Do you pee a little when you cough, sneeze, laugh, run, or jump? This is called stress incontinence. It can happen in anyone, male or female, but it is common in people who have had a baby.

One important thing to note is that while these symptoms are common, they are not normal. Leaking urine at any time is never normal. The good news is, there is lots you can do about it that doesn’t involve drugs or surgery. In fact a little awareness goes a long way.

However, this blog isn’t about things you can do to stop leaks (check out this blog series of 3-5 min reads for more on that). This blog is about some things you probably don’t even realize that you are doing that are possibly contributing to your symptoms of leaking urine.

1. Hovering to pee.

Here’s the scenario. You’re out and about and you are crushing you’re to-do list. Mid way through a trader joes run you realize you have GOT to pee. You don’t have time to check out and get home, and you don’t want to leave your groceries, so you pull your cart up to their public restrooms and run inside. Once inside, you realize that there is literally one square of toilet paper left. Just enough to wipe, but not enough to line the toilet seat. So you hover to pee: squat real low, but don’t sit on the toilet seat and get the job done.

No problem right? Hmmm well you did what you had to do and this is a perfectly fine strategy to use once in a great while, but as far as your pelvic floor goes this is truly not a great habit to get into. Here’s why:

Your pelvic floor has a lot of functions. One of them is to stabilize your pelvis, another is to control voiding. Stabilizing your pelvis like say during a squat requires tensioning of these muscles. Voiding requires relaxation of these muscles. To do both at the same time means you can’t fully relax to void, so what ends up happening is you contract your core muscles to bear down or push out the pee effectively overpowering your pelvic floor muscles. This same overpowering is what happens when we jump, cough, laugh, etc. where gravity, or contraction of muscles to bear down overpowers the pelvic floor to cause leaking. So if when you hover to pee, you are essentially practicing the strategy to promote leaks. So if you can avoid it, don’t hover which feeds into this problem. Sit and let your pelvic floor relax to do it’s thing.

2. Not using a squatty potty to have a bowel movement.

I realize some of you are reading this and asking yourself ‘WTH is a squatty potty??’. Let me rock your world. A squatty potty is a small stool usually 6ish inches that you put under your feet when you take a 2. It raises your knees higher than your hips changing the position of your pelvis and pelvic floor so you can more easily void. There is definitely a patented squatty potty you can purchase, but a stack of books, toddler stool, or small trash can flipped upside down works just fine. Simply put, the squatty potty makes having a bowel movement easier, requires less of the bearing down or straining we mentioned above. If you don’t use it, you should, and your pelvic floor will thank you.

A pic of a Squatty Potty for those of you that aren’t familiar. (image taken from target.com)

3. Power pee.

Here’s the scenario. Your kiddos are destracted and you have a second to run to the bathroom because you’ve been holding it while you made breakfast, cleaned up said breakfast, changed a diaper, and helped de-escalate world war 3 between your oldest and youngest. Half way through this restful time in the bathroom, you hear a loud crash followed by a cry: “MOMMYYYYY!” (or daddy). OH SHIT. You take a deep breath and force out the rest of the pee, yank up your pants, quickly rinse your hands and run out yelling “I’m coming honey!”.

Again, like the hover to pee situation, hopefully this isn’t something that you are doing with every go, but it’s definitely something you’d want to avoid.

Here’s why:

Hopefully this part is starting to sound a bit familiar. Like with the hovering… pushing out, or bearing down to force pee out is basically never a good thing for your pelvic floor. Like I mentioned above, more or less you are practicing the way to engage so that your pelvic floor gets over-powered and you leak. Not only can this sort of habit lead to increased leaking symptoms, but other pelvic floor issues such as prolapse, urine retention aka not fully voiding, or bladder infections (from said urine retention).

4. Blowing your nose while voiding (poo or pee).

Here’s the scenario: You’re a parent. This means that likely more often than not you are short on time with a long to-do list. So you do what any good parent does: multi-task. Set go on the Roomba while you wash the dishes: 2 jobs are getting done at once. Got the dish washer and the washer dryer going at once: 2 jobs getting done at once. Blow your nose while you go to the bathroom: 2 jobs are getting done… wait a minute.

Not a good idea for your pelvic floor. Here’s why:

Blowing your nose involves bearing down or increasing intra-abdominal pressure which challenges your pelvic floor. One strategy to execute a good ‘nose blow’ without leaking is to actually contract your pelvic floor or kegel as you exhale to brace your pelvic floor ahead of bearing down. I go into more detail here in this blog called ‘Blow before you go’. But if you are actively voiding while you blow your nose, then you are needing to relax your pelvic floor and won’t be able to contract it. Here we are again with the bearing down while you relax your pelvic floor action which boils down to practicing a strategy to guarantee leaks. In conclusion, I support multitasking and anything that gets you to the bottom of your to-do list faster, except for blowing your nose while you’re on the toilet.

5. Holding your breath when you sneeze.

Here’s the scenario: you’ve been working from home since March of 2020 and enjoying all of those benefits: no commute, no need to change out of your pajamas unless you want to, ability to flip laundry between meetings (you all know how I feel about multitasking) and sneezing as loudly as you like without offending anyone except for maybe your neighbors. But the time has come to go back in the office 2 days per week. So you squeeze into your favorite pair of hard pants and get to it. The hard pants are not so bad and you have time to do your laundry on the other work from home days but now you have to sneeze mid meeting. And it’s not a zoom where you can mute yourself, this is a real live in-person meeting with the big boss. No time for loud obnoxious sneezes, so you hold your breath to stifle the sneeze.

Not good for your pelvic floor. Here’s why:

The whole physiologic purpose of a sneeze is to forceful evict whatever offender has triggered your upper respiratory system with a giant and sometimes violent exhale. When you hold your breath for any reason you are locking in your pelvic floor and your diaphragm and then the sneeze itself doesn’t have anywhere to go. So if the pressure can’t go up and out it heads down. This is an easy way to overpower a pelvic floor that might be used to getting over powered from all of the above activities. One way to lessen this blow is to exhale and brace or contract your pelvic floor as your sneeze. More on this breakdown here. Sure, you might sneeze a little louder. But if you have a boss who gives you a hard time for sneezing maybe it’s time for a new boss. Also your pelvic floor will thank you.

If you’re interested in learning more about stress incontinence or leaking with activity like running, jumping, coughing, sneezing or laughing click here for my pelvic floor blog. Stay tuned for details of my Functional Pelvic Floor Workshop Launching this fall! This workshop is an active, virtual, 4-part workshop for people who are struggling with stress incontinence and looking for solutions. Follow me on Instagram @drlauralatham for more. Interested in getting details now? Connect with me here.