Bladder problems after C-section
Many women are surprised to leak urine after a C-section. A common belief is that skipping vaginal delivery protects the pelvic floor. A C-section does lower some risks, but pregnancy itself strains the pelvic floor. For nine months it holds up the growing weight of your baby, uterus, and fluid, however your baby ends up being born.
In one study of first-time mothers, 25% of women who had a cesarean before labor reported leaking urine at 6 weeks postpartum, and 23% still did at 6 months. Women who delivered vaginally leaked more often (about 35% at 6 weeks), and a cesarean cut the odds of leaking roughly in half. So a C-section lowers the risk but does not remove it.
Why this happens
- Pregnancy weight: months of growing downward pressure stretch the pelvic floor muscles and connective tissue
- Hormonal changes: pregnancy hormones are thought to loosen connective tissue throughout the body, including the pelvic floor
- Leaking during pregnancy: about 1 in 5 women in the same study leaked while pregnant, and that was the strongest predictor of leaking after delivery (about 3.5 times the odds)
- Surgical recovery: the incision and healing can change how your abdominal muscles and pelvic floor work together
- Your own makeup: some women are born with weaker connective tissue, and higher body weight raises the risk no matter how you deliver
I hear this often in clinic: “But I had a C-section, how can I be leaking?” Much of the risk comes from the pregnancy, not only the delivery.
Prolapse can happen after a C-section too, though it is less common. Within a year of a first delivery, about 5% of women who had a cesarean before labor had prolapse reaching the vaginal opening or beyond, compared with about 15% after vaginal birth.
Signs you should seek help
- Leaking urine when you cough, sneeze, laugh, or exercise
- Sudden strong urges to urinate, with or without leaking, that started during or after pregnancy
- Trouble emptying your bladder fully
- A bulge or heavy feeling in the vagina
Bring any of these up at your postpartum visit or with your primary care doctor. In the study above, leaking after a cesarean barely changed between 6 weeks and 6 months, so for many women it does not go away on its own.
Treatment options
Treatment is the same whether you delivered vaginally or by C-section. What matters is the type of leaking. Stress leaking happens when you cough, sneeze, or exercise. Urge leaking comes with a sudden need to go. Many women have both, and then we start with whichever bothers you more. You do not have to fail one treatment before you can choose another. We decide together based on your symptoms and goals.
For any type of leaking:
- Pelvic floor physical therapy: a pelvic floor PT works on strength, relaxation, and coordination of the pelvic floor, along with your hips and core. We have in-office pelvic floor physical therapists who work closely with our team. In a 2018 Cochrane review, women with stress leaking who did supervised pelvic floor training were about 8 times more likely to report cure than women with no treatment. Training after delivery also lowers the chance of leaking during the first year.
- Core recovery: the incision goes through your abdominal wall, so your therapist can work on core strength alongside the pelvic floor.
For stress leaking:
- A pessary or vaginal insert that supports the urethra during exercise
- Urethral bulking, an in-office injection that helps the urethra close
- A midurethral sling. Planning another pregnancy does not rule it out. Most women who have a sling and later get pregnant stay dry afterward, and we can talk through timing.
For urge leaking:
- Bladder training: spacing out bathroom trips and adjusting fluids to calm urgency and frequency
- Medication
- Botox injected into the bladder, which lasts about 6 to 9 months
- Nerve stimulation: sacral neuromodulation, a small implanted device whose battery lasts 10 to 15 years, or tibial nerve stimulation through the ankle
Your next steps
If you are leaking after a C-section:
- Mention it at your postpartum visit instead of waiting for it to pass
- Note when you leak and what you were doing (coughing, lifting, rushing to the bathroom)
- Ask for a referral to pelvic floor physical therapy or a urogynecologist
Learn more about urinary incontinence
References
- Borello-France D, Burgio KL, Richter HE, et al. Fecal and urinary incontinence in primiparous women. Obstetrics & Gynecology. 2006. doi:10.1097/01.AOG.0000232592.82165.78
- Burgio KL, Borello-France D, Richter HE, et al. Risk factors for fecal and urinary incontinence after childbirth: the Childbirth and Pelvic Symptoms Study. American Journal of Gastroenterology. 2007. doi:10.1111/j.1572-0241.2007.01364.x
- Handa VL, Nygaard I, Kenton K, et al. Pelvic organ support among primiparous women in the first year after childbirth. International Urogynecology Journal. 2009. doi:10.1007/s00192-009-0937-3
- Hilton P, Dolan LM. Pathophysiology of urinary incontinence and pelvic organ prolapse. BJOG. 2004. doi:10.1111/j.1471-0528.2004.00505.x
- Wallace SL, Miller LD, Mishra K. Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Current Opinion in Obstetrics and Gynecology. 2019. doi:10.1097/GCO.0000000000000584
- Lukacz ES, Santiago-Lastra Y, Albo ME, et al. Urinary incontinence in women: a review. JAMA. 2017. doi:10.1001/jama.2017.12137
- Wieslander CK, Weinstein MM, Handa VL, et al. Pregnancy in women with prior treatments for pelvic floor disorders. Female Pelvic Medicine & Reconstructive Surgery. 2020. doi:10.1097/SPV.0000000000000822