Leaking after birth can start affecting more of your day than you realize
It may begin with a few drops when you sneeze, lift the car seat or finally get back to an exercise class. Then you notice that you’re checking where the bathroom is before you leave home, wearing a bladder pad just in case or avoiding a run because you don’t want to worry about leaking halfway through. We see this remarkably often at Oona, and by the time someone mentions it to us, they’ve usually been working around it for a while. Part of the problem is that leaking after birth is so often described as one of those things that simply comes with having a baby. It’s definitely common, but that isn’t the same as saying that nothing can be done or that waiting is your only option. Some leaking improves as the body heals, while some doesn’t, and we have much better information now about who is likely to keep leaking and what can actually help. Understanding the type of leaking you’re experiencing is a good place to begin, because postpartum urinary incontinence isn’t always a matter of having a weak pelvic floor, and a sheet of generic Kegels won’t account for the way your particular muscles are working. Once we know what is happening, we can make a plan that fits your body and the things you need it to do every day.
In this article
- How common is leaking after birth, really?
- What’s actually happening in your body
- The three patterns of leaking, and why the difference matters
- Was it the vaginal birth? And does a caesarean protect you?
- How long does postpartum incontinence last?
- Why Kegels on their own so often don’t work
- What actually helps
- When leaking deserves a closer look
- What happens at a pelvic floor physiotherapy appointment
- Frequently asked questions
- Where to start
How common is leaking after birth, really?
Postpartum leaking is remarkably common. A systematic review and meta-analysis published in the International Urogynecology Journal brought together 24 studies involving more than 35,000 women and found that about 31 per cent leaked urine at some point between six weeks and twelve months after giving birth. A separate analysis of 32 studies and more than 28,000 women came remarkably close, at roughly 26 per cent. What we pay the most attention to is what happened as more time passed. In the first review, around 24 per cent of women were leaking at six weeks, 21 per cent at three months and 32 per cent at twelve months. If time alone solved postpartum incontinence, we would expect those numbers to fall steadily, and they simply didn’t. Some people absolutely do improve as the body heals, but a lot of people need more than time. The rates were also almost identical for first-time mothers and women who’d had more than one baby, at 31 and 30 per cent. This isn’t only something that happens after several pregnancies, and having leaked once doesn’t mean that your body was somehow destined to do it. These numbers are useful because they show us how many people are affected; they don’t tell us what your individual recovery has to look like.
What’s actually happening in your body
Your pelvic floor is a layer of muscle and connective tissue that runs between the pubic bone and tailbone. Among other things, it helps keep the urethra closed when pressure inside the abdomen rises. Every cough, sneeze, laugh, lift or landing creates a quick change in pressure, and the pelvic floor needs to respond at exactly the right moment. Usually that happens without you giving it a thought, which is why most of us don’t spend much time thinking about the pelvic floor until it stops keeping up quite so well. Pregnancy changes ask a lot of this system before birth even enters the picture. For months, the pelvic floor is managing increasing weight and pressure while the connective tissue, rib cage, pelvis and the way you breathe are all changing around it. During a vaginal birth, the muscles stretch considerably and the nerves that supply them may also be stretched or compressed. It’s a lot for one area of the body to manage in a relatively short period of time. Afterwards, there usually isn’t one dramatic injury that explains everything. The muscles may not be producing enough force, their timing may be slightly out of sync, the connective tissue may still be healing and nerve signalling may still be recovering. It’s also entirely possible to have a pelvic floor that is holding too much tension and still leak, because a muscle that is already working hard at rest has very little room left to respond when you sneeze. That’s why we don’t automatically hand everyone the same set of Kegels and send them home.
The three patterns of leaking, and why the difference matters
Stress incontinence is the leaking that happens when pressure goes up, which may be with a cough, sneeze, laugh, jump, lift or run. It accounts for a little over half of postpartum leaking, at around 54 per cent in the pooled data. Urgency incontinence feels different: the need to urinate comes on suddenly and strongly, and you may not make it to the bathroom in time. Putting the key in the front door, hearing running water or arriving home after being out can be enough to trigger it. That pattern accounts for about 26 per cent, while mixed incontinence, where you experience some of both, makes up roughly another 16 per cent. The difference matters because we wouldn’t necessarily treat all three in the same way. Strength and coordination work often forms part of care for stress incontinence, while urgency may respond better to bladder retraining, urge-suppression strategies and a closer look at fluids and bladder irritants. An assessment saves a great deal of frustration here. After all, you can work incredibly hard at an exercise, but it won’t be terribly useful if it’s aimed at the wrong problem.
Was it the vaginal birth? And does a caesarean protect you?
This question comes up all the time. Vaginal birth is associated with a higher risk of postpartum leaking than caesarean birth. Forceps or vacuum-assisted delivery, a longer second stage of labour, perineal tearing, a baby weighing more than four kilograms, giving birth at 35 or older, having had more than one baby, leaking before or during pregnancy also appear consistently in the research. Almost none of that was something you could control on the day, and a list of risk factors should never be read as a list of things you should have done differently. The caesarean question is a little more complicated than it first appears. In a twelve-year study following nearly 4,000 women, those who had only ever delivered by caesarean were less likely to have lasting incontinence than those who had delivered vaginally. However, women whose birth histories included both caesarean and vaginal births had about the same risk as the vaginal-birth group. Pregnancy itself places a significant load on the pelvic floor, which means that leaking after a caesarean is absolutely possible and worth having properly assessed. If you’re recovering from a caesarean and are also dealing with scar tightness, numbness or tugging, our guide to what’s normal for a caesarean scar week by week covers that side of things in more detail.
How long does postpartum incontinence last?
At this point, the usual advice to simply give it time becomes considerably less reassuring. The most useful evidence comes from a study that followed women for twelve years after recruiting them at three months postpartum in Aberdeen, Birmingham and Dunedin. Of the women who were leaking at that three-month mark, 76 per cent were still leaking twelve years later – yes, twelve years, not twelve months. Across the entire group, nearly 38 per cent had ongoing incontinence, and it was having a measurable effect on their quality of life. That’s why we pay attention to leaking early. Some leaking definitely does settle during the first few months as tissue heals and strength returns, so a small leak at four weeks postpartum isn’t a reason to panic. If it’s still happening at three months, though, there’s no need to wait until it becomes more disruptive before asking for help. The six-week postpartum check usually isn’t designed to assess bladder function in any real depth, which is how so many women leave that appointment assuming that waiting is their only option.
Why Kegels on their own so often don’t work
Almost every woman has been told to do Kegels at some point, and many do them faithfully for months without seeing much change. Usually, the problem isn’t a lack of effort. It’s that nobody has checked whether the exercise is right for what the pelvic floor is actually doing. Technique is a big part of this. In a study that assessed women after brief verbal instructions, only about half performed the contraction correctly, while a quarter bore down in a way that could make leaking worse. Being told to squeeze is very different from having someone check whether the right muscles are lifting and whether you can relax them again afterwards. Strength is only one part of the picture. The pelvic floor also needs to relax fully, respond quickly enough to a cough or sneeze, and coordinate with your breathing and abdominal wall. Squeezing harder won’t correct the timing, and it can make things considerably more uncomfortable if the muscles are already holding too much tension. The program itself matters too. Research showing a meaningful benefit uses structured, progressive pelvic floor muscle training, with exercises that change as the muscles improve. In a Cochrane review, 74 per cent of women with stress incontinence who completed training reported improvement or no leaking, compared with 11 per cent in the control group. A few squeezes at red lights can be a useful reminder, but they’re definitely not the same thing as a treatment plan. The research, unfortunately, isn’t equally tidy in every situation. A Cochrane review of pelvic floor muscle training during pregnancy and after birth found the strongest results for prevention: women who weren’t leaking when they began structured training were less likely to develop it in late pregnancy and the early postpartum months. Results were more mixed in studies treating people who were already leaking after birth, partly because the programs and the amount of supervision varied so much. Pelvic floor physiotherapy is still a very sensible place to begin, but we obviously can’t promise the same result for every patient in a fixed number of weeks.
What actually helps
A proper assessment is usually the most useful place to begin because the plan depends on whether your pelvic floor needs more strength, less tension, better timing or a combination of all three. A pelvic floor physiotherapist can look at how the muscles are working and may offer an internal examination if you’re comfortable with one. The point is to understand what is happening in your particular body so that you leave with something considerably more useful than a generic list of exercises. Depending on what we find, treatment may include progressive strength and coordination work, exercises that help the muscles relax when tension is part of the picture, and breathing or pressure-management strategies so that the diaphragm, abdominal wall and pelvic floor work together more comfortably. You may practise contracting the pelvic floor just before a cough, sneeze or lift, rather than trying to catch up once the pressure has already arrived. If urgency is the main concern, bladder retraining, urge-suppression strategies and a look at caffeine, carbonated drinks and frequent “just in case” bathroom trips may be far more useful than strengthening alone. Cutting back too much on fluids usually doesn’t help either, because concentrated urine can irritate the bladder and make urgency worse. We also need to look at what your pelvic floor is being asked to manage throughout the day. Lifting and carrying a growing baby, getting up from the floor, holding your breath through an awkward car-seat lift and returning to exercise all change the pressure moving through this area. Leaking may also show up alongside postpartum back pain, a separation in the abdominal muscles, pelvic organ prolapse or pain with sex. If several of those things are happening at once, they belong in the same conversation rather than being treated as a collection of completely separate problems. Leaking that has been present for months or even years is still worth bringing up. Depending on the type and severity, other options may include a pessary or a conversation with a urogynecologist about surgical treatment. A pelvic floor physiotherapist can help you understand when that referral would be useful, and you definitely don’t have to exhaust yourself trying every possible exercise before you’re allowed to discuss another option.
Not sure where to start?
Book a free 20-minute Care Navigator call and we’ll help you talk through what has been happening and whether pelvic floor physiotherapy is the right first appointment. The call is free, you don’t need a referral and there’s no obligation to book afterwards.
When leaking deserves a closer look
Pelvic floor physiotherapy is the right place to start for most postpartum leaking, but there are a few symptoms that need a conversation with your doctor or midwife as well. Burning or stinging when you urinate, needing to go constantly with pain, blood in the urine or a fever may point to an infection. Difficulty starting the stream, feeling as though the bladder never fully empties or being unable to urinate after birth needs same-day medical attention. Please also have continuous dampness assessed, meaning that you’re wet throughout the day rather than only with effort or urgency. Loss of control over gas or stool, particularly after a significant tear, and leaking that begins suddenly several months after birth when it wasn’t happening before are also important to bring up. If you’re dealing with ongoing pelvic pain alongside the leaking rather than pressure or heaviness alone, our article on chronic pelvic pain is a useful companion to this one.
What happens at a pelvic floor physiotherapy appointment
An initial pelvic physio appointment at Oona is roughly 60 minutes long, and a good part of that time is spent talking about your birth history, bladder habits, what brings on the leaking, what you’ve already tried and what you’d like to get back to doing. Your physiotherapist may also look at how you move and breathe, and at how your body manages pressure during the movements that are difficult for you. An internal pelvic floor examination may be offered, but it’s always your choice. Your physiotherapist will explain exactly what it involves before anything happens, and you can decline it or change your mind at any point. There’s still a great deal that can be assessed and treated without an internal examination, so saying no won’t bring the appointment to a halt. You should leave with a clear explanation of what may be contributing to the leaking, along with a manageable number of things to work on at home. Follow-up appointments are usually spaced out as the plan progresses; this isn’t something that should require you to be in the clinic several times a week. Pelvic floor physiotherapy is available at our Toronto and Newmarket clinics. You don’t need a referral to book, and we can direct bill most insurers when your plan allows it.
Frequently asked questions
Is it normal to leak urine after having a baby?
It’s remarkably common, with a meta-analysis of 24 studies involving more than 35,000 women finding that roughly 31 per cent leaked at some point between six weeks and twelve months postpartum. We wouldn’t call it normal in the sense that it’s inevitable or something you simply have to accept, especially when it’s affecting your day and there are ways we can help.
How long does postpartum urinary incontinence last?
Some leaking settles within the first two or three months as the body heals, but there isn’t one recovery timeline that applies to everyone. If you’re still leaking at three months, it’s worth getting assessed. In one twelve-year study, 76 per cent of women who leaked at three months postpartum were still leaking twelve years later, so there’s no benefit to waiting for it to become more disruptive.
Will Kegels fix postpartum leaking?
They can definitely help some people, but the exercise has to suit what your pelvic floor needs and you need to be doing it correctly. In one Cochrane review, 74 per cent of women with stress incontinence who completed pelvic floor muscle training reported improvement or no leaking, compared with 11 per cent who didn’t train. An assessment can tell you whether strengthening is the right place to begin or whether those muscles first need help relaxing and coordinating.
Can you get pelvic floor physiotherapy if you had a caesarean?
Absolutely. Pregnancy places increasing weight and pressure on the pelvic floor for months, regardless of how your baby is born, and we regularly see people at Oona who are leaking after a caesarean. In long-term research, caesarean birth only reduced the risk of persistent incontinence among women who’d never also delivered vaginally. Pelvic floor physiotherapy can be useful after either kind of birth.
How soon after birth can I see a pelvic floor physiotherapist?
An appointment in the first few weeks can be helpful for breathing, positioning, lifting and gentle movement, and it doesn’t need to include an internal assessment. The timing of an internal examination depends on your healing, bleeding, symptoms and comfort rather than one date on the calendar. If you aren’t sure whether it’s the right time to book, our free Care Navigator can help you decide.
Do I need a doctor’s referral to book pelvic floor physiotherapy in Ontario?
No, you can book directly at Oona. A small number of extended health plans require a referral before they’ll reimburse physiotherapy, though, so it’s worth checking your particular plan.
Does it hurt?
An assessment should never be something you have to push through. If you have pelvic pain or a tender scar, part of the examination may feel uncomfortable, and your physiotherapist can adjust or stop at any time. Please tell them what you’re feeling as you go; that information is useful and helps guide what happens next.
Where to start
Leaking after birth is common, but knowing that doesn’t tell us why it’s happening in your particular body or what will help. If it’s still happening at three months, affecting what you wear, changing where you go or keeping you from exercise, sex or everyday movement, it’s worth having the pelvic floor assessed. You definitely don’t need to wait until it becomes severe. There are enough things in early parenthood that really do need time. Postpartum urinary incontinence is something we can actively help you work on, whether your baby is three months old or you’ve been living around the leaking for years. If you’d like to talk it through before booking anything, the Care Navigator call is free and takes about 20 minutes. If you already know that pelvic floor physiotherapy is what you’re after, you can book in Toronto or book in Newmarket directly. And if you’re piecing together what postpartum care should look like more broadly, our postpartum care guide and our complete guide to pelvic floor health are both good places to carry on reading.
