If you pee when you sneeze, you aren’t alone. If you break out into a sweat when your trainer asks you to do jumping jacks for fear you might “piddle,” you most likely are in the company of fellow “piddlers.”
For years now I have heard these complaints from many of my female clients, and it pisses me off (pun intended) because every single one of them thinks it’s “just them.” I am here to tell you A) it’s not just you, and B) there are a lot of options when trying to strengthen your pelvic floor.
Let’s start with the first point – you are definitely not alone. Urinary leakage, often called stress urinary incontinence, happens when pressure inside the abdomen increases during things like coughing, sneezing, laughing or exercise. If the pelvic floor muscles that support the bladder are weakened, that pressure can cause urine to leak unintentionally.
And just how common is this? Very! About one in four adult women experience bladder leakage, and some estimates suggest up to half of women will deal with urinary incontinence at some point in their lives. Among women over 65, the numbers climb even higher.
Translation: if you’ve ever nervously crossed your legs during a workout class, there’s a very good chance several other women in that room are thinking the exact same thing.
The good news is that the pelvic floor, a sling of muscles supporting the bladder, uterus and bowel, can absolutely be strengthened. Like any muscle group, it responds to consistent training.
One of the most recommended exercises is the Kegel. Now just saying that word is going to make some of you laugh, some of you blush and some of you absolutely puzzled. Over the years I’ve learned that while most women have heard of Kegels, a surprising number have never actually been shown (or told) how to do one.
Which reminds me of a conversation I once had with a 92-year-old client named June (name changed to protect the fabulous). June looked at me one day and said, completely matter-of-fact, “Jen, my doctor told me I need to Kegel so I stop wetting my pants. Can you show me?”
Now I pride myself on being able to teach most exercises, but this one gave me pause.
“June,” I said, trying to maintain professional composure while also wanting to run out of the room, “I can’t really show you … but I can try to talk you through it.”
“Great,” she said. “Because I really can’t stand not wearing grey or black. I’m a New Yorker. We don’t wear white or pastels well.”
“I hear that,” I told her. “We are in fact genetically allergic to most colors other than black and grey.”
Then I explained it the best way I knew how.
“Think about the muscles you feel when you try not to pee. Those are the muscles you want to squeeze. Tighten them and imagine lifting them up like an elevator. Squeeze and bring the elevator all the way up to the penthouse … then slowly release back down to the lobby.”
June thought about it for a moment. “I can’t hold my pee for that long,” she said.
“That’s okay,” I replied. “Hold and lift for as long as you can, then gently release. Over time you’ll make it to the penthouse.”
She nodded, clearly considering the logistics. Then she asked one more question.
“So, what are these balls I keep seeing on Google when I search Kegels?”
At this point I briefly considered a career change.
“Well,” I said carefully, “those are tools some people use to help engage the muscles — kind of like giving the elevator something to carry on the ride up.”
June looked me dead in the eye and said, “Honey, I ain’t carrying nothing up with this.”
And honestly, fair enough. The good news is you don’t need any equipment to get started.
Here are three simple exercises that help strengthen the pelvic floor:
Kegels: Tighten the muscles used to stop urination, hold for about five seconds, then relax. Aim for 10 to 15 repetitions a few times a day.
Glute bridges: Lying on your back with knees bent, lift your hips while squeezing your glutes and gently engaging the pelvic floor.
Pelvic tilts: While lying on your back with bent knees, flatten your lower back into the floor by tightening your abdominal muscles and pelvic floor, hold briefly, then release.
For many women, strengthening alone can significantly reduce symptoms. Pelvic floor training is often the first line of treatment recommended by physicians.
But if strengthening alone doesn’t fully solve the problem, there are medical options available.
One is urethral bulking injections, where a small material is injected around the urethra to help it stay closed more effectively.
Another option is the mid-urethral sling procedure, a minimally invasive surgery that places a small supportive sling under the urethra to help prevent leakage during movement, coughing or exercise. It’s one of the most common surgical treatments for stress incontinence and often very successful. Physicians call it a sling, but I prefer hammock, because it feels more like rest than it does repair.
Now – before anyone panics – surgery is not the first step for most women. But it’s important to know there are options beyond silently crossing your legs every time you laugh. Here’s the part that really gets me: Many women wait years before ever bringing this up to their doctor. And they shouldn’t have to. Leaking when you sneeze isn’t a personality flaw, a punishment from motherhood, or something you simply must accept with age. It’s a common, treatable issue that deserves a little less embarrassment and a lot more conversation.
So, the next time someone admits they’re a fellow “piddler,” don’t whisper about it – compare elevator rides to the penthouse and remind them they’re in very good company.
