Fellowship-Trained Urogynecologist
Urogynecology & Reconstructive Pelvic Surgery
Green Bay, Wisconsin
✓ Medically reviewed May 15, 2026
Why do I leak urine when I cough or sneeze?
If you leak a little urine when you cough, sneeze, laugh, or exercise, you’re not alone. This is called stress urinary incontinence (SUI). It affects roughly 1 in 3 adult women at some point. It happens when the muscles and tissue that support your urethra can’t keep it fully closed during a sudden burst of pressure in your belly.
What’s actually happening
Your urethra is the tube that carries urine out of your body. It stays closed thanks to a mix of muscles, ligaments, and connective tissue. When you cough, sneeze, laugh, jump, or lift something heavy, the pressure inside your abdomen spikes. If the support system is working well, that pressure gets absorbed and your urethra stays shut. When the support has weakened, the urethra can’t hold against that pressure, and urine leaks out.
Think of it like a garden hose. If you step on the hose firmly, water can’t get through even when someone turns up the faucet. But if your foot isn’t pressing hard enough, water leaks out. Your pelvic floor muscles work the same way. When they’re weakened or damaged, they can’t keep the urethra sealed under pressure.
There are actually two parts to the problem. The support under the urethra can weaken, and the seal of the urethra itself can lose strength over time. Most women with SUI have some combination of both.
Why does this happen?
Several things can weaken the support around your urethra:
- Pregnancy and vaginal delivery are the most common cause, sometimes showing up years after childbirth
- Hormonal changes after menopause thin the tissues that help support and seal the urethra
- Chronic coughing or heavy lifting puts repeated strain on the pelvic floor over time
- Carrying extra weight increases constant pressure on the pelvic floor. Women with a BMI over 35 have about 4 times the risk of SUI compared to women at a healthy weight
- Genetics play a role too. Some women naturally have weaker connective tissue
Many women first notice symptoms after having a baby, but SUI can develop at any age. Symptoms often get worse gradually. What starts as an occasional leak may become more frequent over time.
Treatment options
There are several ways to treat SUI. The right choice depends on your goals, how much the leaking bothers you, and what fits your life. I walk through all the options with my patients so we can decide together.
- Pelvic floor physical therapy (PT) goes well beyond Kegels. A pelvic floor therapist works on strength, coordination, endurance, and relaxation. They also address the muscles around the pelvis like your hips, core, and thighs. One Cochrane review found that women doing supervised PT were 8 times more likely to report their leaking was cured compared to no treatment. We have pelvic floor PTs in our office, which makes getting started easy.
- Weight management can make a real difference. Losing even 5-8% of your body weight has been shown to cut SUI episodes by more than half.
- A pessary is a removable support device you wear inside the vagina. It helps reduce leaking during physical activity. Over 90% of women can be successfully fitted with one.
- Urethral bulking is a minimally invasive procedure done in the office under local anesthesia. A gel is injected around the urethra to help it seal better. It’s a good option if you want something more than PT but prefer to avoid a bigger surgery.
- A midurethral sling is the most common surgery for SUI. It’s a short outpatient procedure with a median cure rate around 84% at one year. For women who want a lasting fix, it has the strongest long-term track record.
Many of my patients are surprised by how much better they feel with PT alone. But for those who want a more definitive solution, options like the midurethral sling have very good results. There’s no single right answer. It’s about what matters most to you.
When to see a specialist
If leaking is changing how you live your life, it’s worth talking to a specialist. Maybe you’re skipping workouts, changing what you wear, or carrying pads just in case. A urogynecologist can figure out the exact type and cause of your leaking and build a plan around your goals.
References
- Wu JM. Stress incontinence in women. N Engl J Med. 2021. doi:10.1056/NEJMcp1914037
- Lukacz ES, Santiago-Lastra Y, Albo ME, Brubaker L. Urinary incontinence in women: a review. JAMA. 2017. doi:10.1001/jama.2017.12137
- Kobashi KC, Albo ME, Dmochowski RR, et al. Surgical treatment of female stress urinary incontinence: AUA/SUFU guideline. J Urol. 2017. doi:10.1016/j.juro.2017.06.061
- Wallace SL, Miller LD, Mishra K. Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Curr Opin Obstet Gynecol. 2019. doi:10.1097/GCO.0000000000000584
- Fleischmann N, Chughtai B, Plair A, et al. Urethral bulking. Urogynecology. 2024. doi:10.1097/SPV.0000000000001548
- ACOG/AUGS. Urinary incontinence in women (Practice Bulletin No. 155). Obstet Gynecol. 2015. doi:10.1097/AOG.0000000000001148
- Richter HE, Albo ME, Zyczynski HM, et al. Retropubic versus transobturator midurethral slings for stress incontinence. N Engl J Med. 2010. doi:10.1056/NEJMoa0912658
- Subak LL, Wing R, West DS, et al. Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med. 2009. doi:10.1056/NEJMoa0806375
- AUGS/SUFU. Joint position statement on midurethral slings. Female Pelvic Med Reconstr Surg. 2021. doi:10.1097/SPV.0000000000001096
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