Stress Urinary Incontinence: Why You Leak When You Run, Laugh or Jump
If you’ve ever leaked urine while running, jumping, coughing, sneezing or laughing — you’re not broken, weak, or “past your prime”.
You’re experiencing stress urinary incontinence (SUI).
And despite how common it is, it’s still wildly misunderstood.
Let’s break down what SUI actually is and why it happens.
What is Stress Urinary Incontinence (SUI)?
Stress urinary incontinence is involuntary leakage of urine during physical effort or impact.
Common triggers include:
Running, jumping, hopping
Coughing or sneezing
Laughing
Lifting weights
High-impact exercise
Despite the name, this has nothing to do with emotional stress.
The “stress” refers to physical pressure — specifically intra-abdominal pressure — pushing down onto the bladder.
Many women first notice SUI:
During pregnancy
After childbirth (yes, even after a caesarean)
When returning to impact exercise
At certain points in their menstrual cycle
When training load or fatigue increases
The Pelvic “Plumbing”: How Continence Actually Works
Think of your pelvis as a layered support system, not a single muscle doing all the work.
Here’s what’s involved:
Bladder – stores urine
Urethra – the tube urine passes through
Urethral closure system – sphincter muscles + a soft tissue “seal” that keeps urine in
Pelvic floor muscles – provide active support and respond quickly to pressure
Fascia and connective tissue – a passive “hammock” behind the bladder and urethra
Nearby structures – vagina, uterus and rectum all sharing space and load
Leakage tends to occur when pressure hits suddenly and the system can’t keep the urethra closed in that moment.
The Core Concept: Pressure vs Closure
To understand SUI, you need to understand the relationship between two competing forces.
1. Pressure inside the bladder
Your bladder is excellent at stretching and holding urine with minimal pressure changes — until you cough, jump or land.
Those actions cause a rapid spike of downward pressure.
2. Pressure keeping the urethra closed
At rest, the urethra stays closed thanks to:
Urethral sphincter muscle tone
The soft tissue “seal” of the urethral lining
Blood flow that cushions the closure
Support from pelvic floor muscles
Firm backing from connective tissue (fascia)
Leakage occurs when bladder pressure exceeds closure pressure, even briefly.
The “Backstop” Analogy (Why Support Matters)
Imagine stepping on a garden hose.
Hose on a hard floor? It closes instantly.
Hose on a trampoline? It bends, sinks… and water keeps flowing.
In the pelvis, the urethra relies on firm support behind it to compress shut when pressure hits.
If the connective tissue support behaves more like a trampoline — too flexible, fatigued or under strain — the urethra doesn’t seal effectively, and leakage occurs.
Why SUI Can Happen After Birth — Even With a C-Section
Stress urinary incontinence is not just about vaginal birth.
Pregnancy alone can contribute due to:
Prolonged load on pelvic floor muscles and fascia
Hormonal changes affecting tissue elasticity
Changes in posture and breathing mechanics
Altered pressure strategies through the abdomen
Nerve and muscle changes that may only show up under higher loads later
A history of:
Instrumental birth (forceps)
Long pushing stage
Significant perineal tearing
…can also influence pelvic floor function over time.
And here’s the kicker:
You can feel completely fine in daily life, and only leak when you add impact, fatigue or intensity.
Why Leakage Might Start 10 Minutes Into a Run
This is one of the most common patterns we see.
It usually points to fatigue and load accumulation:
The pelvic floor and closure system cope initially
Repeated impact slows reaction time
Muscles fatigue
Breathing or bracing strategies change
Fascia comes under increasing strain
The system compensates… until it can’t.
That’s why leakage can feel:
Delayed
Inconsistent
Worse at the end of sessions
Absent on some days but not others
Why It Can Be Worse Before Your Period
Hormones matter — especially for connective tissue.
In the late luteal phase (the week before your period), hormonal shifts can make connective tissue:
More pliable
Slightly less stiff
Less effective as a firm backstop
If your support system becomes more “springy”, the urethra may not compress as effectively during impact — even if you’re otherwise dry the rest of the month.
Why Emptying Your Bladder Doesn’t Always Fix It
Two important truths:
Your kidneys never stop making urine
Even if you pee right before exercise, small volumes can still leak.Small leaks feel big
Just a few teaspoons can soak underwear and feel dramatic — even though it’s a tiny fraction of bladder capacity.
Stress Incontinence vs Urgency (They’re Not the Same)
Many women experience a mix of symptoms.
Stress urinary incontinence
Leakage with cough, sneeze, running, lifting, jumping
Urgency
A sudden “I need to go now” sensation
You may or may not leak on the way
They involve different mechanisms — and both are treatable.
What a Pelvic Health Assessment Looks For
When assessing SUI, pelvic health physiotherapists usually explore two main contributors:
A) Tissue support and movement (the backstop)
How much do tissues move under pressure?
What happens in standing, coughing or impact-like tasks?
B) Closure system and muscle response
Can the urethral sphincters stop urine flow quickly?
Can pelvic floor muscles:
Contract and relax well?
Sustain endurance?
Respond fast to sudden pressure?
Because not all leaks are caused by the same thing, identifying the main driver is key to effective management.
A Helpful Concept Check: The Tampon Test
A tampon (used only as a temporary test, not a treatment) can sometimes act as an artificial backstop.
If leakage improves when running with a tampon in place, it suggests support behind the urethra is a significant factor. This can help guide options like:
Targeted pelvic floor rehab
Load management
Breathing and pressure strategies
Temporary support devices for higher-impact activities
Key Takeaways
Stress urinary incontinence is caused by a mismatch between pressure spikes and urethral closure/support
It often appears “suddenly” with increased impact, fatigue or hormonal shifts
Small leaks can feel big — but they’re still meaningful
Effective management usually combines:
Pelvic floor and sphincter strength, endurance and timing
Smarter pressure strategies during exercise
Load modification and return-to-impact planning
Sometimes temporary mechanical support
And most importantly:
Leaking is common — but it is not something you just have to live with.
Book a consultation today to get the support that you need.