Urinary incontinence after childbirth
You made it through pregnancy, delivery, and the newborn weeks, and now you leak when you cough, sneeze, laugh, or pick up your baby. Up to 34% of women report urine leakage after giving birth. It’s common, and it’s treatable.
Why this happens
Pregnancy and delivery put a lot of strain on your pelvic floor. For months, the growing weight of your baby presses down on your bladder and pelvic floor muscles. During a vaginal delivery, those tissues stretch, and the nerves that run them can be injured. In one study, about 80% of women had signs of nerve injury to the pelvic floor after a vaginal birth. Most women get back enough function to stay dry. In some, the damage lasts.
A C-section doesn’t fully protect you, because pregnancy itself is a risk factor. In one study of first-time mothers, 25% of women who had a cesarean before labor still reported leaking at 6 weeks. I cover this in more detail in bladder problems after C-section.
Leaking while you’re pregnant is a strong warning sign. In the same group of first-time mothers, women who leaked during pregnancy had about 3.5 times the odds of leaking after delivery. Higher body weight adds to the risk too.
Will it get better on its own?
Some women improve over the first year as the tissues heal. But leaking that’s still there a few months after delivery tends to stay. In one long-term study, 92% of women who leaked at 3 months postpartum were still leaking 5 years later. If you’re still leaking at 3 months, I wouldn’t count on time alone to fix it.
When to talk to your doctor
- Leaking that’s still there 3 months after delivery
- Symptoms that are getting worse instead of better
- Leaking that keeps you from exercising or being active
- Wearing pads during your regular day
- Sudden strong urges to go, with or without leaking
- Leaking that got worse after another pregnancy
Bring it up at your 6-week visit. You don’t need to wait months before asking for a referral to a pelvic floor physical therapist or a urogynecologist.
Treatment options
The right plan depends on the kind of leaking you have. Stress leaking happens when you cough, sneeze, lift, 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 don’t have to fail one treatment before you can choose another. We decide together based on your symptoms, your goals, and whether you plan to have more children.
For any type of leaking:
- Pelvic floor physical therapy: a pelvic floor PT works on strength, relaxation, coordination, and endurance of the pelvic floor, along with your hips, core, and thighs. They also teach breathing and bracing. We have pelvic floor PTs in the office, which makes it easier to get started. In a 2018 analysis of 15 trials, women who did pelvic floor training after delivery had about half the risk of leaking up to a year later. In women with stress leaking, those who did supervised training were about 8 times more likely to report cure than women who had no treatment.
For stress leaking:
- The Knack: tightening your pelvic floor right before you cough, sneeze, or lift. For some women with mild leaking, this timing trick alone stops it.
- A pessary or vaginal insert that supports the urethra. You can wear one only during exercise or other high-demand activities if you like.
- Urethral bulking, an in-office injection that helps the urethra close
- A midurethral sling. Planning another pregnancy doesn’t rule it out. In the studies we have, most women who had a sling and later got pregnant stayed dry afterward. We can talk through timing.
For urge leaking:
- Bladder training: spacing out bathroom trips and adjusting fluids to calm urgency
- Medication
- Botox injected into the bladder
- Nerve stimulation: sacral neuromodulation, or an implanted tibial nerve stimulator placed near the ankle
If you’re planning another pregnancy, tell me before we choose a sacral nerve stimulator. The usual advice is to turn it off during pregnancy, and symptoms often come back while it’s off.
How I approach it
I start by sorting out which type of leaking you have and how much it bothers you. Pelvic floor therapy is a good place to start for most new moms, but it isn’t a required first step. If you’ve already done therapy and still leak, or you’d rather talk about a procedure now, we can do that at any visit. If you plan to have more children, that changes the timing of some treatments. You can still get treated now.
I’d rather see you at 6 months than at 6 years.
Learn more about urinary incontinence
References
- 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
- 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
- Hilton P, Dolan LM. Pathophysiology of urinary incontinence and pelvic organ prolapse. BJOG. 2004. doi:10.1111/j.1471-0528.2004.00505.x
- Nygaard IE, Heit M. Stress urinary incontinence. Obstetrics & Gynecology. 2004. doi:10.1097/01.AOG.0000137874.84862.94
- Wu JM. Stress incontinence in women. New England Journal of Medicine. 2021. doi:10.1056/NEJMcp1914037
- Richter HE, Burgio KL, Brubaker L, et al. A trial of continence pessary vs. behavioral therapy vs. combined therapy for stress incontinence. Obstetrics & Gynecology. 2010. doi:10.1097/AOG.0b013e3181d055d4
- 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