A WOMAN’S MIDLIFE SURVIVAL GUIDE
I don’t know what the hell is going on, but lately, I pee a little when I sneeze!
Do you pee when you sneeze? Let’s talk about it.
We, women, need to be more comfortable talking about this stuff. Our bodies are doing exactly what they’re meant to do, yet we treat hormonal changes like the elephant in the room. We ignore them, hoping they’ll go away.
Don’t you wish we could have conversations about these types of issues with our girlfriends or female co-workers as easily as we talk about TV shows and our favorite songs?
Imagine sitting with a group of women trading ‘sneeze‑pee’ stories the same way men trade fishing or hunting stories. Laughing, comfortable, unashamed, and figuring out how to deal with these changes together
Instead, we’re out here winging it, trying to figure everything out on our own or with the help of Google and ChatGPT. You’d think nobody else is experiencing the same things we are.
If you’re lucky, you’ve found an outstanding doctor who listens to your concerns and addresses your hormonal, female-related concerns instead of brushing them off.
The good news is that things have really been improving. Not only are better treatments available, but doctors are also beginning to take women’s issues seriously.
And, thanks in part to the Pelvic Floor Research Group (PFRG), doctors have more information to understand women’s biology and the hormonal issues that come with age. The PFRG is an internationally recognized research group that works to improve the understanding and treatment of pelvic floor disorders.
Their goal is to identify risk factors for developing pelvic floor disorders, work with high-risk women to prevent them, and provide the most effective and newest treatments for pelvic floor dysfunction.
With a clear understanding, better tools, and more specialized training, Doctors are better able to address women’s issues more directly.
Some years ago, I was talking to my mom about the changes my body was going through as a result of menopause. I was having trouble sleeping through the night, experiencing vaginal dryness, my libido dropped, and I was dealing with belly fat that appeared almost overnight.
The combination of all these post-menopausal symptoms, especially the ring of fat around my belly that I couldn’t get rid of, pushed me to research hormone replacement therapy options.
During our conversation, Mom asked if I had a weak bladder. This wasn’t the first time she had asked that question. “Just wait,” she said. She swore it was hereditary. That my grandmother and aunt were also cursed with weak bladders.
At the time, my ‘weak bladder’ was fine. Fast forward to this past year, however, and I recall that day as if it were yesterday. I sneezed, and a little pee slipped out. I couldn’t believe it.
But this ‘sneeze-pee’ wasn’t caused by a weak bladder. Well, kind of, but more precisely, it was caused by weakness in my pelvic floor. Our bodies go through changes as we age, and this is unfortunately one of them.
The pelvic floor, which is comprised of muscles that hold up the bladder, uterus, and rectum, naturally weakens as we age. When those muscles can’t clamp down with the same force they used to, any sudden pressure on the abdomen (a laugh, a sneeze, or a cough) can push urine past the urethra.
The technical term for this is stress incontinence, which is experienced by 1 in 3 women over 45, and about half of women over 65. Your pelvic floor muscles and the urethral sphincter lose strength or support. So when you sneeze, cough, or laugh, it’s not strong enough to ‘hold your pee’.
We, women, can’t catch a break! Why do we have to experience all the bad stuff? Why can’t men be cursed with menstrual cycles, hormonal changes, menopause, and all of that? Can you imagine what would happen if men peed when they sneezed or coughed?
Here I am trying to figure out why I can no longer sleep through the night, why every workout feels like I’m starting from scratch, why I’m experiencing brain fog, and why I can’t get rid of this fat like I used to. And now, I’m peeing when I sneeze! What gives?
My primary care doctor prescribed estrogen, progesterone, and estradiol to slowly give my body back the hormones I’ve lost due to menopause. Declining estrogen during perimenopause and menopause is one of the primary drivers of pelvic floor changes.
Estrogen plays a crucial role in maintaining blood flow and collagen. When estrogen levels drop, the tissues of the vagina and urethra become thinner, drier, and less elastic.
Last year, I had an InBody scan and a full blood panel conducted. The results revealed very low levels of estrogen, progesterone, and testosterone, which explains the timing of my “sneeze-pee.” I’m going through the change. Insert sad face here.
My urethra is losing its natural “plumpness.” This makes it harder for the urethra to stay sealed when I sneeze. So, the goal of hormone replacement therapy, in part, is to restore my urethra’s elasticity, to help it close more effectively.
My doctor said it may take some time, but the hormone replacement therapy should help alleviate these incidents. She sounded very confident about that claim, so I hope it works!
If that doesn’t work, there are other options
I’m sure you heard of Kegel exercises. They were all the rage years back for improving sex and strengthening a woman’s pelvic floor. You were to first identify your pelvic muscles by stopping your urine mid-stream. That tightening is the basic foundational move of a Kegel.
Once you’ve identified the muscles of your pelvic floor, you should sit in a chair or lie on the floor and perform a Kegel, squeezing for five seconds, releasing for ten seconds, and repeating for ten repetitions. Big fun!
Well, there’s a new Kegel. A therapist hooks you up to sensors that track and chart the performance of your pelvic floor muscles. It’s called a guided Kegel because the therapist helps you learn to squeeze the correct muscles and relax the wrong ones, to help you learn proper Kegel technique.
What’s funny is that I’ve done a few Kegels as I type. You probably have too.
Another option is a silicone device inserted into the vagaina. It’s called a pessary. It’s a soft, removable device that supports the areas affected by pelvic organ prolapse, which happens when your pelvic floor is weakened. Organs like your bladder, rectum, vagina, or uterus slip out of place.
It works by lifting and supporting the urethra. The silicone device can be worn daily or only during physical activity and is often used by those who are comfortable managing a device placed in their vagina.
There’s also the option to get urethral bulking injections. The procedure is minimally invasive (don’t you love that term). A substance is injected into the urethral wall to help it close more effectively, preventing leakage during physical activity. In essence, it makes the urethra “plump,” so it closes better.
The gold standard option is sling surgery. This surgery involves placing a sling made from mesh or human tissue to support the urethra or bladder neck. It’s considered effective for managing urinary incontinence, with several options available depending on individual needs.
In a nutshell, the sneeze-pee is treatable!
Alternatively, incorporate these exercises
If you’d like to keep it simple, start with Kegel exercises. We’ve been trained to believe they’re the holy grail of pelvic floor strengthening, but there are other exercises to add to your pelvic floor program.
Bridges are another exercise you can try. They look deceptively easy because you’re just lying on your back, lifting your hips, and squeezing your glutes, but don’t let that fool you.
They’re great for pelvic support. Once your hips are at the highest point, hold the position for a few seconds, clench your glutes, then slowly return to the starting position. Strong glutes help stabilize the pelvis, which takes pressure off the pelvic floor.
Next, throw some good old-fashioned squats into the rotation as well. Squats strengthen the glutes, hips, and thighs, which are major players in pelvic stability. When these muscles are strong, the pelvic floor can contract and relax more effectively.
Of course, there’s the adductor machine, which you might be familiar with. It’s that machine at the gym that can make you feel uncomfortable using it, depending on which direction it’s facing. That’s the one.
The inner thighs and pelvic floor are like neighbors who share a fence: when one gets stronger, the other benefits.
Similar to the adductor machine, squeezing a ball between your knees activates the adductors, which in turn helps the pelvic floor engage more naturally. It’s subtle, but effective. There are also contraptions you can buy to help you perform this movement. I found that out by accident.
There are a few more exercises that would help, but for the sake of brevity, I’ll stop there.
At the end of the day, the goal of pelvic floor exercises is to strengthen the whole network of muscles around the pelvis so it can stop overworking and start functioning the way it’s meant to.
Strengthening your pelvic floor is more about building a supportive system of muscles that work together. When the pelvic floor is left to do its job alone, that means the primary muscles supporting it aren’t helping out.
This brings me back to where this story began.
Let’s do a better job of supporting each other. Whether it’s tips on how to sleep better at night, how to eat enough protein, or laughing about peeing when we sneeze. Our biology will do what female biology does!
The more we talk about it, the less alone we feel. It’s not something to be ashamed of.
Be well!
Edrika
Disclaimer: I’m not a doctor and don’t claim to be. This is for informational purposes only. Always consult with a qualified healthcare provider before beginning any new exercise program, especially if you have existing health conditions, mobility limitations, or concerns about your heart, joints, or balance.