• Nicole Cozean, PT, DPT, WCS

Pelvic Pain when Coughing or Sneezing

Why Does it Hurt to Sneeze?

Pain with sneezing or coughing is unfortunately common. It can be a sharp pain in the lower abdomen, pelvic pain, or feel like pain in the uterus, ovaries or perneum. While this is common, it should not hurt to sneeze or cough!

Pain, the Pelvic Floor and Sneezing, Coughing and Laughing


Imagine you’re the pelvic floor – coughs, sneezes, and sniffles are some of your biggest enemies. The muscles of the pelvic floor have to hold their ground when faced with even the most powerful sneeze. Not even the eyelids can do that--try sneezing with your eyes open sometime!


These events create pressure in the abdomen and force the pelvic floor to contract to counter-act that abdominal pressure. When that happens and there's dysfunction in the core or pelvic floor, the body can interpret it as pain in the lower abdomen, pelvic pain, or deeper pain feeling like it comes from the uterus or ovaries.


A pelvic floor physical therapist can work with you to resolve pelvic floor dysfunction. Here's how to find one!


Other Symptoms


Pain with sudden movements like coughing or sneezing is often a canary in a coal mine. You might have other pelvic health issues you aren't even aware are related.


It's relatively common to have painful intercourse, low back pain, urinary urgency/frequency or other pelvic health issues if you're noticing pain with sneezing or coughing.


Holding Back Urine with Sneezing or Coughing

The muscles of the pelvic floor are responsible for both holding back urine throughout the day and keeping everything within the pelvis in the proper position. A sneeze is a blast of energy through the abdomen, putting downward force on the bladder and other pelvic organs. Especially with repetitive sneezing and coughing, the pelvic floor can be put under significant unrelenting stress that can contribute to increased pelvic floor symptoms of incontinence, increased urgency and even pain. This is why many of our patients notice their symptoms flare during or just after an illness.

Coughing Places a Higher Strain on the Pelvic Floor than Lifting, Running, or Jumping!

Coughing places more strain on the pelvic floor than lifting, running, jumping, or sit-ups

When the pelvic floor isn’t working properly, sneezes are some of the most common moments – along with laughing and heavy lifting – when a little bladder leakage is most likely. When a sneeze or cough is on it's way, the pelvic floor has to sense the tsunami coming and immediately clench in preparation. A healthy pelvic floor will time the contraction perfectly, preventing leakage. Unfortunately many pelvic floors need a little extra help. They may contract, but after the sneeze or cough. If you are experiencing leakage with coughing or sneezing, try performing a "knack", or a contraction of the pelvic floor (imagine squeezing to stop your pee and poo) immediately before coughing or sneezing. This can help your pelvic floor time it's contraction better and keep you dry!

It’s not just powerful sneezes or coughs that are the enemy; a simple case of the sniffles can be an insidious enemy of the pelvic floor. That’s because the pelvic floor relaxes best with deep breathing, allowing the diaphragm to descend and easing tension through the abdomen and pelvis. Instead, the sniffles force us to take short, shallow breaths, which causes the pelvic floor to stay in a constant state of tension. This state of tension can also increase our bodies fight or flight response, which can increase seemingly unrelated symptoms of poor digestion, poor sleep, and pain associated with other illnesses or injuries. 

Whether you are coughing, sneezing, sniffling, or all of the above, it is a good idea to do some diaphragmatic breathing or stretches to relax the pelvic floor to give it a break as frequently as you can. Often when the pelvic floor is working in overdrive it will not naturally relax on it's own--that is why those who suffer from pelvic pain or other pelvic floor dysfunctions will experience an increase in symptoms. Try some of these stretches to give your pelvic floor a much needed rest break.

Winter is the prime time for colds, flus, and other illnesses. The best way to keep your pelvic floor healthy is to keep your body healthy! Many of us are unwittingly sabotaging our immune system during these winter months, but there’s a lot we can do to maintain our health during the chilly season and keep the pelvic floor stress-free as the leaves change.  

Part 2: Stop Sabotaging your Immune System (and Pelvic Floor)!

Additional Resources

Dr. Nicole Cozean is the founder of PelvicSanity physical therapy, Orange County's premier pelvic floor physical therapy clinic.  One of only 270 PTs to be board-certified in the pelvic floor, and the first PT to serve on the ICA Board of Director s, Nicole is the author of the acclaimed and best-selling book The Interstitial Cystitis Solution (2016).  She is an adjunct professor at her alma mater, Chapman University. The PelvicSanity blog focuses on presenting practical, positive information to help patients beyond the walls of Nicole's clinic. 


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