You laughed hard at something at the dinner table. You sneezed twice in a row at your desk. Or maybe you were halfway through a run.
And then it happened: a small leak of urine that you weren't expecting.
Maybe you laughed it off. Maybe you quietly changed your clothes and didn't tell anyone.
You're not alone. Urine leakage is very common, but many people don't talk about it. It can happen at any age. It can affect people who have had children and people who haven't. It can happen to competitive athletes and people who have never stepped foot in a gym.
Because we don't talk about it much, people often assume one of two things: either leaking urine is rare and embarrassing, or it's just a normal part of getting older, having a baby, or exercising.
Neither is completely true.
Here's what may be happening in your body, how common urine leakage really is, and what research tells us can help.
What's Actually Happening?
There are a few different types of urine leakage.
Stress urinary incontinence is leaking that happens with physical effort or pressure. This might happen when you laugh, cough, sneeze, lift something heavy, jump, or run.
When you do these activities, pressure increases inside your abdomen. Your pelvic floor and the muscles around your urethra, the tube that urine passes through, need to respond quickly to help keep urine in.
Urgency incontinence is different. This happens when you suddenly feel a very strong need to pee that is difficult to hold. Sometimes you may leak before you can get to the bathroom.
Mixed incontinence means you experience both types.
Your pelvic floor plays an important role in bladder control. The pelvic floor is a group of muscles at the bottom of your pelvis. These muscles help support your bladder, uterus, and rectum. They also help control the opening of the urethra.
If these muscles are weak, tight, poorly coordinated, or have trouble responding quickly enough, leaking can happen.
That doesn't necessarily mean your pelvic floor is weak. Some people with strong pelvic floor muscles still leak, especially during higher-impact activities.
How Common Is Urine Leakage?
Urine leakage is very common.
Research suggests that about one-quarter to almost one-half of women experience some type of urinary incontinence. Stress urinary incontinence is one of the most common types.
It also isn't just something that happens after having a baby or as you get older.
Research has found urinary incontinence in about one-third of female athletes across different sports. Many of these athletes have never been pregnant.
High-impact activities, such as running and jumping, are linked with more leaking than lower-impact activities.
This doesn't mean you should avoid high-impact exercise. It means your pelvic floor may need help learning to manage the demands of these activities.
Why Does Leaking Happen?
There usually isn't one single cause.
Pregnancy and vaginal birth can put extra pressure on the pelvic floor and affect the muscles and nerves in the area.
Hormonal changes during perimenopause and menopause can also affect the tissues around the bladder and pelvic floor.
Other things that may increase the chance of leaking include:
- Chronic coughing
- Constipation and regularly straining to have a bowel movement
- Higher body weight
- More flexible connective tissue
- Changes in pelvic floor strength or coordination
- Aging
Age can play a role, but it isn't the whole story. Some people in their 70s have no bladder symptoms, while some people in their 30s experience regular leaking.
Your anatomy, muscle coordination, fitness, health history, and the demands you place on your pelvic floor can all play a role.
What About Leaking While Running or Exercising?
If you leak during running, jumping, CrossFit, or another high-impact activity, you're not the only one.
Every time your feet hit the ground, your body has to manage force and pressure. Your pelvic floor needs to respond quickly, over and over again.
Leaking during exercise can be a sign that your pelvic floor is having difficulty managing that specific demand.
It does not automatically mean you need to stop exercising.
Many people continue running, lifting, or playing sports while working with a pelvic health physiotherapist to improve pelvic floor strength, coordination, technique, and overall capacity.
Sometimes changing your training for a short period can help. Other times, you may be able to keep doing your usual activities while working on your pelvic floor.
The right approach depends on you.
What Does the Research Say Can Help?
Pelvic floor muscle training has some of the strongest research behind it for treating urinary incontinence in women.
Large research reviews have found that pelvic floor exercises can reduce leaking. Supervised programs that last at least three months may be more effective than trying to figure out the exercises on your own.
But pelvic floor exercises aren't simply about doing more Kegels, the exercises need to match what your body needs.
Some people need more strength. Others need better coordination or endurance and some people actually have a pelvic floor that is too tight and need to learn how to relax it.
Bladder training and changes to certain habits, such as fluid or caffeine intake, may also be helpful for some people.
Research also suggests that making sure you are doing pelvic floor exercises correctly can improve results. A pelvic health physiotherapist can assess how your muscles are working and help choose exercises that fit your needs.
It's also important to know that change takes time. Most research looks at programs that last several months, not quick fixes.
What Happens During a Pelvic Health Physiotherapy Assessment?
If you've never had a pelvic health assessment, you might not know what to expect.
Usually, your physiotherapist will start by talking with you about your symptoms, health history, goals, and when your leaking happens.
Depending on your symptoms and your comfort level, your physiotherapist may offer an internal pelvic floor examination.
This can help assess:
- Pelvic floor strength
- Muscle coordination
- Endurance
- Your ability to contract and relax the muscles
An internal examination is not required at every appointment. It should only happen with your consent. Your physiotherapist should explain what they are doing and make sure you are comfortable throughout the assessment. Your treatment plan will then depend on what the assessment finds.
You might work on pelvic floor strength, coordination, endurance, or relaxation. You may also discuss bladder habits, fluid intake, caffeine, exercise, breathing, and other factors that could be contributing to your symptoms.
If something needs medical assessment or falls outside physiotherapy, your physiotherapist may also recommend speaking with your family doctor or another healthcare provider.
When Should You Get Leaking Checked?
An occasional small leak during a very hard sneeze, big laugh, or intense workout can happen.
What matters more is how often it happens and how much it affects your life.
It may be worth getting assessed if leaking:
- Happens regularly
- Is becoming more frequent
- Changes how you exercise
- Makes you plan your day around bathroom access
- Stops you from doing activities you enjoy
- Happens along with pelvic pressure, heaviness, or pain
- Is simply bothering you
There isn't a specific number of leaks per week that means you need treatment.
If you want to understand why it's happening or learn whether something can be done about it, that is enough reason to ask for help.
Getting Support Without Another Trip to a Clinic
Sometimes the hardest part of getting pelvic floor physiotherapy isn't deciding whether you want help but finding the time to get to an appointment.
Childcare, work, transportation, mobility challenges, and busy schedules can all make getting to a clinic difficult.
In-home pelvic health physiotherapy removes most of these barriers. Your physiotherapist comes to you, so your assessment and treatment can happen in the comfort and privacy of your own home.
Core Connection provides mobile pelvic health physiotherapy in Victoria, the Cowichan Valley, North Vancouver, and West Vancouver.
The Bottom Line
Leaking urine when you laugh, cough, sneeze, run, or exercise is common. It can happen at different ages, after childbirth, and even in young athletes who have never been pregnant.
And there are things that can help.
Pelvic floor muscle training has strong research behind it and is often one of the first treatment options for urinary leakage. The best program depends on what your pelvic floor actually needs.
You don't necessarily have to stop running, jumping, lifting, or doing the activities you enjoy.
If leaking is happening regularly, changing what you do, or simply bothering you, a pelvic health physiotherapy assessment can help you better understand what's happening and what your options are.