
Sneeze pee and pregnancy
When a woman is pregnant, several factors influence her need to pee. These include the effects of hormones, and later in the pregnancy, the weight of the baby on her bladder. In addition, there are physical changes that also impact pressure on her bladder and pelvic floor.
Here are a few of the physical changes:
- As the baby grows, its location under the diaphragm can restrict normal downward motion. This interrupts the relationship between the diaphragm and the pelvic floor.
- Pregnancy hormones, in addition to the weight of the baby, also cause a softening and stretching of the pelvic floor. This is great for birth preparation, but muscles that are too long cannot contract well.
- To accommodate the size of the growing baby, a mother’s abs stretch and lose strength. This, in combination with the growing baby, means that she needs new strategies for posture and balance. And any of these can potentially result in downward pressure on her pelvic floor.
For pregnant women, there is a combination of hormones, strength loss, and increases in pressure that make stress incontinence more likely.
Sneeze pee that continues postpartum
Depending on which study you read, vaginal deliveries may or may not make postpartum incontinence more likely. Regardless of which is true, there is a greater amount of stretching required of the pelvic floor during a vaginal delivery that will, at least, need time to recover.
In addition, those mechanical changes that occurred during pregnancy do not always resolve on their own in the postpartum stage. Lots of women continue with altered posture or breathing patterns that create excess pressure on the pelvic floor.
As an example, let’s say that while pregnant, a mother starts to breathe up on her inhale, instead of down. She finds this strategy because there is a baby in the way preventing downward movement of her diaphragm. However, if she breathes up on her inhale, then she needs to breathe down on her exhale.
This all seems pretty reasonable until she sneezes, laughs, or coughs particularly hard. All of these involve increased force on her exhale. If her exhale now moves down, then she increases the pressure down onto her pelvic floor. These muscles may or may not be strong enough to withstand the force. And she may or may not continue these same habits, even years after her baby is born.
Sneeze pee months or years down the road
For some women, stress incontinence occurs in the early postpartum days and then resolves on its own, only to reappear months, or even years, later. When this happens, the answer usually relates to the way she creates pressure. Because there are lots of ways to do this, she can alter her strategy over time with varying degrees of success.
This can cause incontinence related to the way she breathes, such as we discussed with sneezing, coughing, or laughing. Or it can occur with exercises like running, jumping, or lifting. These require increased stability as compared to every day activities. To meet the increased demand, the woman ramps up her internal pressure. And if she is someone who creates downward pressure, it just might be too much for her pelvic floor.
Sneeze pee, cough pee, laugh pee, run, jump, or lift pee are all signs that she might be happier with a different strategy. Learning other options can help a mother to solve this kind of issue.
How to resolve sneeze pee
Sometimes, the answer is literally as simple as doing a few Kegels and going on about your merry way. But more commonly, it’s not this simple.
For two reasons:
- Strengthening the pelvic floor involves repeatedly contracting the pelvic floor and for lots of women, this isn’t as straightforward as it sounds. Most likely, this isn’t a body part you’re overly familiar with. And even further, function or weakness in other places in your body can influence the ability to contract these muscles.
- Managing pressure within our systems isn’t something most of us regularly consider. If you put too much pressure down on your pelvic floor, no amount of strength can overcome it. Instead, you need to find a different strategy for stability that doesn’t ask so much of your pelvic floor.
The answer is different for different women. Our life experiences vary. Our bodies and our understanding of them are not the same. The strategies we use to accomplish the same things can be quite different. There isn’t one answer that works for everyone. If you need help finding the right strategy for you, my first recommendation is always to find a good pelvic floor physical therapist. You can find one here or here.
If for any reason that isn’t an option for you, this is exactly why I’ve developed an online program for mothers just like you.