Ask a PT: This question may be embarrassing, but what can I do about urinary urgency and leakage when coughing and sneezing?

leakThe solution to this problem may be way easier than you think. For most of our patients with these issues, the problem is NOT weakness in the pelvic floor due to pregnancy, low back pain, disc herniation, fibromyalgia, but rather OVERUSE and muscle SPASM in the pelvic floor related to continuous over use of these muscles. Then you find yourself in an urgent situation, and when you need your lower pelvic floor muscles to tighten further, they reach a tipping point and are ineffective in preventing leakage.

Before rushing to your OB/Gyn, try out this test you can do right now to determine the state of your pelvic floor muscles. Ready? Tighten your lower pelvic floor muscles as if you are doing a “Kegel’s” exercise. Hold as tight as you can for 3 seconds, then try to relax the same muscles as quickly as you can. Count how many seconds it takes for the muscles to return to their resting state.

If you are like the overwhelming majority of my patients, this relaxation that should take less than .5 seconds, probably took 3-5 seconds. This is the root of the problem. The fix is easy. Do this “reverse Kegel’s” exercise: tighten the lower pelvic floor muscles (like you are trying to stop the flow of urine) for 2-3 seconds, then relax as quickly as possible. Do this exercise 10-15 times, several times throughout the day. You can even do 1 second “Quick Hitters,” working on improving neuromuscular control of your lower pelvic floor. For most women, you will notice a difference within a week of doing these exercises on a daily basis.

This didn’t work for you? Your Kegel’s exercise is a weak, sad, state of affairs? Then go ahead and try the traditional Kegel’s exercises with a 5 second hold. If you have pain or feel structures falling down or through, please see your OB/Gyn so he or she can help you diagnose what else you may have going on. Sometimes prolapse or herniation occurs, requiring a surgical procedure, so please don’t be shy, but get help as soon as you can to address this issue before it gets even worse.

Not sure what’s going on? Feel free to call or email our physical therapists who specialize in the treatment of the pelvic floor anytime at 920-215-2050 or, and we will be happy to point you in the right direction.