After baby there are so many ways your life and your body can be changed! It can be a lot to process – especially on very little sleep – and hard to know where to find guidance on what is normal, what could be problematic, and what can be done about any of it! When it comes to the facts about postpartum bladder control, this post is a good place to start!
Urinary incontinence is the technical name for the involuntary loss of urine.1 You may have heard terms, like ‘bladder leakage’ or ‘a weak bladder.’ While these are not medical terms, they refer to the same condition. Urinary incontinence affects approximately 1/3 of new moms during the first 3-months postpartum.2 Fortunately, for most women, the frequency and severity of urinary symptoms is relatively low in the early postpartum period and may resolve.2,3 For the small percentage of postpartum women with severe urinary leakage, these symptoms can persist at 6-12 months postpartum and it is recommended to have a discussion with your healthcare provider.2
Women with Cesarean deliveries are less likely to report incontinence in the early postpartum period compared to women with vaginal deliveries.2 But, in the long term, rates of incontinence even out between women with C-section or vaginal births, so this is not a compelling reason for an elective Cesarean.3 Cesarean sections bring their own additional risks, so if you are considering an elective c-section, discuss this thoroughly with your healthcare provider.
Stress incontinence (involuntary urine loss that occurs with coughing or sneezing, physical activity or exertion1) is the most common type reported by all postpartum women. Urgency incontinence (involuntary urine loss that occurs with the urge to urinate1) is less prevalent among first time moms but becomes more prevalent with additional pregnancies and deliveries.
Why the increased risk of urinary incontinence postpartum?
During labor, the deep pelvic floor muscles, the levator ani, experience significant strain and stretch up to 5 times or more their original length to allow the baby to pass through the birth canal.4 Similarly, the connective tissues that support the bladder and urethra may be stretched or weakened during delivery. When this muscular and structural support is disrupted, women may be more likely to experience postpartum incontinence. The pelvic (pudendal) nerves may also be compressed or over-stretched during labor and delivery, which can interfere with sensation and proper muscle function of the pelvic floor and contribute to postpartum urinary symptoms.4
This all sounds like quite a lot of stress to the pelvic floor – and it is! Childbirth is no easy feat, and related injuries to the pelvic floor may lead to incontinence symptoms in the early postpartum period. Remarkably, for many women, these injuries heal on their own within the 6-12 months after delivery, and incontinence symptoms often resolve.3 If symptoms persist beyond 6-12 weeks postpartum, physical therapy or other interventions are recommended and you are encouraged to discuss this with your healthcare provider, especially if they are bothersome to you.
What else can increase the risk of postpartum urinary incontinence?
Risk factors for postpartum incontinence specifically following vaginal delivery include:5
- Vacuum or forceps assisted delivery
- Higher birthweight babies (>8 lbs)
- Larger head circumference (35-37 cm)5
What do these have in common? They increase the stress and strain on the pelvic floor and contribute to injury or weakening of the muscles, nerves and connective tissues important for continence. This may also explain why having 2 or more of these factors increases the risk of postpartum incontinence even more.
Other risk factors for experiencing postpartum incontinence are:
- Having urinary incontinence before getting pregnant or during the pregnancy6
- Having more than one pregnancy/childbirth
What to do about postpartum urinary incontinence?
In short, do your pelvic floor muscle exercises (aka. Kegels)! Pelvic floor muscle exercises during pregnancy and postpartum can both prevent and treat urinary incontinence, and you may find it helpful to work with your health care provider or a physical therapist to be sure you are doing your exercises correctly.4,7 If leakage symptoms bother you, or are severe and/or persist beyond 3 months postpartum, it is important to discuss treatment options with your health care provider.
- Haylen BT, De Ridder D, Freeman RM, et al. An International Urogynecological Association / International Continence Society Joint Report on the Terminology for Female Pelvic Floor Dysfunction. Neurourol Urodyn. 2010;29:4-20. doi:10.1007/s00192-009-0976-9
- Thom DH, Rortveit G. Prevalence of postpartum urinary incontinence: A systematic review. Acta Obstet Gynecol Scand. 2010;89(12):1511-1522. doi:10.3109/00016349.2010.526188
- Fritel X, Ringa V, Quiboeuf E, Fauconnier A. Female urinary incontinence, from pregnancy to menopause: A review of epidemiological and pathophysiological findings. Acta Obstet Gynecol Scand. 2012;91(8):901-910. doi:10.1111/j.1600-0412.2012.01419.x
- Nobili F, Mallozzi M, Scarani S, Marci R, Caserta D, Soave I. Pelvic floor muscle training for prevention and treatment of urinary incontinence during pregnancy and after childbirth and its effect on urinary system and supportive structures assessed by objective measurement techniques. Arch Gynecol Obstet. 2019;299(3):609-623. doi:10.1007/s00404-018-5036-6
- Wesnes SL, Hannestad Y, Rortveit G. Delivery parameters, neonatal parameters and incidence of urinary incontinence six months postpartum: a cohort study. Acta Obstet Gynecol Scand. 2017;96(10):1214-1222. doi:10.1111/aogs.13183
- Gartland D, Macarthur C, Woolhouse H, Mcdonald E. Frequency, severity and risk factors for urinary and faecal incontinence at 4 years postpartum : a prospective cohort. 2015:1203-1211. doi:10.1111/1471-0528.13522
- Wu YM, McInnes N, Leong Y. Pelvic Floor Muscle Training Versus Watchful Waiting and Pelvic Floor Disorders in Postpartum Women: A Systematic Review and Meta-analysis. Female Pelvic Med Reconstr Surg. 2018;24(2):142-149. doi:10.1097/SPV.0000000000000513