The cost of being a mother
Contrary to whatever else you may have heard, sneeze pee is NOT something you have to endure as the price of being a mother. Neither is laugh pee, cough pee, run pee, jump pee, or lift pee.
All of these varieties of unwanted pee are actually referred to as stress incontinence. There are difference kinds of incontinence, but stress incontinence is the form most likely to affect the postpartum population. (Here’s a systematic review and meta-analysis if you’re interested.)
It occurs because the mechanical stress of these activities—sneezing, laughing, jumping, etc.—puts too much pressure on the muscles that hold pee in. Instead of these muscles doing their job correctly, the pee leaks out when it isn’t wanted.
From here on out, I’m going to use the phrase ‘sneeze pee’ interchangeably with ‘stress incontinence’ because I want to emphasize that it’s the force (or stress) of the sneeze that causes the unwanted result.
Why does sneeze pee occur?
Last week, when I talked about diastasis recti, I mentioned that your torso is basically like a cylinder of muscle. At the top of this cylinder is your diaphragm, and at the bottom is your pelvic floor. The muscles of your back and your abdominals wrap around the sides.
A piston analogy
I need to make a bit of a detour here to use a car analogy. (Maybe not the typical analogy to use with mothers, but we’re all modern women, right?) I’ll keep it simple because engines aren’t really my field of expertise. However, I do know this much.
In an internal combustion engine, there are pistons. A piston moves up and down inside of a cylinder, decreasing pressure on the downstroke and increasing pressure on the upstroke.
That was short and sweet, right?
Back to the human body
Inside each of us, there are no pistons. But inside of that muscular cylinder I was referring to, we have the ability to generate pressure. Just like an internal combustion engine, we can create and relieve pressure, but unlike an engine, we can direct that pressure up or down or out.
There are a lot of reasons why a woman might create pressure in any of these directions. But too much pressure out can cause a hernia or a diastasis. Too much pressure down can cause pelvic organ prolapse (when the organs that should be on the inside are, instead, coming out of the vagina) or urinary incontinence.
So, what should happen?
Well, let’s think about this. Why do you cough or sneeze?
Because you need to expel something through your mouth or your nose. You’re not trying to push anything out the bottom. Just like the piston inside of an engine, the force you generate should move upward. If it moves downward, it’s putting too much pressure on your pelvic floor and increasing the chance of leaking. Not to mention it’s become pretty ineffective at expelling anything from your mouth or nose.
The same is true of a laugh. A laugh is the forceful expelling of air through your nose or mouth in response to something you find humorous. Again, there should be no pushing of anything out the bottom when you laugh. Maybe you haven’t experience laugh pee. Do you ever toot when you laugh? Same reason. The pressure is going the wrong direction.
Lifting, running, and jumping are a little bit different. They have more to do with controlling a load than with expelling air. But maybe you’ve heard that you should exhale on exertion?
This is true because when you exhale, your pelvic floor should rise and contract. The contraction of your pelvic floor helps with a contraction of your abs, and a contraction of your abs provides stability to your spine and helps to expel the air out of your nose or mouth.
You can see how all of this contributes to an upward force to assist with lifting, running, or jumping without putting undo pressure down on your pelvic floor. That downward force puts too much pressure on the muscles that hold in your pee, and if you do it enough times or with enough force, you will get lift pee, run pee, or jump pee.
Sneeze pee and pregnancy
When a woman is pregnant, the baby takes up space inside of that muscular cylinder we’ve been discussing. This causes a lot of changes to occur in the way a mother generates force. Here are some examples:
- the ability of her diaphragm to move up and down
- the ability of her abdominals and back muscles to contract due to changes in their length or angles of pull
- the strength and activity levels of the pelvic floor
All of these changes mean that a pregnant woman has to devise a new strategy for generating force within that muscular cylinder. Some women find effective strategies with no second thought, while lots of women create too much downward force and end up causing sneeze pee (or laugh pee or jump pee—you get the idea).
On top of the changes that occur during pregnancy, difficult vaginal deliveries can increase the likelihood of stress incontinence. And still other women have incontinence that shows up days, weeks, or even years after their babies are born.
How do you stop sneeze pee?
At this point, you can probably see that the answer to this is to generate upward force instead of downward force. But if it were that simple, we’d all be doing it already, right?
The solutions for stopping any unwanted pee are as diverse as the women that complain of it. But at least with stress incontinence, it really does boil down to ‘why are you creating downward pressure in the first place?’ For example, what mechanically changed during pregnancy or postpartum?
- Are you a shallow breather or belly breather?
- Is your pelvic floor weak?
- Are you asking too much of your pelvic floor?
- Do you contract your abs in a way that creates this downward pressure?
For some women, the answer to ending unwanted pee is as simple as a few Kegels. But for others, it can be a lot more complicated. If you need one-on-one help with sneeze pee, a pelvic floor physical therapist is your answer. If you’d like to learn more about your own body, here’s a review of the Mama Made Strong program from a mother in her 50’s.