Leaking When You Laugh?
by Dr. Sarah Joy White, PT, DPT, CD
Have you ever heard (or said), “don’t make me laugh, or I’ll pee”?
Do you cross your legs when you sneeze?
Are you the person who knows where every bathroom is when you go out?
You’re not alone! Leakage of urine is fairly common, about 13 million people in the US deal with it. And it’s not always a sign of weakness or deconditioning. Depending on the sport, up to 76% of female athletes experience leakage. So we know it’s common, but is it something you just have to live with? No!
So why does it happen? It can be for any of several reasons. There can be a lack of strength, coordination, or endurance in your muscles, there can be pressure from constipation pushing on your bladder, there can be a structural issue in your pelvis, or you could be doing things that pressurize your abdomen and your pelvic floor can’t hold against that pressure. If you look up urine leakage online, the internet will tell you your pelvic floor is weak and that you need to do kegels. For some people, this works. But for some people, it can do nothing or actually make the leakage worse! So what are you supposed to do?
First, do a self-check of your pelvic floor! Everyone has these muscles, not just women. If you’re comfortable, using a hand mirror to look at the region between your sit bones is helpful. Otherwise, you can sit on your hand and take note of what you feel.
Squeeze like you’re trying not to pee. Do you feel a squeeze around your vagina and/or anus? Can you feel just that squeeze, and not your glutes and inner thighs?
Relax. Let go of that squeeze. Do you feel that relaxation happen without a delay?
Cough. Do a big cough. Do you feel a squeeze around your vagina and/or anus? Can you do that without leaking?
Bear down like you’re trying to pass gas or have a bowel movement. Do you feel your pelvic region lengthening/pushing down?
If the answer to any of these is no, that means you likely have a pelvic floor issue and would benefit from pelvic physical therapy to help your muscles support you better. If the answer to all of the above questions is yes, that’s great! That means your pelvic floor is doing the right things at the right times. This tests coordination, but we can still have a weakness or tension issue that this test doesn’t show. If you’re having leakage, a pelvic physical therapist can do more tests to see exactly what kind of support your pelvic floor needs.
So what’s normal? We don’t discuss our bathroom habits in polite conversation most of the time, and we start learning to use these muscles as babies, before we have language to talk about it. Many people may have pelvic issues, and think it’s just how the bladder works. For context: we usually consider “normal” frequency of urination to be every 2-4 hours during the day and 0-1 times during the night. The “normal” way to urinate is to relax and let urine flow out without pushing or straining. And the “normal” amount of urine leakage for any age is NONE!
What can you do about it? If the squeeze is the difficult part of the tests above, you may need to work on strengthening. Try a few daily kegels and see if the leakage improves. If the relax is the difficult part, you may need to work on releasing tension. Try doing some deep breathing and cat/cow movements. If the cough is the difficult part, you may need to work on coordination. Try doing a kegel every time you cough, sneeze, or lift something heavy. And if the bearing down is the difficult part, you may need to work on stretching. Try doing a “shh” sound when you’re on the toilet. These are the first tips to help with these issues, but many people need more individualized support. A pelvic physical therapist is the best-suited healthcare professional to help you with this.
At Vivian Joy Physical Therapy, Dr. Sarah Joy can do a complete evaluation of your pelvic floor muscles and the surrounding structures to tell you the exact cause of your leakage and how to get rid of it. You can use the “Book Now” button above to schedule a free discovery call with her.
References
Leslie SW, Tran LN, Puckett Y. Urinary Incontinence. [Updated 2024 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan.
Joseph C, Srivastava K, Ochuba O, et al. Stress Urinary Incontinence Among Young Nulliparous Female Athletes. Cureus. 2021;13(9):e17986. Published 2021 Sep 15. doi:10.7759/cureus.17986
