It’s no secret that your body goes through a lot of changes during pregnancy and childbirth, but postpartum urinary incontinence may feel like a big secret until it happens to you.
Like many things when it comes to pregnancy and delivery, postpartum incontinence isn’t exactly something new moms are shouting about from the rooftops. But if you find it’s harder to control your bladder after pregnancy, just know that you are not alone: About one-third of women report urinary incontinence within 6 months after delivery.
Some moms may assume postpartum incontinence is just part of their “new normal” as a parent, but it’s not something you have to live with forever. While postpartum incontinence is common, there are ways to treat it.
We spoke with two experts—Kecia Gaither, MD, MPH, MS/MBA, FACOG, a double board-certified physician in OB-GYN and Maternal-Fetal Medicine, and Heather Jeffcoat, a DPT, Pelvic Health Physical Therapist and Poise partner—for their best advice to get your bladder back under control.
What is Postpartum Incontinence?
Urinary incontinence is the involuntary release of urine, which can range from just a few drops to completely emptying the bladder. When this occurs after pregnancy and childbirth, it is considered postpartum urinary incontinence.
Officially, there are three main types of urinary incontinence, according to The American College of Obstetricians and Gynecologists:
- Stress urinary incontinence (SUI) is leaking urine when coughing, laughing, or sneezing. Also common in this category is leaking urine when walking, running, or exercising.
- Urgency urinary incontinence is a sudden strong urge to urinate that is hard to stop. This may include leaking urine on the way to the bathroom.
- Mixed incontinence combines symptoms of both SUI and urgency urinary incontinence.
Dr. Gaither explained that postpartum incontinence typically occurs when you perform a forceful action like coughing or sneezing, or a physical activity like running and jumping—which would fall into the SUI category. And while it tends to resolve within a year, a small percentage of women may still have symptoms up to 5 years postpartum, Dr. Gaither said.
What Causes Postpartum Incontinence?
There is not necessarily one single thing that causes postpartum incontinence. Rather, it can happen for any number of reasons, Dr. Gaither explained.
To start with, pregnancy and delivery—especially with a large baby—can lead to postpartum incontinence. This is because the weight of the growing uterus and the process of pushing during vaginal delivery can weaken the pelvic floor, causing urine to leak.
While some studies have linked vaginal delivery to an increased risk for postpartum incontinence, it can also happen after a C-section delivery.
“Regardless of the mode of delivery, pregnancy in general—especially a first pregnancy—increases your risk of pelvic floor dysfunction, which can include urinary incontinence due to lack of pelvic floor muscle strength or lack of urethral support,” Jeffcoat said.
Other causes can include:
- Forceps or vacuum during delivery
- Certain genetic factors
- Being overweight
- A multiple gestation pregnancy
- Delivering vaginally
- Prior experience with postpartum urinary incontinence
- An episiotomy
How to Treat Postpartum Incontinence
Experts agree: There are treatment options for postpartum incontinence, and it is not something you have to live with. Your OB-GYN or other healthcare professional can help come up with a plan that’s best suited to your specific needs, as there is no one-size-fits-all approach.
Dr. Gaither and Jeffcoat both said that one of the best ways to manage postpartum incontinence is through pelvic floor physical therapy, which can improve a number of postpartum-related symptoms, including leaking urine. And if you’re not familiar with pelvic floor therapy, we’ve got everything you need to know about postpartum pelvic floor wellness here.
Your OB-GYN should be able to recommend a pelvic floor physical therapist in your area—and some even accept insurance, though not all.
Along with pelvic floor therapy, your healthcare provider may recommend:
The goal is to learn how to control the urge to empty the bladder and increase the time span between urinating to normal intervals (every 3–4 hours during the day and every 4–8 hours at night).
These are pelvic muscle exercises that help with bladder control and strengthen the pelvic muscles.
For SUI, a pessary may help without having to resort to surgery. A pessary is a device that is inserted into the vagina to support the vaginal walls to lift the bladder and urethra.
There are medications available to help control bladder spasms and relax the urethra that you can discuss with your doctor.
Certain procedures can help repair the nerves that connect through the bladder. Sacral neuromodulation involves sending a mild electrical signal along a thin wire under the skin of the low back, close to the nerve that controls the bladder to improve function. Percutaneous tibial nerve stimulation (PTNS) is similar to acupuncture, where a needle is inserted in a nerve near the ankle, which sends a signal to the pelvic floor when it is connected to a special machine.
Can You Prevent Postpartum Incontinence?
Both experts agreed that avoiding high-impact or strenuous exercises (like running) during pregnancy and for 12 weeks after delivery can help protect your pelvic floor.
But for some people, that may not be enough. Working with a pelvic floor therapist if you experience any signs of pelvic floor dysfunction—like incontinence or pelvic pressure—is your best bet.
Understandably, many moms don’t think about postpartum incontinence until it happens to them, but it can be helpful to have a plan in place beforehand, Jeffcoat told us.
“Even if you are not experiencing any pain or dysfunction, it can also be valuable to consult a pelvic health physical therapist for a birth prep program. Just a few visits starting around week 34 of your pregnancy can help empower you during and after delivery.”
The bottom line is this: If something doesn’t feel right to you—even if it is common and normal to experience, like postpartum incontinence—speak up and ask your doctor or other healthcare providers to work with you on a treatment plan. Your care doesn’t and shouldn’t end when pregnancy does. Thankfully, more and more doctors, healthcare providers, and parents are recognizing this, talking about it, and doing better than before.