Postpartum Incontinence Causes and Treatment

You may have heard jokes about moms who pee their pants after having children, but is postpartum incontinence really something to laugh about? Many people mistakenly think that having postpartum incontinence is normal after pregnancy. While it is common for many women, it is not necessarily normal. If you are experiencing postpartum incontinence, there are treatment options you should be aware of.

Postpartum incontinence is a serious condition that does affect some women after pregnancy, but it doesn’t have to derail their lives completely. Here’s what you need to know about postpartum incontinence, how to talk to your doctor about the condition, and treatment options for regaining control of your bladder—and your life.

Tips for postpartum incontinence
Illustration by Brianna Gilmartin, Verywell.

What Is Postpartum Incontinence?

Most commonly, postpartum incontinence refers to urinary incontinence, which is the involuntary partial or full release of a woman’s bladder after pregnancy and childbirth. For many women, 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 BioMed Central Pregnancy & Childbirth cohort study on postpartum urinary incontinence, incontinence during pregnancy is very common, affecting nearly half of all pregnant women.

If you pee your pants regularly doing pregnancy, you are also more likely to have problems controlling your bladder after pregnancy. The BioMed study found that women who experienced pregnancy incontinence have a three times higher risk of then going on to develop postpartum incontinence at 3 months postpartum.

Understanding Urinary Incontinence

The American College of Obstetricians and Gynecologists explains that there are three types of urinary incontinence:

  1. Stress urinary incontinence: This type occurs when a woman exerts pressure, such as when coughing, laughing, sneezing, or with physical activities such as running, jumping, or exercising. The classic example is a mom jumping on the trampoline who pees her pants!
  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 in women post-pregnancy, although stress incontinence is more common in younger women who have recently given birth. Urgency incontinence tends to occur more as a woman gets older, and it is not necessarily linked to postpartum incontinence. Women who experience incontinence during their pregnancy are also more likely to have incontinence after delivery as well.

Fecal Incontinence

Fecal incontinence after pregnancy and delivery can also occur, but it is much less common. Fecal incontinence may occur if a woman has a 4th-degree tear into her anus, or if a fissure develops from the vagina to the anus.

Unlike urinary incontinence which can be helped in some cases with physical therapy, fetal incontinence usually requires surgical intervention to correct.

What Causes 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.

Instead of having just one proven cause, doctors think that postpartum urinary incontinence is linked to several factors, including genetics and how you deliver.

For example, women who deliver vaginally are more likely to have postpartum incontinence after a vaginal delivery rather than a C-section. You are also more likely to experience postpartum incontinence if you:

  • Are overweight
  • Had incontinence during your pregnancy or before
  • Have a multiples pregnancy
  • You have been pregnant and delivered a baby before
  • Have a forceps delivery
  • Have a vacuum delivery

There are common theories on the causes 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.

Women who have tears that occur as a result of delivery are not more likely to have urinary incontinence. And in the past, some doctors also thought that women who have heavier or larger babies, or women who push for extended periods of time may be more likely to have postpartum incontinence, but studies have not shown that to be the case.

How to Prevent Postpartum Incontinence

It was previously thought that performing episiotomies would help protect a woman’s pelvic floor and prevent urinary incontinence, but a BioMed study found that episiotomies do not help prevent urinary incontinence. Perineal massage has also not been found to help prevent incontinence or to cause it.

The single most beneficial way to deal with postpartum incontinence is to prevent it from occurring in the first place. However, many pregnant women are simply not educated on how to protect their pelvic floor during pregnancy.

The best thing you can do to prevent postpartum incontinence is to protect your pelvic floor before any injury occurs.

You can protect your pelvic floor during pregnancy by:

  • Visiting a physical therapist during your pregnancy 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 that you need to work with.
  • Avoiding high-impact exercises, such as jumping jacks or jump-roping, that may place extra pressure on the pelvic floor.
  • Maintaining a core-strengthening program throughout your pregnancy, such as prenatal yoga.

Exercise for Prevention

There is absolutely no reason to avoid exercising during your pregnancy unless your doctor has placed you on strict bed rest. In fact, regular exercise can help you strengthen your core and protect your pelvic floor. You will just want to be careful to work with a trainer or specialist, if at all possible, 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, it’s generally recommended that pregnant women 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.

How to Talk to Your Doctor

It is extremely important that, when speaking with your doctor, you are 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 some women have to pay for having children.

Postpartum incontinence is not normal and there is treatment available to help improve the condition. If your doctor will not help you, you should seek out a new care provider.

You should also talk to your doctor if you are experiencing leaking. While rare, it could be a sign of a larger problem such as pelvic organ prolapse. Your doctor will just make sure everything is alright.

Treatment Options

Treatment for postpartum incontinence will depend on how severe the incontinence is, to what degree it is affecting a woman’s daily activities and the cause of the incontinence. Unfortunately, postpartum incontinence usually will not just “go away” or get better on its own over time; in fact, it can get worse if left untreated.

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.

By strengthening the muscles of the pelvic floor that support the bladder, a woman can help regain control of her bladder. You can ask your doctor for recommendations of where to start finding help for pelvic floor exercises and many insurances will actually cover pelvic floor therapy, so check with your insurance provider.

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 large majority of moms experience it. If you are suffering from postpartum incontinence or leakage, you should 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 women are able to regain controls of their bladders and go onto life without incontinence issues in their lives.

Having a baby should not mean that you have to accept peeing your pants regularly, so if you’re having issues, talk to your doctor about assessment and treatment options.

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13 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading
  • Wesnes, S. L., Hunskaar, S., Bo, K., & Rortveit, G. (2009). The effect of urinary incontinence status during pregnancy and delivery mode on incontinence postpartum. A cohort study. BJOG : an international journal of obstetrics and gynaecology116(5), 700-7.