Expert Advice: Leaking When You Sneeze

You’re 30 weeks pregnant and talking to a female coworker. You sneeze and suddenly have a look of embarrassment on your face. She looks back at you and says, “oh honey, don’t worry we all leak when we’re pregnant, just wait until after the baby comes”. Though this may be quite COMMON that doesn't mean its NORMAL. A typical functioning human male or female, young or old, should be able to go through a day of work, sleep, intercourse, and exercise without leaking.

There are many factors contributing to leaking during pregnancy and post partum:

  • The uterus is expanding as the baby grows, all of the organs are moved around, and the baby puts pressure on the bladder.

  • The deep postural muscles (your core) weaken with lack of activation (typically keeping the abdominal contents in place).

  • Your ligaments are also looser due to pregnancy hormones.

  • Changes in posture which changes the alignment of the pelvic floor

  • Dehydration and constipation

  • Lack of body awareness due to the changes of your center of gravity

  • Trauma during delivery

  • Diastasis Recti

When you cough, laugh, sneeze, lift, or exercise there is an increase in pressure in the abdominal cavity. If the postural muscles are not strong enough to accomodate this pressure change, the abdominal “balloon” will push on the bladder, which is already sitting low. The bladder cannot handle the pressure increase and you will leak. In addition, the diaphragm needs to work appropriately to accommodate the changes in pressure.The diaphragm should pull down to allow air into the lungs and stretch upwards during exhalation. When the diaphragm is glued to the ribs for any reason (belly breathing, tight “6 pack” muscles, bearing down during bowel movements or labor) it doesn’t stretch and relax appropriately. This keeps the abdominal balloon under high pressure which continues to push on the bladder.

c Low Pressure Fitness

At the 6 week checkup its common practice for the doctor to allow moms back to “normal activity”. The problem with this is that most moms exercise routines include high impact training, superficial abdominal strengthening, and belly breathing. The core needs to be rebuilt with care from the inside out.

So what can we do to avoid leaking?

•Keep the deep abdominals (transverse abdominals) strong

•Leave the outer abdominals to rest (6 pack)

•Practice thoracic (rib) breathing versus belly breathing

•Work on your posture! When the body is in alignment, the organs will follow suit

•Drink enough water

•Don’t push during a bowel movement, instead keep your feet up on a stool such as a squatty potty

•Practice stopping your urine midstream and you should be urinating for about 8 seconds each time

•Do not push yourself if you feel pain or heaviness in below the belly button when returning to exercise

If you have symptoms of leaking, pain during intercourse, difficulty with bowel movements, abdominal separation, or problems with your cesarean or perineal scar site, please seek help from a specialist.

As always, reach out with any questions or concerns!


Elizabeth Morel is the owner of Little Movers PT, Physical Therapy for mom and baby. She provides innovative hypopressive training for core and pelvic floor restoration. She also provides pediatric physical therapy and craniosacral therapy for babies with a specialty of breastfeeding support. You can find her at , Facebook Little Movers PT and instagram @littlemoverspt