Stress incontinence: peeing when you run, cough, or laugh

A little leakage when you laugh, cough, or exercise? It’s a common experience for many women — about one in three, in fact. This is called stress urinary incontinence. It simply means that everyday movements or a hearty chuckle can sometimes lead to involuntary urine leakage. It happens when pressure on your bladder — from activities like laughing, coughing, sneezing, or moving — causes you to leak urine. 

Stress incontinence is common, but that doesn’t mean it’s normal or something you just have to deal with. There are solutions. 

Here, learn more about what causes stress incontinence, and how to prevent and treat it — especially with exercises from our Hinge Health physical therapists.

What is stress urinary incontinence?

Urinary incontinence (UI) is the involuntary or accidental loss of urine — a condition that affects more than 60% of women. Stress urinary incontinence (SUI) is the most common type. Stress incontinence symptoms involve involuntary urine leakage when you do things that put extra pressure on your bladder, such as coughing, sneezing, laughing, exercising, lifting, bending over, or having sex. Other activities, like jumping or running, can also cause an accidental leak.

Other types of urinary incontinence include urge incontinence, overflow incontinence, and mixed incontinence.

What causes stress incontinence?

Stress urinary incontinence happens when muscles and other tissues that support your urinary system become weak or don’t work as well as they should. It’s often related to issues with your pelvic floor. Activities that put extra pressure on your bladder can cause urine to leak out because your body isn’t able to hold it in as effectively.

Common triggers for leaking urine include:

• Coughing

• Sneezing

• Laughing

• Exercising

• Lifting something heavy

• Bending over

• Having sex

The amount of pee you leak is usually small. But if your bladder is full, you may pass larger amounts of urine.

Stress incontinence and your pelvic floor

Your pelvic floor is a group of muscles and connective tissues that stretches like a hammock from your pubic bone in the front to your tailbone in the back. It helps support pelvic organs, including your bladder, and plays a role in bladder control, bowel control, and sexual health.

Problems with your pelvic floor muscles can affect your bladder and urethra (the tube that carries urine out of the body). Weakness in your urinary sphincter — the ring of muscle that keeps the urethra closed — can also play a role. When these muscles aren’t working properly, anything that puts pressure on your stomach and pelvic muscles — like sneezing, laughing, or bending over— may lead to urine leakage.

More causes of stress incontinence

Factors such as pregnancy and childbirth, aging and menopause, obesity, prior pelvic surgery, and chronic or repeated pressure on your abdomen can weaken or strain the muscles and tissues that support your bladder and urinary sphincter, making it harder to control urine flow and increasing your risk of leakage. Here’s how these factors can raise your risk or worsen stress urinary incontinence symptoms:

• Pregnancy and childbirth. During pregnancy, the added weight from your growing belly and other changes puts extra pressure on your pelvic floor, which can stretch the muscles and tissues that support your bladder. Plus, vaginal delivery can sometimes strain or weaken the muscles in your pelvic floor or urinary sphincter. The more vaginal deliveries you have, the higher your chance of experiencing stress urinary incontinence.

• Aging and menopause. Decreasing estrogen levels during and after menopause can reduce muscle mass and weaken connective tissue. This can impact your pelvic floor and urethral muscles, which can lead to difficulty controlling urine flow.

• Obesity. Excess weight can increase pressure on your abdominal and pelvic organs, which can raise your risk of stress incontinence.

• Previous pelvic surgery. Hysterectomy or other pelvic or vaginal surgeries may affect pelvic floor muscles and nerves and contribute to stress incontinence. 

• Prolonged pressure on your abdomen. Chronic constipation or coughing, or frequently lifting things in a way that puts pressure on your pelvic floor can strain these muscles, which may lead to bladder control problems or make stress incontinence worse.

Why do I pee when I cough, laugh, sneeze, or run?

You pee when you cough, laugh, sneeze, or run because these actions put extra pressure on your bladder. If the muscles and tissues of your pelvic floor are weak or less supportive, they can’t keep the bladder closed tightly, so urine can leak out.

“If you leak when you run, it doesn’t mean you’re out of shape. Elite athletes deal with incontinence, too,” says Heidi Austin, PT, DPT, a Hinge Health physical therapist. “And it’s not just a problem for older adults or those who have given birth,” she says. 

While it’s often due to problems with your pelvic floor, other musculoskeletal issues can also play a role, Dr. Austin explains. “Leaking pee while running could be a symptom of problems with muscles in your hips and core,” she says. Plus, poorly coordinated breathing or breath-holding during exercise can increase abdominal pressure and make leaks more likely, she explains.

The above exercises help strengthen, coordinate, and improve the responsiveness of the muscles involved in bladder control, making it easier to prevent urine leaks during running, coughing, sneezing, or laughing. For example, diaphragmatic breathing promotes flexibility and endurance in the pelvic floor, while quick hold Kegels specifically train the fast-twitch muscle fibers you need to react quickly to sudden pressure from coughing, sneezing, or running. Kegel chair squats and bridges further build strength and stability in the pelvic floor, core, and lower body, so these muscles can better support your bladder and prevent leakage when your body is under stress. Together, these exercises target the key muscles and movement patterns needed for reliable urinary control in real-life situations.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

More ways to manage stress incontinence

In addition to exercise therapy, you can prevent or treat stress incontinence by adopting healthy toilet habits, avoiding bladder irritants, and staying hydrated, as well as considering techniques like bladder training to improve bladder control and reduce leakage. Making small changes — such as sitting fully on the toilet, avoiding constipation, and creating a bathroom schedule — can help relieve pressure on your pelvic floor and support better urinary continence throughout the day. Try these strategies to help manage stress incontinence:

• Practice healthy toilet habits. Don’t “hover” over the toilet seat to pee; sit and relax to fully empty your bladder. Don’t delay bowel movements. If you’re constipated, avoid straining, which can put pressure on your pelvic floor. Instead, place a small stool or box underneath your feet so your knees sit higher than your hips. This can help relax your pelvic floor and make it easier to pass stool, says Dr. Austin. 

• Avoid or limit bladder irritants. If certain foods or drinks increase your symptoms, consider cutting them from your diet or reducing your intake.

• Stay hydrated. “Many people limit their fluid intake as a way to manage stress incontinence,” says Dr. Austin. “But concentrated urine is actually a bladder irritant and can make things worse.” Proper hydration or consuming water after bladder irritants can improve stress incontinence symptoms.

• Bladder training. These are techniques that can help you train the muscles that control your bladder. While it’s meant for people who pee more frequently than “normal” (often about eight times a day with two to four hours in between), bladder training can also help you manage incontinence:

• Set an interval goal (e.g., two hours between trips to the bathroom)

• Make a schedule

• Practice urge suppression if you feel the urge to go before your scheduled time Delaying even five minutes can help your bladder learn to wait to empty

• Gradually adjust the interval between bathroom breaks until you reach three to four hours between trips

If exercise therapy and lifestyle strategies don’t bring relief, your healthcare provider may discuss other treatment options, such as:

• Vaginal devices to help prevent leaks. Urethral support devices are small, disposable inserts placed in the vagina with an applicator (like a tampon) to support the urethra and help prevent leaks — many are available over the counter. Pessaries are soft, flexible silicone devices fitted by your doctor and worn inside the vagina to support the bladder or other pelvic organs. Pessaries are reusable and can be especially helpful if you have leaks during physical activities.

• Injections. Synthetic (bulking) filler injections add support around your urethra to help keep it closed and prevent urine leakage.

• Surgery. Different procedures use stitches or other materials to support your urethra or the bladder neck and help prevent leaks under stress.

Pelvic floor physical therapy for stress incontinence

When problems with your pelvic floor muscles contribute to stress incontinence, pelvic floor physical therapy can help. A pelvic floor physical therapist (PT) can assess your condition, help modify your activities, empower you with tools and tips to manage symptoms, and personalize your exercise program. You can see one in person or use a program like Hinge Health to access a PT via a telehealth video visit.

To ease symptoms of stress urinary incontinence, physical therapists may especially recommend three kinds of exercises: strengthening moves like Kegels, quick engagement of your pelvic floor, known as the ‘Knack,’ and deep breathing.

1. Kegels

Exercises to strengthen your pelvic floor, such as the Kegel exercises described above, can strengthen hip, core, and pelvic floor muscles to help hold urine inside the bladder, preventing leakage. Your PT may recommend combining strengthening exercises with a device called a pelvic trainer. Inserted into your vagina, pelvic trainers have sensors that provide real time biofeedback to monitor your pelvic floor contractions.

Note that Kegels are not the cure-all for every urinary problem: If your pelvic floor is too tight instead of weak, strengthening exercises can make some urinary problems worse.

2. The ‘Knack’

Engaging your pelvic floor right before you cough or sneeze helps close your urethra (the outlet for urine) so you avoid leaks. Pelvic floor physical therapists call this technique the ‘Knack.’ Performing the Knack before moderate coughing, for example, has been shown to prevent up to 98% of leaks after just a few weeks of practice. You can use this technique for any situation (sneezing, laughing, blowing your nose, straining during exercise, etc.) that increases abdominal pressure. 

Here's how to Knack:

• Do a Kegel to contract the muscles in and around your urethra, vagina, and anus. 

• Maintain the contraction and perform a cough, then relax your pelvic floor muscles.

• Contract your muscles again and cough with more force, or perform repeated coughs.

• Vary the length of the contractions with a mix of quick (two seconds) and long (five to 10 seconds) holds to train your pelvic muscles for endurance and rapid response.

• Avoid holding your breath, pulling your stomach in, straining, or contracting other nearby muscles.

3. Deep breathing

Practicing diaphragmatic breathing, or deep belly breathing (see above), helps coordinate the muscles of your diaphragm and pelvic floor. When these muscle groups work together effectively, it can help support the bladder and improve control over urine flow. Deep breathing increases awareness and activation of your pelvic floor muscles, helping you engage and relax them as needed. Over time, strengthening this mind-muscle connection can reduce the risk of accidental leaks, especially during activities like coughing, sneezing, laughing, or exercising. Diaphragmatic breathing also helps reduce tension in the abdomen and pelvic region, which can further improve bladder function and control.

PT tip: think beyond Kegels

Kegels can strengthen your pelvic floor muscles to help support your bladder and prevent leakage by holding urine inside. “But don’t limit yourself just to Kegel exercises,” says Dr. Austin. Your pelvic floor muscles are also connected to your core and hips, so it’s important to strengthen all these areas together. Everyday habits matter, too. “A physical therapist can look at the whole picture and help create a plan to reduce leaks and get you back to what you love,” says Dr. Austin.

How Hinge Health can help you

If you have pelvic pain, bladder, bowel, or other pelvic symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

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