What is postpartum urinary incontinence, and can it be treated?

By Dr Claire Giuliano

Have you been blessed with a wonderful bundle of joy, though have been left with a particularly frustrating postpartum issue? Don’t worry, you’re not alone.

Leaking urine, or postpartum urinary incontinence, is common, and most women will experience sporadic leaking the first two weeks after giving birth while the pelvic muscles are healing. However, symptoms persisting beyond the first two weeks can indicate something else is at play, and seeking help can make a difference.

You are likely to find information online (curse Dr Google!) that will tell you leaking up to a year, or even five years, is normal postpartum. This is simply incorrect. We would bet our bank accounts that no women want to “just live with it" because American culture has normalized leaking urine postpartum.

So, we’re going to dive deep on all things postpartum incontinence, from how common it is and how to treat it to some tips for when you find your way back between the sheets.

What is postpartum urinary incontinence?

Let’s start with the basics. Urinary incontinence is a loss of bladder control. When loss of bladder control occurs following childbirth, this is called postpartum urinary incontinence. This can be triggered by high impact events like jumping, sneezing, or coughing, which is called stress urinary incontinence. Other times loss of bladder control may be triggered by hearing running water or not being able to make it to the bathroom on time, which is called urge incontinence. Some individuals will experience both avenues of urinary leaking, and this is called mixed incontinence.

How common is postpartum incontinence?

Stress urinary incontinence is significantly more prevalent postpartum than urge incontinence, however both are a heightened risk to all individuals postpartum. A prospective study quoted up to 21% of women had unresolved urinary incontinence 1 year postpartum. We could get on a soap box about it, but from the perspective of a pelvic floor therapist this is simply unacceptable. Our doctors and referring practitioners need to be aware of this and give patients the resources they deserve. Pelvic floor therapists are experts in helping individuals recover optimally postpartum and beyond, including resolving symptoms of bladder incontinence after birth.

How long does postpartum urinary incontinence last?

Leaking urine postpartum is normal the first few weeks following delivery because the pelvic floor muscles have been overstretched and potentially torn. If leaking continues to occur after the first few weeks, this is not normal and it is worth seeking help to find a resolution.

How do you treat postpartum incontinence?

Seek help from a pelvic floor therapist

Whatever you do, don’t rely on Dr Google. If postpartum urinary incontinence could be easily resolved by exercises that you could Google or follow on Instagram then there would not be such a widespread issue. Anyone experiencing postpartum urinary incontinence (or incontinence at any time in their life, for that matter) should seek out help from a pelvic floor therapist if the issue does not resolve on its own.

Consult a professional, not Google

The first thing that pops up in a quick Google search about postpartum incontinence is kegels. If we were to give you one piece of sage advice, know that kegels are NOT the answer and can sometimes worsen symptoms.

Picture this scenario – you just had delivered your baby with a second degree tear and the healing scar tissue is tightening the pelvic floor muscles due to its thickness and lack of movement. You see a trending tik tok video that says to do kegels for bladder incontinence after birth. You start contracting an already tight area, and now create more tightness which leads to pain and more urinary leaking. Don’t fall in this trap! Yes it’s true that someone may have a very weak or lengthened pelvic floor, and kegels may help, but it certainly won’t be a long term solution.

Slowly return to your usual exercise routine

The best course of action when treating postpartum incontinence is to slowly return to your normal exercise routine around 6 weeks after birth as long as you do not have any vaginal bleeding and/or your cesarean scar is healed. Listen to your body. If you are overly fatigued or have pain with exercise, this should be avoided until you can move without pain. And if symptoms don’t resolve, call your local pelvic floor therapist!

What causes postpartum urinary incontinence?

Growing another human in your body is a huge task! This is especially a big task for your pelvic floor muscles, which are supporting the weight of your growing baby. During labor, the pelvic floor muscles expand to roughly 300% of their length to allow for birth. While this is a normal process of human mechanics, it inherently causes damage to the pelvic floor muscles for many women.

Studies have found that an average of 32% of women will have significant damage to their deep pelvic floor muscles following vaginal delivery. With this in mind, any muscle in the body needs to be healthy to perform normal daily functions. The urethra and supporting muscles involved in urination are thus affected and may render symptoms of urinary leaking while the body is healing. As said before, the body may heal on its own within a few weeks. But if it does not, then the acute stage of muscle trauma postpartum may become a chronic issue, which is ultimately when urinary incontinence may persist.

Sex tips if you're suffering from postpartum incontinence.

If you are having urinary leaking with daily activities, penetrative intercourse may also be a time when postpartum incontinence symptoms rear their head. During penetration, leaking can occur from thrusting toward the bladder. Combine this motion with a weak or uncoordinated pelvic floor postpartum, and urinary leaking is likely to happen. When urinary leaking happens during orgasm, this is usually from the urethral muscle spasming in response to stimulation.

Thankfully Pepper has some quick tips to avoid this situation.

Empty your bladder

First off, make sure to empty your bladder prior to sexual intimacy. If you’re going on a hot date and know things might get spicy in the bedroom, avoid or limit any bladder irritants that day. This includes carbonated beverages, caffeine, and alcohol.

Experiment with different positions

Lastly, try different positions! This is a surefire way to keep things hot and saucy in the bedroom. If you are the receiver, laying on your stomach while your partner is above your back is one of the best ways to take pressure off your bladder. Side-lying in a spooning position is another great way to relieve bladder pressure.

If you’re experiencing postpartum urinary incontinence, know that you are not alone and the majority of birthers postpartum are also experiencing this. Follow the tips above to navigate your symptoms, and if things don’t resolve within a couple months postpartum, call your local pelvic floor therapist–they are there to help!

Claire is a pelvic floor therapist with a distinct specialty certification in pelvic rehabilitation (PRPC). She is the private clinic owner of Rooted Pelvic Health & Hand Therapy in Sun Valley, Idaho. She treats all gender diversities for pelvic floor-related conditions including sexual dysfunction, gynecological cancer recovery, and chronic pelvic pain. Claire's mission is to improve overall function and quality of life with lasting results for her clients. As a contributing writer to Pepper Together, Claire seeks to provide education about a subject that deserves more attention. She hopes that by spreading the word about pelvic floor conditions she can break the stigma about conversations around sex, and provide simple solutions to improve sexual intimacy.