Giggle incontinence: when a child wets while laughing

What is giggle incontinence?

Some children wet only when they laugh hard. During laughter the bladder suddenly squeezes on its own, and urine comes out. Usually this is not a few drops but a complete or almost complete emptying of the bladder. This is called giggle incontinence.

It is most common in girls before puberty. The exact cause is not known. One explanation is that laughter triggers a reflex in the brain that makes the bladder contract; another is that an overactive bladder muscle plays the main role.

Symptoms

• wetting happens only during laughter, often a large amount,
• no leaking with coughing, jumping or running,
• at other times your child holds urine and pees normally,
• it can be very embarrassing, especially at school.

If your child also has sudden strong urges during the day, goes to the toilet very often, or wets without laughing, this may point to other types of daytime wetting, such as an overactive bladder.

Diagnosis

The diagnosis is based mainly on what your child and you describe. Other causes should be ruled out first:

• a bladder diary for at least 2 days (printable form): when and how much your child pees, how much they drink, and when they get wet,
• a urine test to rule out infection,
• checking for constipation, because a full bowel affects how the bladder works (bladder and bowel dysfunction),
• uroflowmetry and an ultrasound of the urine left after peeing.

Treatment

There is no specific treatment with proven benefit. Care is built step by step.

General measures first (urotherapy):

• regular toilet visits through the day, so the bladder does not get too full,
• enough fluid, spread evenly through the day,
• treating constipation,
• sitting comfortably on the toilet: feet supported, no rushing, giving the bladder time to empty fully,
• learning to tighten the pelvic floor muscles when laughter starts.

Further options. If wetting continues, the doctor may discuss biofeedback (your child learns to control the muscles through a game on a screen) or medicine. Some children are given a trial of a medicine used for attention deficit disorder (methylphenidate). Evidence for its benefit comes from studies with small numbers of children, wetting can come back when it is stopped, and it has side effects. So only the doctor decides whether to prescribe it, after discussing the benefits and risks with the family. Medicines that relax the bladder are mainly considered when there are other symptoms, such as sudden strong urges.

Whether treatment is needed also depends on how often wetting happens: if it is rare, families may choose to skip daily medicine and stick with general measures.

What to expect

Giggle incontinence usually becomes less frequent and goes away as children grow. Explain to your child that it is not their fault, do not scold them, and do not forbid laughing. If wetting continues despite several weeks of general measures, see a pediatric urologist.