Urinary incontinence—loss of bladder control when you sneeze, cough, or laugh—is very common in pregnant and postpartum women, and many factors impact its length and severity. “About six weeks after birth, I generally recommend pelvic floor therapy,” says Dr. Rebecca Stern, an obstetrician and gynecologist in Boca Raton, Florida and urinary incontinence specialist. “The level of elasticity of the tissue is the most important,” Stern says. “Someone who is 20 is going to have better elasticity in their tissue and a better ability to bounce back than someone who’s 40. After multiple pregnancies and deliveries, there’s going to be more significant damage to the tissue.” The good news is that there are many noninvasive treatment options that can help.
How common is postpartum urinary incontinence?
About one in four women will have urinary incontinence in their lives, and while there are several reasons, pregnancy and childbirth are two leading causes. “The saying is that three C-sections will equal one vaginal delivery, as far as urinary issues are concerned,” says Stern. In other words, “it’s not as significant with a C-section, but it certainly is there.”
What causes postpartum urinary incontinence?
“Pregnancy itself weakens the pelvic floor and all the tissue in that area,” explains Stern, “So the urethral bladder angle is affected by the weight of the pregnancy. That’s why even Cesarean patients experience urinary incontinence.” As the baby’s head travels through the pelvis “It definitely damages a lot of the tissue strength and the pelvic floor.” Vaginal delivery stretches the tissue, leaving it slack and not as supportive.
How can I prevent it?
Kegels. Doing them before and while you are pregnant builds pelvic floor strength, and a strong, healthy pelvic floor recovers better.
“It’s prevention to teach younger girls how to do their Kegels—and how important it is—and it can prevent them from having an issue in the future,” Dr. Stern says.
If you don’t know how to do Kegels—or even what they are—now is the perfect time to start working on them. Kegel exercises are pelvic floor muscle training: You’re strengthening the muscles that support your bladder so your bladder is less likely to leak. And you can do Kegels virtually anytime.
- To isolate the right muscles, stop urinating in midstream. The muscles you are contracting are the ones to focus on.
- Tighten and contract the muscles for a count of three. If it helps, envision that you are contracting the muscles around a very small ball and you can’t drop the ball. Then relax for a count of three.
- Repeat ten to fifteen times in one session. Repeat each session daily.
What can I do about it?
Pelvic floor therapy is the most common treatment for postpartum urinary incontinence, and you can start once the uterus returns to its normal size, which is around six weeks postpartum, according to Stern. A pelvic floor therapist teaches patients how to find and squeeze the right pelvic floor muscles, how to do Kegels properly, and how to maintain a Kegel practice between visits. “Once the uterus returns to its normal size, I have patients do Kegels every time they’re feeding the baby, since they’re going to be feeding multiple times a day,” says Stern. In some cases, Kegels might not be the best exercise for early postpartum, and a pelvic floor therapist will be able to guide you through more appropriate strengthening moves.
Another benefit of pelvic floor therapy is biofeedback. In biofeedback sessions, electrodes placed externally or a small sensor placed in the vagina during exercises lets you know when the correct muscles are being engaged. Your midwife or obstetrician can refer you to a pelvic floor specialist, and visits are usually covered by insurance—but check with your provider first. You can also find a reputable pelvic floor specialist at Academy of the American Physical Therapy Association's Pelvic Floor Division.
If pelvic floor therapy isn’t enough, there are other options that can help:
“If someone is nursing and not improving, that’s when I would probably add a little bit of local vaginal estrogen,” Stern says. Local estrogen therapy is noninvasive and helps build collagen to support the repair of vaginal tissue. “You live in a progesterone environment when you’re nursing, and estrogen really helps the vaginal tissues.”
Laser therapy and radiofrequency treatments both stimulate collagen production, and options like TempSure Vitalia by Cynosure use radiofrequency energy to tighten and reshape vaginal tissue. Pelvic floor therapists perform radiofrequency treatments, which are done with a device similar to an ultrasound wand and usually last 20 to 30 minutes. The treatment usually requires three sessions and runs about $2,500 to $3,000 for all three treatments.
An alternative to working with a pelvic floor therapist is a pelvic floor exerciser for strengthening. These devices essentially help your body do Kegels. Some are worn externally, like Elitone and Innovo, and others, like Elvie, are placed inside the vagina. Each works differently to contract pelvic floor muscles for you. They range from $199 to $500. Doctors advise waiting at least six weeks after vaginal delivery or 12 weeks after a C-section before using an at-home device, and always check with your doctor before starting any course of treatment with an at-home device.
“Caffeine and carbonation tend to be bladder irritants,” says Stern. Caffeine can have a mil diuretic that increase urine production and may increase contraction of the smooth muscle in the bladder, and the carbon dioxide in fizzy drinks can irritate the bladder lining. One study found citric acid may increase bladder pressure , and spicy and acidic foods can also contribute to irritation.
On the most extreme end of the spectrum is surgery. “I would not encourage surgery until someone is done with childbearing and has taken all the precautions and explored all other possible treatments,” Stern says.
How long will it last?
It depends—no pun intended—on many factors, like age, tissue elasticity and damage, and number of previous pregnancies. Some women stop leaking six weeks after delivery, but in one study, 22% of participants experienced urinary incontinence symptoms one year postpartum. And another study found that women who delivered vaginally were 8% more likely than women who had a C-section to experience long-term stress urinary incontinence symptoms.
More importantly, without therapy, pelvic floor issues usually won’t heal themselves. Even if incontinence isn’t an issue immediately after childbirth, Stern recommends strengthening exercises for prevention. “Someone who is eight to 12 weeks postpartum might not tell you that they're really leaking,” she says, “but it can become an issue later in life without prevention.”
But pelvic floor exercise has a proven impact: In a study of 84 women, 41 participated in 12 weeks of pelvic floor muscle training beginning at nine weeks postpartum. At six months postpartum, only 57% of this group still experienced incontinence, as compared to 82% of the women that did no pelvic floor training at all.