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Postpartum urinary incontinence

Postpartum urinary incontinence, unlike fecal incontinence, is a common subject among those who have given birth. In some ways, the discussion around it can over normalize what can be a very frustrating issue, actually preventing people from seeking available treatment. Although urinary incontinence is common postpartum, it is not normal.

First a note about the bladder 

The bladder is supported by the pelvic floor muscles, which are also responsible for controlling urination. When these muscles are damaged or strained, which can happen during pregnancy and/or childbirth, it can result in the inability to control urination. 

There are several reasons why you might experience urinary incontinence after a vaginal childbirth. 

Weakened pelvic floor

For some, after childbirth, the pelvic floor is weakened and less able to control the bladder.

Damaged pelvic nerves

The pelvic nerves can also be damaged during a vaginal birth, causing limited ability to control the bladder. This is particularly common with extended or particularly challenging labor.

Injury during delivery

For example, the use of forceps to aid in delivery can damage the muscles of the pelvic floor or the nerves that control the muscles of the pelvic floor leading to urinary incontinence. 

The week after birth

For many, postpartum urinary incontinence will improve in the weeks after birth as the pelvic floor muscles heal. It’s recommended that women start kegels after giving birth once they can be performed pain-free. Those with pelvic floor injuries will likely need support from a pelvic floor therapist.  

And, if you continue to experience these issues six weeks or more following birth, it’s time to talk to a provider. When you do, bring a breakdown of how often you’re experiencing urinary incontinence and what the circumstances are when it happens. For example, do you leak a little when you sneeze? Or are you leaking more when you find you have to urinate really badly? While talking to a provider about this can feel uncomfortable for some, it is an extremely common issue that providers are trained to talk about and treat. 

Treatment options 

If urinary incontinence is persisting, your provider may perform some tests and will offer you a treatment plan. 

Lifestyle changes

The treatment plan may include a recommendation to practice pelvic floor strengthening exercises, like kegels and to incorporate lifestyle changes, such as changing what and how much you are drinking. Your provider may recommend that you establish a regular routine of emptying your bladder before you have the urge to go as well as intentional water drinking habits. 

Another very effective way to treat urinary incontinence is to work with a pelvic floor physical therapist. This person will be specifically trained in the anatomy of all of the muscles that are involved in supporting your bladder and uterus, the same ones you use to hold in urine when you’re on your way to the bathroom. They can evaluate how well you are doing kegels and offer additional therapies and exercises to help. 

Medication options 

There are a variety of medications to choose from and your specific situation will help your provider determine which one is right for you. They may have you start on a low dose and slowly work your way up depending how your bladder responds. 

Surgical options

When lifestyle changes and medication don’t work, your provider might recommend a surgical procedure. This could include a bulking agent to strengthen the urethra, implantation of a pacemaker to stimulate the nerves to the bladder, a sling procedure, or even Botox injections, which help to relax the bladder muscle. These interventions are not typically used until you are at least 6 months postpartum and whether to use them may depend on your future childbearing plans.

Urinary incontinence is not just an expected outcome of childbirth that you have to live with. It can be incredibly uncomfortable at best and prevent you from doing things you love at worst. Speak to your healthcare provider to come up with a treatment plan that works for you. 

This content was reviewed by Dr. Lisa Hickman and Dr. Katie Propst. Dr. Hickman runs the Childbirth Pelvic Floor Disorders Clinic at The Ohio State University Wexner Medical Center. Dr. Propst runs the Postpartum Care Clinic at Cleveland Clinic. 


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