Why Do I Pee When I Cough? Female Causes & Treatment Options

If you've ever been surprised by an unexpected urine leak while coughing, you are not alone. Urinary leakage, triggered by physical exertion or certain movements, is a common but rarely discussed issue among women of all ages.

So, why does this happen, and what can you do about it?

In this article, we’ll explore the underlying causes—like weakened pelvic floor muscles and hormonal changes—and outline practical, effective treatment options that can help you regain confidence and control.

Stress Incontinence: The Reason You Pee When You Cough

Stress urinary incontinence happens when physical exertions, like coughing or laughing, put pressure on the bladder, causing urine to leak. This happens because the pelvic floor muscles and urethral sphincter, which help control urine flow, become weakened or lose adequate support around the urethra (the tube that you pee from) over time.

Life events like pregnancy, childbirth, menopause, and even regular high-impact activities, like weight lifting, can significantly contribute to this condition. The good news is that, depending on the severity, the condition is often manageable and treatable.

Other common triggers

Coughing may not be the only time you experience leaks. You might also notice urine leakage during:

• Laughing

• Lifting heavy objects

• Sneezing

• Jumping

• Engaging in sexual activity

The amount of urine you leak may depend on the amount of pressure transmitted through the abdomen to the bladder and urethra and the severity of your condition. Whether you leak a few drops or a few drops or a more noticeable amount, you should still take your symptoms seriously and discuss them with a healthcare professional..

What Causes Stress Incontinence?

Typically, stress incontinence is caused by weakened pelvic floor muscles and a loss of support around the bladder and urethra.

This can happen due to pregnancy and childbirth, which stretch and strain these muscles, or during and after menopause, when lower oestrogen levels can contribute to the thinning of the tissue of the urethra and bladder neck. However, the natural ageing process and prolonged lack of general physical activity can contribute to muscle deconditioning, potentially including the pelvic floor,o causing your pelvic floor muscles to weaken over time.

Other factors, like obesity, chronic coughing, or repeated heavy lifting, can put additional chronic pressure on your bladder and pelvic floor, increasing your risk of urine leaks. Understanding these causes is the first step toward finding the right solution.

Risk factors

You are at a higher risk of developing stress incontinence if you've experienced or are experiencing the following conditions:

• Pregnancy

• Childbirth ( including C-section but more common with vaginal birth or instrumental delivery)

• Menopause

• Obesity

• Nerve injuries affecting the lower back or pelvis

• Pelvic surgery (e.g. hysterectomy)

• Chronic coughing (e.g. due to smoking, asthma, COPD)

• Chronic constipation with straining

• Diabetes (potentially due to nerve damage or associated obesity)

What Can I Do About It?

The good news is that stress urinary incontinence is both treatable and manageable. Here are some of the most effective options to help you take control of your symptoms.

Strengthen your pelvic floor muscles

Weakened pelvic floor muscles are a primary cause of stress incontinence. If you want to strengthen these muscles, a pelvic health physiotherapist can guide you through a series of specialised pelvic floor exercises, which may include Kegels, where the primary focus is on correctly identifying, contracting, and relaxing the pelvic floor muscles).

Alternatively, you can perform these exercises in the comfort of your own home once you have learnt the correct technique. While online resources are available, guidance from a pelvic floor physiotherapist is highly recommended to ensure correct technique, which is crucial for effectiveness and to avoid straining..

Wear incontinence pads and leak-proof underwear

While wearing incontinence products like absorbent pads and leak-proof undies isn't going to "fix" your incontinence, it can drastically improve your quality of life and confidence during treatment. These products are designed to absorb urine quickly so that you minimise the sensation of wetness or irritated skin.

By wearing the right pads and underwear, you can cough, laugh, and sneeze with greater security.

Lifestyle changes

Simple lifestyle changes can also reduce stress on your bladder and help improve your bladder control:

• Lose weight: If you're overweight, there may be excess abdominal fat which can put more pressure on your bladder and pelvic floor, which can make your stress incontinence worse. Losing excess weight can help alleviate this pressure.

• Quit smoking: Not only will this greatly improve your general health, but it will also reduce or eliminate a chronic smoker’s cough, and you may also see an improvement in your stress incontinence symptoms.

• Manage fluid intake: avoid excessive fluid intake, but ensure adequate hydration (typically 1.5-2 litres daily unless advised otherwise by a doctor).

• Avoid bladder irritants (if relevant): Reducing alcohol intake and avoiding known bladder irritants (like caffeine, spicy foods, artificial sweeteners) can be particularly helpful if you also experience urinary urgency alongside stress incontinence (mixed incontinence.

• Adopt a nutritious diet: Eating a nutritious diet rich in fibre can also help prevent constipation, which can put added pressure on the pelvic floor.

Medications

Medications are not typically the first-line treatment for pure stress incontinence, but may be considered in certain conditions. For example, if your stress urinary incontinence is related to genitourinary syndrome of menopause, then you may be prescribed local or systemic HRT to help support your symptoms.

Duloxetine is occasionally used off-label to help improve urethral closure, but it has potential side effects and is usually considered by specialists.

Pessaries

Pessaries are small devices that are inserted into the vagina to support the pelvic organs or urethra and reduce leakage associated with stress incontinence. These devices, which are typically made from silicon, are used to treat stress incontinence and pelvic organ prolapse. These need to be properly fitted by healthcare professional

Surgical options

Surgery is usually reserved for cases where conservative treatments haven’t been effective or for severe incontinence. Some of the most common surgical treatments include:

• Mid-urethral sling- Involves placing a supportive sling under the urethra

• Colposuspension: Lifting the bladder neck through an abdominal incision to reduce leaks.

• Urethral bulking injections: where a bulking agent is injected into the walls of the urethra to improve the seal and prevent urine leakage.

These surgeries come with potential complications, so make sure you speak to your surgeon and ask as many questions as you can before deciding on surgery.

FAQs

Will treating my cough get rid of my urine leakage?

No. While treating a chronic cough (e.g. by stopping smoking or managing asthma) can help alleviate the trigger and reduce the severity or frequency of leaks, it doesn’t address the root cause of stress incontinence, which is typically weak pelvic floor muscles or urethral support issues.

What are the other types of urinary incontinence?

In addition to stress urinary incontinence, the other types include:

• Urge incontinence: Leakage associated with or immediately preceded by a sudden, compelling urge to urinate.

• Overflow incontinence: Caused by the bladder not being able to empty itself properly (chronic urinary retention).

• Functional incontinence: Not getting to the bathroom in time, often caused by physical barriers and health conditions (mobility problems or dementia).

• Mixed incontinence: A combination of both stress and urge incontinence.

More than 50% of people with stress incontinence also have urge incontinence symptoms, which is usually related to an overactive bladder.

What can be done to prevent urinary incontinence?

As urine leaks in women are often influenced by life events like pregnancy, childbirth, and menopause, complete prevention isn’t always possible. However, you can look after your bladder and pelvic floor health by performing pelvic floor exercises, drinking enough water, maintaining a healthy weight, avoiding smoking, managing constipation and eating a nutritious diet.

How is stress incontinence diagnosed?

Your general practitioner will start by asking about your symptoms and medical history. You may also be asked to keep a bladder diary so your GP can get a realistic idea about how often you're experiencing urine leaks and the potential causes.

In some cases, you may also have to undergo a physical examination as part of your incontinence assessment.

What are some of the impacts of stress incontinence?

Occasional urine leakage when there's pressure on the bladder may not seem too serious, but stress incontinence can have a huge impact on mental and physical health. The condition may contribute to anxiety or low mood, affect relationships and deter you from making plans or engaging in physical activities.

Final Thoughts

As many as 1 in 3 women may experience leaking when they cough, sneeze, or laugh at some point in their lives. So, there is no reason to feel embarrassed if you experience similar symptoms.

Here at Jude, we empower women by breaking the stigma around conditions like urinary incontinence, overactive bladder, and other common issues. Our online blog offers a wealth of valuable information, and we've also created a range of specialised incontinence products.

With the right combination of lifestyle changes, exercises, and treatments, there’s no reason for your stress incontinence to hold you back indefinitely. Take control today by speaking to your healthcare provider and embracing a more confident, active lifestyle!