Contrary to what many people believe, leaking pee is not a normal consequence of aging. Many people (especially women), tend to commiserate with each other over the need to change clothes after laughing hard. But what most people don’t know is that there are fairly simple things you can do to drastically improve, if not eliminate, urinary leaking.
Leaking urine when you laugh, sneeze, or perform some sort of activity is officially called Stress Urinary Incontinence, or SUI. This occurs when the muscles of your “saddle,” or pelvic floor, are not strong enough to withstand increases in pressure (or stress) to the abdominal cavity. The result is that urine is forced out of the opening to the bladder, or urethra. (Imagine squeezing a water balloon that has not been tied off at the end.)
SUI is a very common occurrence, and is especially prevalent in women, due to both anatomical and procedural differences compared to men. First, just the fact of having a vaginal opening makes it more difficult for women’s pelvic floor muscles to function; men’s pelvic floor muscles are attached at the center and therefore more anatomically stable. Second, many women have medical events and procedures that cause trauma and scarring to the pelvic floor muscles, which makes it more difficult for them to function. Examples include childbirth (especially with a muscle tear or episiotomy), hysterectomies, and bladder surgeries. This is not to say that men never have SUI, but it is exceedingly more common in women.
So what can you do if you find yourself leaking from SUI? Pelvic floor exercises (sometimes known as “Kegel” exercises) are a good place to start: from a seated position, think about how you can feel your pelvic floor “saddle” touching the chair. Now gently squeeze and lift those muscles, as if you were lifting them up away from the chair. Hold that squeeze for 5-10 seconds as you breathe steadily, and repeat 10 times, 3x/day. This exercise can help strengthen the pelvic floor muscles and encourage them to be your “last line of defense” in holding back urine.
If your symptoms continue after trying this simple exercise, you may consider seeking out help from a pelvic rehabilitation physical therapist. A pelvic rehab PT can more fully assess how your pelvic floor muscles are working, and re-train them to work during real-life activities. Pelvic rehab PTs are trained to look specifically at the timing and coordination of your pelvic floor muscles, among other things. They will also make sure that the exercises you’ve been doing are actually activating the correct muscles; many women think they’re doing Kegels correctly but in fact are activating hip, abdominal, or gluteal muscles instead.
Remember, urinary leaking is not a normal or inevitable part of aging. Treatment for SUI is painless and can be very simple, but most importantly, it will allow you to keep laughing without fear for decades to come. Laugh on, friends!