COPD Coughing and Incontinence: How to Balance Breathing and Bladder Issues

Urinary incontinence can be uncomfortable, embarrassing, and more common in people with COPD. Understanding why can help you manage it.

When you see the cherry blossoms bloom, your mind might immediately shift from their beauty to the allergy season to come. Your COPD-related coughing may worsen, but that’s not even your top concern. Nope. It’s the leaking, aka the unwanted peeing, that occurs as you cough.

When uncontrolled, it can be downright embarrassing, leaving you wary of engaging with loved ones or standing in line at the grocery store. It’s an isolating feeling, but you aren’t alone.

Some research shows that you’re more likely to experience what’s known as urinary incontinence if you have COPD.

“Simply put, urinary incontinence means accidental leakage of urine,” said James Anaissie, MD, a urologist at Memorial Hermann Medical Group–Memorial City Urology in Houston, Texas. “It’s actually quite common, especially in women.”

According to Anaissie, urinary incontinence can affect your ability to live the life you want. However, there are ways to manage urinary incontinence related to COPD so you can feel less isolated and improve the quality of your days ahead.

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What is urinary incontinence?

Urinary incontinence is the uncontrolled leakage of urine, but people will have individual experiences with the issue. For instance, “Leaking can vary from a small dribble to leaking the entire contents of the bladder,” said Mina M. Fam, MD, a urologic oncologist at Hackensack Meridian Health.

Fam adds that there are several types of incontinence, including:

• Stress incontinence: Coughing, laughing, and other straining from a lack of muscle control around the bladder cause leaking.
• Urge incontinence: The constant urge to pee has many causes, such as aging. Sometimes, leaking occurs.
• Overflow: The bladder is so full that it leaks a little at a time.

“Some of these types of incontinence can occur together and can be difficult to determine without proper evaluation by a urologist or urogynecologist,” Fam said.

What’s the link between COPD and incontinence?

Sometimes, it can be helpful to know you’re not the only one dealing with something, and leaking or a constant urge to pee may be high on your list.

One 2019 study suggested that the number of people with COPD experiencing urinary incontinence is underestimated. The authors wrote that urinary symptoms are incorrectly chalked up to the respiratory condition.

The study also noted that this misinterpretation of urinary symptoms is delaying people’s ability to get the care they need to manage and control incontinence.

Older research from 2017, which only included men, showed that urinary incontinence was more common in those with COPD compared to their male peers without it.

What gives?

“Incontinence can occur in patients with COPD for many different reasons,” Fam said. “Understanding the cause of the incontinence could help the patient and their doctor come up with a plan to minimize the incontinence, but also ensure COPD is treated adequately.”

Some causes can be due to the nature of COPD, Anaissie said. “Anything that increases the pressure in your abdomen will increase the chances that you leak, and people with COPD, who may experience excessive coughing, that can lead to increases in urinary incontinence.”

Medications may also play a role. Fam says some inhaled medicines to treat COPD, like a class of drugs called anticholinergics, can cause the body to relax too much. As a result, Fam said they can “cause a person to retain urine and cause overflow incontinence.”

Additionally, steroids used to treat COPD can weaken the immune system and trigger urinary tract infections (UTIs). And if you’ve ever experienced a UTI, you know that the infection can increase how often you need to run to the bathroom.

Tips for managing incontinence

According to Anaissie, one of the best ways to manage incontinence is to get coughing under control (the best you can) through lifestyle changes and treatments like pulmonary rehabilitation. Here are a few other ways you can regain control.

1. Follow a schedule

Fam and Anaissie suggest what’s referred to as timed voiding or heading to the restroom on a schedule, such as every 2 to 3 hours.

“Even if you don’t feel like you need to,” Anaissie said. “It can prevent your bladder from getting too full and, thus, decrease the chance that it leaks whenever you increase the pressure in your abdomen.”

2. Identify triggers

Just as you may have a list of factors that exacerbate your COPD, try to notice patterns in your incontinence.

“Identifying which activities lead to leakage, such as exercise or sex, can help you know to use the restroom right before that activity,” Anaissie said. “There are also certain foods and beverages that can increase the risk of urge incontinence, such as spicy food, caffeine, and alcohol, which you can avoid.”

3. Discuss medication side effects with a professional

Since some medications for COPD can relax the bladder, it’s worth asking your doctor about side effects.

“Be sure to review your medication list with your doctor on a regular basis, particularly if you have developed new-onset urinary difficulty and incontinence,” Fam said. “There may be an alternative medication that can be used instead.”

4. Try pelvic floor exercises

A doctor can refer you to a pelvic floor physical therapy center where you can learn strengthening exercises.

“They can teach you exercises to strengthen the muscles in your pelvic floor and increase control over your incontinence,” Anaissie said.

One quintessential pelvic floor exercise is the kegel.

“Kegel exercises can help strengthen the pelvic floor muscles that control leaking,” Fam said. “When these muscles are stronger, leaking can be minimized with coughing in patients with COPD.”

5. Review medication and surgery options

Medication and surgical options are also available. The National Insitute of Diabetes and Digestive and Kidney Diseases (NIDDK) lists the following medications for bladder control:

• Oxybutynin
• Tolterodine
• Fesoterodine

If you’re seeing multiple doctors for many conditions, ensure your doctor has an updated list of all your over-the-counter and prescription medications. They’ll check that they don’t cause any issues when taken together.

The NIDDK also lists the following surgical options for incontinence:

• Sling procedures: Surgeons develop a supportive sling using your body’s tissue or human-made materials. This sling will support the bladder neck and ensure the urethra stays closed.
• Bladder neck suspension: This can reduce leaking from stress incontinence by raising the part of the bladder that attaches to the urethra.

When to seek urgent care

Urinary continence is rarely a cause for significant alarm. However, Fam said sometimes, your urinary incontinence might require emergency care. These situations include incontinence alongside the following:

• pain
• fever
• inability to pee

Takeaway

Some research suggests that people with COPD are more likely to have urinary continence — or unintended leaking. The condition can be embarrassing and isolating and reduce your quality of life. However, there are treatments available to help you manage the issue.

First, it’s important to pinpoint the cause of the incontinence. For some, it may be coughing, which can reduce muscle control (needed to prevent unintended urination). Medications may also play a role.

Peeing on a schedule, such as every 2 to 3 hours, and avoiding foods and beverages (like caffeine) that increase your urge to urinate can help.

Review your medications with your doctor to determine if side effects like bladder relaxation are the cause. There may be alternatives available.

Pelvic floor therapy, medication, and surgery can all help treat and manage urinary incontinence. You and your care team can discuss the best options based on your unique needs so you can feel more comfortable and confident enjoying life.