You aren’t crazy - Yes, you can leak pee more during certain phases of your menstrual cycle
- MomTrainer
- 5 hours ago
- 5 min read
Ah the sneeze-pee. This is something we either laugh off or are so mortally embarrassed we hide from. Either way, many of us don’t seek treatment or push any further on this past sneeze-peeing being a common postpartum experience.
I have the honor of sharing space with newly post and post-partum women, so I get all the tea about the pee. One of my students in class bravely asked if this was something other students were noticing particularly before the onset of menstruation.
Guys.
I hear this all the time. And I've definitely experienced this myself. But no OB or midwife ever had anything to support this, so I brushed it off. However, two clients in particular also had questions about this, so I went down the rabbit hole to find any information I could point them towards.
To begin, postpartum menstruation, especially once our cycles begin to regulate, can feel very different. I think sometimes it’s a result of many of us learning and tracking our cycles in order to get pregnant, but the physical symptoms are more noticeable. Many of us have more intense ovulation cramps, heavier or more intense periods, and changes with urinary stress incontinence AND urgency.
I say this because I hear this all the time from decades of working with postpartum people. Sneeze-peeing is a real (and solvable) thing, and if you are tracking your cycle you might notice a pattern. I have had several OB/ GYNs, Pelvic PTs, and other women’s health professionals tell me that there hasn’t been enough research in this area to support this.
This, unfortunately, is true, as with most women’s health research. However, I found something!!
In 2008 there was a study done by the Royal College of Obstetricians and Gynaecologists, and its sample size is very small, but check this out:
“The times at which symptoms were said to be at their worst were reported by the women as follows: during a period (n=20; 36%); just after a period (n=4; 7%); middle of the month (n=8; 15%); just before a period (n=23; 42%). The prevalence of abnormal detrusor activity on videocystourethrography increased significantly with time from the last menstrual period (χ2 for trend=6.56, P=0.01) and might reflect increases in the circulating level of progesterone following ovulation. “
So if you also have been digging around the internet looking for answers, this is generally what you will see.
We know already there is a solid relationship of estrogen and the muscles of the pelvic floor. With the decrease of estrogen these muscles tend to weaken. Many of my clients have noticed that not only are they sneeze-peeing (urinary stress incontinence), but they have a harder time “holding it”. This is what is believed to be the “abnormal detrusor activity”. Basically it contracts to help you void/ pee along with the relaxation of your internal urethral sphincter.
The US National Library of medicine (sited below) in 2023 notes :
“A subset of women may have detrusor overactivity with poor contractility, which can lead to overflow incontinence. This condition is common in the aging female population. Detrusor overactivity is often associated with urgency incontinence. Urgency incontinence is the sudden urge to urinate, which may lead to leakage. Urgency incontinence is common in older women with other comorbid diseases. Treatment of the underlying disease is the most effective treatment. Usually, the first steps in treatment involve conservative options with lifestyle modifications, pelvic floor exercises, and bladder training”
The 2008 study suggests that the detrusor muscle may weaken with an increase of progesterone after ovulation and estrogen shifts can interfere with bladder control. We also know that the anatomy of the pelvis can also cause issues with postpartum voiding.
We know that with pregnancy comes a shift in your pelvic organs. Your bladder and rectum will likely move in relationship to your uterus and placenta. The pelvis tends to tilt forward to adjust for the change in gravity as baby grows, and this doesn’t help either. When our pelvis gets “stuck” in the open birth pattern (see Lynne Schulte’s resource cited below), this can result in pelvic floor weakness, poor posture, and pain.
Regardless of birth outcome, you can experience urinary and/or rectal incontinence. Not a normal symptom for you to ignore, we shouldn’t just laugh this off or buy whatever the internet wants you to.
There are many strategies that a PT can recommend for your own issues, which is why it is so important for you to seek individualized care. These breathing and posture techniques that I teach in my classes can help:
They certainly won’t hurt either, as I use these breathing and pelvic floor cueing techniques in all of my prenatal and postpartum classes.
There have been many studies done to suggest that a lack of proper care for your postpartum body can make mental health outcomes worse. I’ve seen this with many of my clients, unfortunately, which is why this stuff matters so greatly. If you are a runner and you can’t start a run without peeing, this can impact your mental health.
We need many more follow-up studies on this. I would love to see rates with second / subsequent pregnancies, Cesarean vs Vaginal delivery, if there is prevalence with advanced-maternal ages, athletes vs non, and if there are daily practices to prevent this during our postpartum menstrual cycle.
Many of my clients have been suggested to insert a tampon before a long run along. Many have benefited from PT exercises, pessaries, and other strategies before surgery is even discussed. Personally, I think it’s helpful to keep an eye on your cycle so you can adjust your workouts and keep progressing while avoiding discomfort. You can progress your running on weeks where you aren’t likely to have symptoms, and rest/ cross train during ovulation or menstruation.
Anyway, I think if this is something you are experiencing, please know that a) you aren’t crazy and b) you can seek treatment from a pelvic pt for some extra help with this. PT is extremely helpful to identify the root cause and treatment of why you may be experiencing these patterns.
Is this something you are noticing / struggling with? Please share an anonymous comment below or reach out to me directly.
For more resources and workouts for postpartum, please see my postpartum resources or click over to my blog.
Reminder - with feeling - that I, Sarah Ann Kelly, am just a mere trainer and group fitness instructor with zero medical training other than a degree in psychology and various certifications. I prefer to work with my clients on the outside, please seek the counsel of a licensed professional. Nothing on MomTrainer.com is intended as medical advice. This is just for fitness and funsies.
I hope this helps.
Xo
Studies!
