Urine Drainage When Coughing and Sneezing

Q:  I would like to know about urine drainage when coughing and sneezing. Why is this subject not spoken more about and kept in the closet? What does one do? Where to go for help? And where can one read more about it?

A:  Your question describes a malady known as urinary incontinence. A recent medical journal described this condition as a "silent epidemic". More specifically, urinary incontinence (UI) is defined as the involuntary loss or leakage of urine sufficient to be a problem for either individuals and/or their caretakers. The presence of UI is most common in people over the age of 65, the chronically ill, and nursing home patients. As many as 15-30% of those living independently experience this problem with women afflicted at twice the frequency of men.

The failure to diagnose UI has several facets. Often, it is simply not reported to one’s physician. Perhaps embarrassment, lack of knowledge of treatabilty, or a belief that this is somehow "normal" are explanations. It also appears that physicians may not ask patients if they are experiencing any episodes of incontinence.

There are several causes to be considered in the diagnosis of UI. The first two have to do with the muscle tissue in the wall of the bladder that facilitates emptying. This is called the detrusor muscle. This muscle can develop a kind of irritability and contract when it should not or it may be severely weakened and not contract well meaning that the bladder fails to empty completely leaving larger amounts of residual urine. There is a small muscle or sphincter that controls the exit tube of the bladder or urethra that may fail to remain closed completely during bladder filling. As a result, coughing or sneezing, or straining through lifting can cause leakage. A less common form may have to do with insufficient bladder emptying through a partial blockage at this same exit point. An individual can have just one, or a combination, of these.

Treatment is relative to the specific cause. First, tell your doctor you are having a problem. Just because this is not life threatening, it doesn’t mean its not important. There are many women who simply won’t go out in public for fear of an episode in a restaurant, or in the home of a friend or relative. The odor associated can be difficult to conceal and the volume of urine released unpredictable.

Undergarments can be helpful but ought not to be considered the treatment of choice without considering other possibilities. Surprisingly, many treatment options are quite simple. The cause may be one of a series of medications you may already be taking and the problem resolved by a substitution. There are exercises that can be suggested to increase the strength of weakened muscles. Medications may be added to help keep the exit muscle more tightly closed. In many women, menopause is the culprit and oral estrogen or topical estrogen applied vaginally may be of great assistance. Surgery may be an option for some as well.

Thank you for your question. I hope my answer has encouraged you and others to get help that is readily available.

Dr. Russell Robertson is Associate Dean for Faculty Affairs and Associate Professor of Family and Community Medicine at the Medical College of Wisconsin. His biweekly column of medical advice also appears in the CNI Community Newspapers throughout metropolitan Milwaukee.