1 in 3 women over 45 leak urine when they sneeze or cough. What to know about stress incontinence and when to see a doctor.

Accidentally peeing when you sneeze, laugh, cough or exercise can be embarrassing, as well as uncomfortable and worrisome. It’s also common: About 1 in 3 women over the age of 45 experiences urine leakage, also known as stress urinary incontinence.

“While it occurs in many women following childbirth or as they age, it is not something that is ‘normal’ or that women just have to deal with,” Dr. Mary Duarte Thibault, assistant professor of obstetrics and gynecology–urogynecology at Baylor College of Medicine, tells Yahoo Life. Dr. Andrew Hundley, director of urogynecology and pelvic reconstructive surgery at the Ohio State Wexner Medical Center, views stress incontinence is a quality of life issue. “[The] decision to seek care and intervention should be driven by the level of bother that any given individual experiences,” he tells Yahoo Life. Here’s what you need to know about stress incontinence and how it’s treated.

What causes stress incontinence?

Stress incontinence is caused by the inability of the urethra — the tube that connects to the bladder and carries urine out of the body — to remain fully closed when there is increased pressure on the bladder and urethra, explains Thibault. “This can be due to weakening of pelvic floor muscles and connective tissue around the urethra and/or incomplete closure of the urethra,” she says. “The amount of urine leakage can vary from a few drops or enough to soak through clothing.”

There are several reasons why pelvic floor muscles can become weak, including pregnancy, childbirth, obesity, chronic straining to have bowel movements, chronic coughing and menopausal hormone changes with age-related decreases in muscle mass.

When should you see a doctor about it?

When symptoms such as frequent urination, urgency to go or leaking start impacting your life, it’s time to tell your doctor what’s going on. “When women start to avoid certain activities they enjoy like exercise, socializing or travel, then their quality of life is being negatively impacted,” Hundley says. “They can withdraw socially, and that’s not healthy,” he says.

Your doctor will ask questions to understand a pattern of the urine leakage, which can help them determine the specific type of incontinence you may have. They will also perform a physical exam and may ask for a urine sample. “Your doctor may develop a treatment plan for you or they might refer you to a specialist like a urogynecologist or urologist,” says Thibault.

What lifestyle changes can help?

In many cases, behavioral changes, including working on strengthening the muscles of the pelvic floor, can improve stress incontinence. Here’s what experts recommend:

Maintain a healthy weight

“We know that obesity is a risk factor for urinary incontinence, and weight loss in obese women has been shown to improve stress urinary incontinence symptoms,” says Thibault.

Take care of constipation and other health conditions

Chronic straining during bowel movements puts stress on pelvic floor muscles over time, so talking with your health care provider about the best ways to take care of constipation can make a difference. Treating or managing conditions that lead to chronic coughing such as asthma and bronchitis, as well as habits such as smoking, can also help improve stress incontinence.

Strengthen pelvic floor muscles

Practicing Kegel exercises under the direction of your doctor and guidance of a physical therapist who specializes in working with pelvic floor muscles can help. These exercises involve lifting and holding and then relaxing your pelvic floor muscles.

“There can be a disconnect between the brain and the pelvic floor muscles such that you may think you are activating the pelvic muscles, but you are not actually doing so or activating the muscles in your legs or buttocks or abdomen instead,” says Thibault. Working with a physical therapist can retrain your brain to activate the correct muscles.

What other treatment options are there?

If lifestyle changes aren’t working, your doctor may suggest a medical device called a pessary that is inserted into the vagina for support. This is a soft and flexible plastic device that is fitted to the patient. It can be reused and worn all the time or during certain activities like exercise. “Women can place and remove [pessaries] on their own, which can be highly effective at reducing or preventing leaking,” says Hundley.

About half of women who are fitted with a pessary continue to use it long-term and about half go on to have more advanced treatments, notes Thibault. In some cases, surgery is recommended. There are several options, including mid-urethral mesh slings — a ribbon of synthetic mesh that is placed into the vagina to support the urethra. This is the most commonly performed procedure for stress urinary incontinence. “The permanent mesh used in these procedures does not have the high rates of complications that were found with mesh used in other types of vaginal surgeries,” notes Thibault.

An alternative is a pubovaginal fascial bladder neck sling, which is similar to a midurethral mesh sling, except a strip of your own tissue (or fascia) is placed into the vagina to support the urethra. If a sling can’t be used, other options include Burch colposuspension, in which stitches are used to lift and support the muscles that connect the bladder to the urethra, preventing leakage, along with urethral bulking injections — an office-based or operating room procedure that involves injecting a material, such as silicon, into the sides of the urethra to strengthen it. “The injection into the walls of the urethra helps the opening of the urethra to be more narrow, leading to less urine leakage,” Thibault explains.

While the injection is less invasive and has minimal recovery time, it’s not considered a permanent procedure. “You may need repeat injections or another procedure for incontinence later,” says Thibault.

Experts say that while leaking urine after doing normal things like sneezing and coughing can be bothersome, you’re not alone in experiencing it. By talking to your doctor and making some lifestyle changes or in some cases having a procedure, you can treat the common condition.