From the Guidelines
Giggle incontinence is a form of stress urinary incontinence where involuntary leakage of urine occurs in response to laughing, as defined by the International Continence Society 1.
Definition and Causes
It is characterized by the involuntary leakage of urine during or immediately after laughing, despite having normal bladder control at other times. This condition primarily affects children and adolescents, particularly girls, though it can persist into adulthood. The exact cause remains unclear but may involve a neurological connection between the brain's laugh center and bladder control pathways, essentially creating a reflex-like response that bypasses normal bladder control mechanisms.
Treatment Options
Treatment options for giggle incontinence include bladder training exercises like timed voiding and pelvic floor muscle strengthening. Medications such as anticholinergics (like oxybutynin starting at 5mg daily) or imipramine (starting at 10-25mg daily in children, 25-75mg in adults) may be prescribed for severe cases 1. These medications work by relaxing the bladder muscle or increasing bladder capacity. Behavioral modifications are also important, including avoiding bladder irritants like caffeine, emptying the bladder before social situations where laughing might occur, and practicing distraction techniques when feeling the urge to giggle.
Key Considerations
- Differential diagnosis is essential to distinguish giggle incontinence from other forms of urinary incontinence (UI), such as urgency, mixed, extraurethral, and overflow incontinence, as treatment approaches differ 1.
- Treatment for giggle incontinence encompasses a spectrum ranging from conservative measures to surgical interventions, tailored to individual patient characteristics, preferences, and severity of symptoms.
- Conservative management includes pelvic floor muscle training (PFMT), behavioral therapy, and lifestyle modifications, which may yield significant improvements in symptom severity 1.
Management and Prevention
While the provided evidence primarily focuses on stress urinary incontinence, the principles of management, including the importance of pelvic floor muscle training and lifestyle modifications, can be applied to giggle incontinence. Ongoing research is necessary to optimize outcomes and ensure patient safety, particularly for complicated cases where data on comparative effectiveness remain limited 1.
From the Research
Definition of Giggle Incontinence
- Giggle incontinence is the involuntary and often unpredictable loss of urine during giggling or laughter in the absence of other stress incontinence 2.
- It is a rare syndrome in which apparently complete voiding occurs specifically during laughing, and needs to be differentiated from stress incontinence and detrusor instability 3.
- Giggle incontinence is considered a bladder storage disorder in which laughter causes an uncontrollable episode of urinary incontinence that cannot be stopped until the bladder is completely emptied 4.
Characteristics and Prevalence
- It occurs mainly in women (69.5%) at 5 years of age, with a prevalence ranging from 8.4 to 16.2 years (average age of 12.4 years) 4.
- Some cases have a family history of the disease (13-16.7%) 4.
- To date, 351 GI cases have been reported, primarily affecting females after the age of 5 years, causing complete bladder emptying during uncontrollable laughter 4.
Treatment and Management
- Biofeedback therapy can be used to strengthen pelvic floor muscles and allow children to remain continent during an uncontrolled detrusor contraction provoked by laughing 2, 3.
- Biofeedback enables children to visualize the pelvic floor muscles during exercises, helping them to attain better control of their function 3.
- Management involves urotherapy techniques, biofeedback, and methylphenidate 4.
- Pelvic muscle exercises with biofeedback technique are a promising additional mode of treatment for children with voiding disorders 5.