Involuntary loss of urine during laughter

Specialty: Nephrology and urology.

• laughing incontinence
• gigglenuria
• urinary incontinence due to laughter in women

Why it occurs

• Laughter-induced urethral instability or bladder hypertonia (a central or peripheral reflex that causes abrupt detrusor contraction or urethral relaxation mediated by the autonomic nervous system in response to laughter, different from pure stress urinary incontinence)
• Weakness of the pelvic floor muscles (associated with multiple births or intrinsic weakness of the connective tissue)
• Concomitant sensory overactive bladder
• Anatomical variation of the distal urethral support

Initial workup

Detailed voiding diary to document episodes; urinalysis and urine culture (to rule out active infection that exacerbates urethral instability); complete urodynamic study (cystomanometry and pressure-flow study) to evaluate whether there are detrusor contractions induced by provocative maneuvers; pelvic floor ultrasound.

Standard management

• Oxybutynin — 5 mg 2 to 3 times a day orally, anticholinergic that reduces uninhibited detrusor contractility induced by laughter, monitoring side effects such as dry mouth and constipation) or Solifenacin (5-10 mg daily orally, with a better tolerability profile
• Specialized pelvic floor physiotherapy with Kegel exercises and biofeedback — very effective first-line non-pharmacological treatment
• Programming for posterior tibial nerve stimulation techniques.