Giggle incontinence (GI) is classically defined as involuntary, often complete bladder emptying occurring exclusively during or immediately after laughter in children with otherwise normal bladder function (1). In clinical practice, however, urinary leakage during laughter may also occur in children with accompanying lower urinary tract symptoms (LUTS) and/or bowel dysfunction (2,3). We aimed to characterize the clinical spectrum of children presenting with urinary leakage during laughter and to determine how often this complaint occurs as an isolated phenomenon versus as part of a broader bladder and bowel dysfunction profile.

This retrospective case series included 28 children presenting with urinary leakage during or immediately after laughter at a tertiary pelvic floor health center between January 2021 and March 2026. Children were included regardless of whether they had accompanying LUTS or bowel symptoms. Patients with known neurological disorders, congenital urinary tract anomalies, or structural urological abnormalities were excluded. Demographic and clinical data were extracted from medical records, including age, sex, body mass index (BMI), symptom duration, leakage severity, associated LUTS, bowel symptoms, and patient-reported outcome measures. Bladder and bowel symptoms were assessed using the International Bladder Symptom Score (IBSS), Pediatric Incontinence Questionnaire (PinQ), visual analog scale (VAS) for symptom severity, a 3-day bladder diary, and a 7-day Bristol stool diary. Patients were categorized as having giggle incontinence or non-isolated laughter-associated urinary leakage with accompanying LUTS and/or bowel dysfunction.

Of 121 children referred to our center for daytime urinary incontinence, with or without nocturnal enuresis, 28 were identified as having urinary leakage associated with laughter and were included in this retrospective analysis. The median age was 10.5 years, and 19 patients (67.9%) were female. Fourteen children (50.0%) met the criteria for giggle incontinence, whereas the remaining 14 (50.0%) had additional bladder and/or bowel symptoms, indicating a non-isolated presentation. Nocturnal enuresis was present in 8 children (28.6%), and bowel dysfunction (constipation and/or fecal incontinence) in 8 (28.6%) (Table 1).

These findings suggest that urinary leakage during laughter often extends beyond the classical definition of isolated giggle incontinence. The variability in leakage severity and the frequency of associated bladder and bowel symptoms support the view that laughter-associated urinary leakage may represent a broader clinical spectrum rather than a single uniform diagnosis. Applying the label of GI to all such cases may obscure clinically relevant LUTS or bowel dysfunction and may influence treatment planning.

Urinary leakage during laughter in children should be considered a presenting symptom rather than automatically being equated with true giggle incontinence. Many affected children demonstrate associated LUTS and/or bowel dysfunction, and some may not fit the classical phenotype. Comprehensive bladder and bowel assessment is therefore essential before assigning a diagnostic label or planning treatment.

Nevéus T, von Gontard A, Hoebeke P, et al. The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children's Continence Society. J Urol. 2006;176(1):314-324.
Logan BL, Blais S. Giggle incontinence: Evolution of concept and treatment. J Pediatr Urol. 2017;13(5):430-435.
San ST, Barnes EH, Caldwell PHY. Urinary incontinence during laughter in children: Is it giggle incontinence? J Paediatr Child Health. 2021;57(12):1971-1975.