I wet myself when I sneeze!

by Dr Howard Lee

I recently had a baby and when I sneeze, cough or laugh I wet myself. Is this a common problem and will it resolve itself over time?

answer

It is very common for urinary stress incontinence - which is the condition you describe - to develop after child birth. It is usually a temporary, acute condition where 'pressure within the abdomen', such as occurs when you sneeze, laugh, cough or exercise, causes a small amount of urine loss. For most people, a period of regular pelvic floor exercises will cure the problem.

During the recent birth of your baby, your pelvic floor muscles, which support your bladder, became stretched and this has upset the mechanism that controls the bladder outlet muscles themselves. (The actual mechanism of urinary control is, in fact, quite a complicated system) Other factors may also have had some influence, too: the actual length of time of your labour - a very long labour, as well as a very fast 'uncontrolled' delivery can cause stretching of the pelvic floor muscles; as does an assisted delivery - particularly a forceps extraction.

It is important, therefore, to start pelvic floor exercises - known as Kegels (named after Dr Kegel - as soon after the birth as possible. The first step is to try and identify these muscles for yourself. To do this try to 'stop and start' the flow of your urine; by doing this you will quickly learn to feel just which muscles you are going to exercise (but don?t do this long-term as it may possibly increase the chance of a urinary infection). Once you have been able to identify your pelvic floor muscles you simply have to tighten and relax these muscles over and over - whenever you have the opportunity. Start with 10-15 contract/release actions per session, several times a day; then gradually increase the number of daily sessions. Your midwife or health professional will also be able to describe some variations on the basic Kegel exercise; these will also help to build up your pelvic floor muscles more efficiently.

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I wet myself when I sneeze!