Most people assume that leaking urine after having a baby, aka postpartum incontinence, is just the price a person pays for becoming a birthing parent. But while it is COMMON, it doesn’t have to be NORMAL! There is so much that you can do to help yourself if you are struggling with incontinence, and especially postpartum incontinence.
I thought everyone had some urine leakage after having a baby?
It is true that developing incontinence is incredibly common during and after pregnancy. A recent systematic review (Moossdorff-Steinhauser 2021) found that the general rate of urinary incontinence between 6 weeks and one year postpartum was 31%. However, the overall prevalence ranged between 10-63%. That is a lot of people dealing with incontinence after having a baby! But, just because it is common, it doesn’t mean there isn’t anything you can do about it. In fact, it’s just the opposite!
Really? So you are saying that I shouldn’t have to cross my legs every time I have to sneeze?
YES! Even sneeze-pees, or stress urinary incontinence, can be helped after having a baby. Stress incontinence is the most common form of postpartum incontinence, occurring in 54% of those who leak after having a baby (Moossdorff-Steinhauser 2021). It includes leaking urine when you cough, sneeze, laugh, lift anything heavy, etc. Urge urinary incontinence is leaking on the way to the bathroom, and does occur after having a baby, but is less common. Some people have a combination of the two, which is known as mixed urinary incontinence.
But what can I do about incontinence? Do Kegels help?
Pelvic floor strengthening can definitely help with incontinence (Daly 2022), and Kegels are one part of that! But especially for stress incontinence, the timing of the pelvic floor muscles is incredibly important. Any time you feel a cough or a sneeze coming on, you want to tighten your pelvic floor, and lift the muscles up towards your head. This can help prevent leaks with coughing and sneezing (Yakıt Yeşilyurt 2022). But, other things are important too, like general pelvic floor and core strengthening. Plus, especially for urge incontinence, even what you are eating and drinking can make a big difference in how often you leak. Hint: don’t decrease your water intake just to avoid incontinence, as it can actually make you leak more!
So how many Kegels should I do in a day to help me stop leaking?
The answer to this one is complicated. While it is true that improving your pelvic floor function is a big part of treating incontinence, Kegels are not appropriate for every person. Sometimes people are leaking because their pelvic floors are actually holding too much tension, and these people actually need to learn how to relax their pelvic floors to help their leaking. Other people have very weak pelvic floors and need to do a lot of strengthening, while others may have poor pelvic floor endurance. So there is no one right answer to your question! Your best bet is to have a pelvic health physical therapist do an examination of your pelvic floor to recommend what is right for you. You can look up one near you here or here.
If I am still breastfeeding, does that matter?
YES. Breastfeeding places your whole body in a state of lower estrogen. This impacts the pelvic floor in several ways, including a decreased moisture barrier at the end of the urethra (the tube where your pee comes out). This certainly contributes to incontinence, and so for as long as you are breastfeeding or producing milk, you are more-susceptible to leaking (Snyder 2021).
How can MommaStrong help me? I’d love to see a PT but don’t have the time or money right now!
MommaStrong has so many great options for incontinence! The best part about MommaStrong is that it really addresses your whole body from head to toe, to help with everything that might be causing you to leak as a new parent. This includes how you are breathing, your posture, the coordination between your deep abdominals and your pelvic floor, and of course pelvic floor strength in general! We have our Hazy Days and New Momma programs that will help you with general postpartum recovery and strength, no matter how far along you are postpartum. Plus we have an Incontinence Deep Dive to tackle the specifics of what causes people to continue to leak! And then after that, you take what you have learned in the Deep Dive and apply it to your daily workouts to maintain the strength you have gained.
Daly, D., Higgins, A., Hannon, S., O’Malley, D., Wuytack, F., Moran, P., Cusack, C., & Begley, C. (2022). Trajectories of Postpartum Recovery: What is Known and Not Known. Clinical obstetrics and gynecology, 10.1097/GRF.0000000000000726. Advance online publication. https://doi.org/10.1097/GRF.0000000000000726
Moossdorff-Steinhauser, H., Berghmans, B., Spaanderman, M., & Bols, E. (2021). Prevalence, incidence and bothersomeness of urinary incontinence between 6 weeks and 1 year post-partum: a systematic review and meta-analysis. International urogynecology journal, 32(7), 1675–1693. https://doi.org/10.1007/s00192-021-04877-w
Snyder, K., Peterson, J., & Bargstadt-Wilson, K. (2021). “No One Told Me About This Part”: What Breastfeeding Women Want and Need to Support Their Physical Health. Journal of Women’s Health Physical Therapy, 45(2), 51-56. doi: 10.1097/JWH.0000000000000195
Yakıt Yeşilyurt, S., Özengin, N., & Topçuoğlu, M. A. (2022). Comparing the efficacy of the Knack maneuver on pelvic floor muscle function and urinary symptoms using different teaching methods: a prospective, nonrandomized study. International urogynecology journal, 1–9. Advance online publication. https://doi.org/10.1007/s00192-022-05213-6