What You Can Do About Postpartum Incontinence

You may have heard jokes about moms who pee their pants after having children, but is postpartum incontinence really something to laugh about? It is a serious and frustrating condition, but it doesn’t have to derail your life.

Many people think that having postpartum incontinence is normal after pregnancy. While it is common, it is not necessarily normal. If you are experiencing postpartum incontinence, there are treatment options for regaining control of your bladder—and your life.

What Is Postpartum Incontinence?

Most commonly, postpartum incontinence refers to urinary incontinence, which is the involuntary partial or full release of the bladder after pregnancy and childbirth. In many cases, this may look like leaking or dribbling a little urine if their bladder is full, when performing a physical activity like running and jumping, or with forceful movements like coughing and sneezing.

According to a 2004 study on postpartum urinary incontinence, incontinence during pregnancy is very common, affecting nearly half of all pregnancies. And if you pee your pants regularly doing pregnancy, you are also more likely to have problems with bladder control after pregnancy. The same study found that people who experienced pregnancy incontinence had a three times higher risk of postpartum incontinence at 3 months postpartum.

Urinary Incontinence

There are three types of urinary incontinence, according to the American College of Obstetricians and Gynecologists.

1. Stress urinary incontinence: This type occurs with pressure on the bladder, such as when coughing, laughing, sneezing, or with physical activities such as running, jumping, or exercising.
2. Urgency urinary incontinence: This type is a sudden, uncontrollable urge to urinate, which usually results in leakage on the way to the bathroom.
3. Mixed incontinence: A mixture of both stress and urgency.

All three types of urinary incontinence can occur post-pregnancy, although stress incontinence is more common in younger people who have recently given birth. Urgency incontinence tends to occur more with age, and it is not necessarily linked to postpartum incontinence. If you are experiencing leaking, be sure to tell your doctor. While rare, it could be a sign of a larger problem such as pelvic organ prolapse.

Fecal Incontinence

Fecal incontinence (stool leaking from the anus) after pregnancy and delivery can also occur, but it is much less common. Fecal incontinence may occur with a fourth-degree tear into the anus, or if a fistula develops from the vagina to the anus. Fetal incontinence may require surgical intervention to repair.

Causes of Postpartum Incontinence

Experts know that bearing children increases the risk of urinary incontinence postpartum, but here’s the confusing part: They aren’t sure exactly which part of being pregnant or giving birth causes the issues.

For example, people who deliver vaginally are more likely to have postpartum incontinence than those who have a C-section. You are also more likely to experience postpartum incontinence if you:

• Are overweight
• Had incontinence during your pregnancy or before
• Had a multiple pregnancy (twins, triplets, etc.)
• Have previously been pregnant and delivered a baby before the current pregnancy
• Had a forceps delivery
• Had a vacuum delivery
• Had certain genetic factors

There are common theories on causes of postpartum incontinence, though. One is that it occurs as a result of injury during delivery. A related theory is that it is a result of damage to the muscles and structures that support the bladder, known as pelvic floor injury.

For instance, postpartum urinary incontinence could occur because pregnancy puts pressure and strain on the muscles of the pelvic floor, which also support the bladder. When those muscles are weakened over time, by the growth of the baby, and by the pressure of pushing during labor, bladder control is also affected. So, postpartum incontinence is thought to be due to changes in the muscles during pregnancy rather than delivery itself.

People who have tears that occur as a result of delivery are not more likely to have urinary incontinence. In the past, some doctors also thought that people who have heavier or larger babies, or who push for extended periods of time during delivery, might be more likely to have postpartum incontinence. But there is no evidence that either of those is the case.

Preventing Postpartum Incontinence

It was previously thought that performing episiotomies would help protect the pelvic floor and prevent urinary incontinence, but research has found that episiotomies do not help prevent urinary incontinence. Perineal massage has also not been found to help prevent incontinence or to cause it.

You can protect your pelvic floor during pregnancy by:

• Visiting a physical therapist who specializes in pelvic floor health to get specific, targeted exercise for your pelvic floor
• Talking to your doctor about ways to protect your pelvic floor based on how your pregnancy is progressing and any special considerations with your pregnancy
• Avoiding high-impact exercises, such as jumping, that may place extra pressure on the pelvic floor
• Building and maintaining a strong core throughout pregnancy, such as through a prenatal yoga practice

Exercise to Prevent Incontinence

There is usually no reason to avoid exercising during pregnancy unless your doctor has suggested you do so. In fact, regular exercise can help you strengthen your core and protect your pelvic floor. If at all possible, work with a trainer who is knowledgeable about modifications that you may need during your pregnancy.

Because your abdominal muscles will move quite a bit during pregnancy, it’s important not to do certain exercises that will strain them and potentially injure your pelvic floor. For example, avoid exercises that focus heavily on the transverse abdominals, since those are separated during pregnancy. Exercises that work the transverse abdominals include planks, sit-ups, straight leg raises, and twisting crunches.

Treatment Options

When speaking with your doctor, be firm about wanting to solve postpartum incontinence. Never let a doctor dismiss your concerns or try to tell you that postpartum incontinence is normal or a price that you have to pay for having children.

There is treatment available to help improve the condition. If your doctor cannot help you, consider seeing a specialist such as a urogynecologist or pelvic floor physical therapist.

Treatment for postpartum incontinence will depend on how severe the incontinence is, to what degree it is affecting your daily activities, and the cause of the incontinence. In some instances improvement does occur spontaneously with weight control, return of normal hormonal milieu, and exercise. But unfortunately, postpartum incontinence usually will not get better on its own over time; in fact, it can get worse if left untreated.

Pelvic Floor Therapy

One of the first lines of treatment for postpartum incontinence is to work with a physical therapist or a pelvic floor therapist to help strengthen the muscles of the pelvic floor. Strengthening the muscles that support the bladder can help you regain control of your bladder.

Ask your doctor for recommendations of where to start finding help for pelvic floor exercises. Many insurance plans will cover pelvic floor therapy, so check with your insurance provider.

Other Treatments

Pelvic floor therapy can help most women relieve symptoms of postpartum incontinence, but may not completely cure it. Depending on the extent of the incontinence, other options for treatment include:

• Medications to reduce urgency and frequency of urination
• Surgery to support the urethra to reduce leakage
• Nerve stimulation to help repair the nerves that connect to the bladder

A Word From Verywell

You shouldn't have to deal with postpartum incontinence, even if a majority of people experience it. If you are suffering from postpartum incontinence or leakage, let your doctor know and work with a pelvic floor specialist to help strengthen the muscles of your pelvic floor. With therapy and guidance, many people are able to regain control of their bladder.