Urinary incontinence after childbirth
You survived pregnancy, delivery, and the newborn stage, but now you’re dealing with bladder leakage that won’t quit. If you’re leaking when you cough, sneeze, laugh, or pick up your baby, you’re not alone. Up to 34% of women report urinary incontinence after giving birth. And it’s not something you have to live with.
Why this happens
Pregnancy and delivery put a lot of strain on your pelvic floor. During pregnancy, your growing baby presses on your bladder and pelvic floor muscles for months. During a vaginal delivery, those tissues stretch and the nerves that control them can be temporarily injured. Research shows that about 80% of women have some degree of pelvic nerve changes after vaginal birth.
Even a C-section doesn’t fully protect your pelvic floor. Pregnancy itself is a risk factor. In one study, 25% of women who had a cesarean before labor still reported urinary leakage at 6 weeks.
Your pelvic floor can recover, but it needs time and sometimes some help. Many women heal on their own. Those who don’t have real treatment options that work.
When to talk to your doctor
- Leaking that continues beyond 6 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
- Leaking that got worse after another pregnancy
If any of these sound familiar, bring it up at your next visit. If leaking is still happening at your 6-week or 3-month checkup, ask about a referral to a pelvic floor physical therapist. Starting early helps.
What treatment looks like
There are several options, and the right mix depends on your symptoms, your body, and your goals. I like to talk through these with patients so we can figure out a plan together.
- Pelvic floor physical therapy – this goes well beyond Kegels. A trained therapist works on strength, relaxation, coordination, endurance, and surrounding muscles like your hips, core, and thighs. They also teach you breathing and bracing techniques. Studies show that women who work with a therapist are 8 times more likely to be cured than those who do nothing. We have pelvic floor PTs in the office, which makes it easier to get started.
- The Knack – learning to tighten your pelvic floor muscles right before you cough or sneeze. This timing trick alone can stop leaks for some women.
- Time and healing – tissue recovery continues for up to a year after delivery.
- A pessary – a small removable support device you can wear during exercise or other high-demand activities.
- Specialist evaluation – if you’ve tried therapy and it’s not enough, a urogynecologist can walk you through other options, including minimally invasive procedures.
What the research shows
Postpartum pelvic floor therapy has good evidence behind it. A 2018 Cochrane review of 38 trials found that pelvic floor training during pregnancy reduced incontinence risk by 29% in the 3-6 months after birth. Another meta-analysis of 15 postpartum trials showed a 56% reduction in urinary incontinence up to 12 months out.
Each pregnancy adds strain. Higher BMI also compounds the effect of birth-related injury. These aren’t reasons to feel discouraged. They’re reasons to get help sooner rather than later.
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. Curr Opin Obstet Gynecol. 2019. doi:10.1097/GCO.0000000000000584
- Borello-France D, Burgio KL, Richter HE, et al. Fecal and urinary incontinence in primiparous women. Obstet Gynecol. 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. Am J Gastroenterol. 2007. doi:10.1111/j.1572-0241.2007.01364.x
- Wu JM. Stress incontinence in women. N Engl J Med. 2021. doi:10.1056/NEJMcp1914037
- Richter HE, Burgio KL, Brubaker L, et al. Continence pessary compared with behavioral therapy or combined therapy for stress incontinence. Obstet Gynecol. 2010. doi:10.1097/AOG.0b013e3181d055d4