How Common is Leaking Urine Postpartum & How to Handle It

What is Postpartum Urinary Incontinence? 

Postpartum urinary incontinence is when you unintentionally pass or release urine after pregnancy and childbirth. According to a 2019 study, approximately one-third of women experience urinary incontinence between the second trimester of pregnancy and into the first 3 months after childbirth. Urinary incontinence is a common side effect of birth and generally resolves itself as the body heals. 

Unfortunately many women feel embarrassed and may not tell friends, their partners, or their healthcare provider. This condition is very common and not something to be ashamed about. However, it is not something you have to accept and live with.

Not seeking help can sometimes lead to loneliness, shame, perhaps a reduction in exercise, sex, etc. Let’s break the taboo and help you know that 1) you’re not alone and 2) there are options to help you, and 3) you do not need to suffer through it. 

What Causes Postpartum Urinary Incontinence? 

Giving birth can impact a woman’s ability to control her bladder. Incontinence is common in new mothers and can even develop years after childbirth.  During pregnancy, the growing uterus can weaken the pelvic floor muscles, leading to urine leakage. Giving birth itself can also affect these muscles, causing incontinence symptoms to persist after delivery. In a study done by the National Institutes of Health researchers found that women who had a  C-section were at approximately half the risk of developing stress urinary incontinence (incontinence resulting after a cough, sneeze or other activity) and overactive bladder, compared to women who had a spontaneous vaginal birth.

Hormones, genetics, and lifestyle factors such as smoking can also increase the risk of postpartum incontinence. Factors like damage to the bladder nerves or pelvic muscle nerves, movement of the urethra and bladder, pelvic floor tears, and assisted deliveries with forceps or a vacuum can all contribute to urinary incontinence.

2 Types of Incontinence

There are two primary types of urinary incontinence that commonly affect women: stress incontinence and urge incontinence. 

Stress incontinence happens when pressure on the bladder leads to leakage, often due to weakened pelvic floor muscles. Activities like sneezing, laughing, or coughing can cause unintentional urination. This is the one that I think we all hear about most, and accept as the new norm. But it’s not normal or something you have to deal with the rest of your life. 

Urge incontinence, also known as overactive bladder, occurs when there is a sudden, intense need to urinate, leading to leakage before reaching the bathroom (been here many a time and done that!). Some people experience both types, this is known as mixed incontinence

Symptoms

One of the main symptoms of incontinence is that of unintentionally leaking urine, but other symptoms can also include: 

• Spasms and pressure in the pelvic area
• Bedwetting
• Using the bathroom more than eight times a day or more than twice at night

Stress incontinence can lead to urine leakage during activities such as:

• Exercising
• Laughing
• Coughing or sneezing
• Lifting heavy objects
• Standing up
• Bending over

The impact of different activities on leakage depends on the severity of incontinence. An overactive bladder can cause leaking urine along with a sudden or uncontrollable urge to pee.

Risk Factors

Some risk factors that can contribute to leaking urine postpartum can include:

• Already experiencing incontinence before childbirth, or during pregnancy
• Having a history of smoking
• Developing bladder issues during pregnancy
• Experiencing a prolonged labor
• If you are first-time Mom
• Expecting a baby with a higher birth weight
• If you encounter complications during labor and delivery, such as stitches, tears, or the use of forceps
• Having gestational diabetes

How to Manage Leaking Urine

First and foremost talk with your medical provider. They are familiar with your birth and can give you specific advice for your situation.

Secondly, it is beneficial for all new moms to schedule an appointment with Pelvic Floor Physical Therapist. They are specially trained to be your pelvic floor’s best friend. They can help understand if your incontinence is linked to muscles, ligaments, or nerves. They can give you specific exercises to support your pelvic floor to improve your incontinence symptoms. In many other countries seeing a pelvic floor physiotherapist is standard care for all postpartum mothers.

Other options for managing leaking urine: 

• ​​Percutaneous tibial nerve stimulation (PTNS) is a non-invasive treatment for overactive bladder. In PTNS sessions, a doctor inserts a thin needle into the ankle near the tibial nerve. The needle sends electrical impulses to the tibial nerve, which then transmits signals to the sacral nerves in the spine that regulate bladder and pelvic floor function. Over time, these pulses help interrupt malfunctioning nerve signals, reducing urinary incontinence symptoms. You will need to discuss this option with your medical provider and should often be considered after you have tried less invasive options.
• You could try to train your bladder. Start by urinating every 30 minutes, even if you don’t feel the urge, and gradually increase the intervals between bathroom breaks each day. This training may help you achieve more typical urination intervals of every three to four hours during the day and four to eight hours at night.
• Boost your fiber intake. Increasing fiber can help prevent constipation after pregnancy, which in turn reduces pressure on your bladder.
• Stay hydrated. Continue drinking at least eight glasses of fluids daily. Cutting back may lead to dehydration and urinary tract infections. However, you may want to limit fluids near bedtime if you are experiencing nighttime incontinence.
• Avoid bladder irritants. Steer clear of coffee, citrus, tomatoes, soft drinks, and alcohol, as these can irritate your bladder and make urine control more difficult.
• Use absorbent pads or specialized underwear to help absorb any leaks instead of tampons, which aren’t recommended during the postpartum recovery period. These can range from panty liners to adult diapers based on severity. Options include reusable and single-use types, and they discreetly absorb urine to protect your clothing.
• Another option is a pessary.  A pessary is a device inserted into the vagina to support the urethra and bladder and prevent leaks. Custom-made and over-the-counter options are available, with both single-use and longer-term reusable types. However, as mentioned above, they should not be used until 6 weeks postpartum. Check in with your healthcare provider before using one. 

If you continue to experience leaking urine postpartum after 6 weeks, speak to your healthcare provider and discuss concerns. They can help you to get a referral for a pelvic floor specialist, and if the problem is severe enough, they may suggest a surgical procedure. It’s worth discussing all options before proceeding down that route.

Final Thoughts

Although urinary incontinence is common during and shortly after pregnancy due to hormonal and anatomical changes, it often resolves as the body recovers. Women should know that urinary incontinence after childbirth should never be accepted as a permanent part of life now. In some instances, it may persist, but effective solutions are available for those who seek assistance. You can seek treatment as soon as symptoms arrive during pregnancy or postpartum.

There are accessible treatments available, and the first step is often seeking help from a healthcare provider. I also cannot advocate enough about seeing pelvic floor specialists who can help you out before you do any surgical procedure.