UNC Health Care
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I Pee When I Sneeze—What Can I Do About It?

For many women, peeing while sneezing is more than a common occurrence—it’s a frequent annoyance and often an embarrassment that many experience in silence.

What they might not realize is that urinary incontinence is normal: About a quarter to a third of Americans experience it. And though many might think it’s a permanent issue, it’s treatable.

Stress incontinence, a form of urinary incontinence, happens when physical activity such as coughing, sneezing or running puts pressure on the bladder, explains Samantha Pulliam, MD, director of UNC Urogynecology and Reconstructive Pelvic Surgery.

Stress incontinence is caused by weakened pelvic floor muscles or other physical changes in the body. For women, bodily changes such as pregnancy, childbirth, menopause or hysterectomies are main causes of stress incontinence.

Other risk factors include:

  • Being female
  • Age
  • Being overweight
  • Smoking
  • Family history
  • Other diseases, such as diabetes or neurological conditions and illnesses that cause chronic coughing or sneezing

So, what can you do to treat stress incontinence? Dr. Pulliam recommends the following treatments to help prevent leakage:

Vaginal Pessaries

A pessary is a ring device that sits in the vagina. “The vagina is just underneath the urethra, so the pessary pushes underneath the urethra to support it,” Dr. Pulliam says. With this extra support, there is an increased outflow from the urethra and a corrected angle between the urethra and bladder, both of which can help stop leakage.

Pelvic Floor Physical Therapy

“Seeing a physical therapist can help to ensure that the pelvic floor muscles are working properly and are strong enough either to inhibit leakage or to calm the bladder to resist an urge,” Dr. Pulliam says. Along with this more formal training, at-home Kegel exercises can also help strengthen the pelvic floor muscles.

Urethral Bulking

This procedure involves injecting a bulking substance, such as collagen, around the urethra to either close a hole or build thickness in the urethral wall. This added thickness helps the urethra withstand extra pressure from physical activity.

That said, the effects of urethral bulking aren’t as long-lasting as other treatment options, Dr. Pulliam says. As a result, this procedure is used less often and is usually reserved for older patients.

If the above treatments don’t help, surgery could also be an option. Dr. Pulliam says, in most cases, surgery should only be explored if less invasive treatments don’t work.

Surgical options for urinary incontinence include:

  • Vaginal sling procedure, where a piece of tissue or synthetic material is used to create a sling around the urethra, which helps keep the urethra closed
  • Sacral nerve stimulation, which requires implanting a neurostimulator device in the body to help control muscle function

Talk with your doctor about which treatment is right for you.

How To Strengthen your Pelvic Floor Infographic


Do you need to see a urogynecologist? Find one near you.

Samantha Pulliam, MD, is director of Urogynecology and Reconstructive Pelvic Surgery and an assistant professor at the UNC School of Medicine.