Incontinence After Childbirth

Incontinence after childbirth at a glance

• During pregnancy and after childbirth, many women experience at least some degree of involuntary urination, called urinary incontinence.
• Some women also experience bowel (fecal) incontinence, which is involuntary loss of fecal matter.
• Many factors can contribute to postpartum incontinence, including the baby passing through the birth canal during delivery, the increased weight of the uterus during pregnancy, and the unique hormones produced in pregnancy.
• Genetics and lifestyle factors, such as smoking, also play a role in a woman’s likelihood of developing incontinence after pregnancy.
• Women with a higher body mass index (BMI) during and after pregnancy have a higher chance of incontinence after childbirth.
• Women who delivered their child naturally have a 50% greater chance of developing incontinence after childbirth than women who had a Caesarean delivery.
• First line treatments for incontinence depend on individual circumstances, but can include strengthening exercises (Kegels), bladder training, nerve modulation, pelvic floor therapy, electrical stimulation to improve pelvic floor muscle contraction, or a pessary.
• If after childbirth symptoms have not resolved with first line treatments, surgery can be used to treat incontinence.

What is postpartum incontinence?

During and following pregnancy, as many as 4 in 10 women experience urinary incontinence, or the involuntary loss of urine. Despite the normalcy of incontinence after childbirth, many new mothers may feel shame or embarrassment about this change in their bodies.

The lack of dialogue about incontinence in many communities also leads some women to assume that this is an issue with no easy solutions. Truthfully, incontinence is not only very common, but also responds to a number of noninvasive treatment options that can greatly improve or eliminate symptoms.

There are several types of urinary incontinence, but most postpartum women experience stress incontinence. Laughing, coughing, sneezing, jumping and other activities can put extra pressure on the bladder sphincter, the muscular valve at the bottom of the bladder that controls urine flow. This pressure can lead to urine leakage, or stress incontinence, during those activities.

What causes postpartum incontinence?

Giving birth is extremely tough on the body and can change a woman’s urinary control abilities. During pregnancy, the weight of the expanding uterus can weaken the strength of a woman’s pelvic floor muscles and cause urine to leak.

Giving birth can also affect those same muscles. Symptoms of incontinence may persist even after delivery. Hormones, genetics and other lifestyle factors, like smoking, can also make it more likely that a woman will experience incontinence after childbirth.

The following conditions may also add to postpartum bladder control problems

• Damage to the nerves that control the bladder, rectum and pelvic floor muscles.
• Movement of the urethra and bladder from their usual position.
• Having an episiotomy or experiencing a tear in the pelvic floor muscle during delivery.
• Undergoing an assisted vaginal delivery with either forceps or a vacuum, which can damage the pelvic floor and anal sphincter, leading to urinary or fecal incontinence.

 Read Stacy’s story on how surgery helped her return to running after giving birth to her son.

Incontinence is common in new moms but can also develop in the months and years after childbirth – some women don’t experience problems until their 40s. Whenever postpartum incontinence issues begin to develop, women should consider making an appointment with a female pelvic health specialist. We offer many treatment options that can improve the mother’s quality of life.

Risk factors for incontinence after childbirth

Women are more likely to have incontinence if they also had leakage problems during pregnancy, particularly in the first or second trimester. Women who also had long deliveries or needed forceps during labor are also more likely to experience urinary leakage.

According to the National Institutes of Health, women who have a natural delivery are 50% more likely to experience incontinence than women who deliver by C-section.

Women with a high BMI, or those who retain pregnancy weight gain after the birth of their child(ren), are more likely to experience incontinence and pelvic organ prolapse (POP) after giving birth. Postpartum weight loss decreases the risk of urinary incontinence, even if other risk factors such as age and/or type of delivery method exist.

Postpartum incontinence treatments

The good news in regard to incontinence after childbirth is that there are many treatment options. Some common treatment options are listed below.

• Diet and exercise. Food and drinks such as coffee, citrus, spicy foods and soda can all irritate the bladder. Cutting back on or eliminating these foods may help improve incontinence symptoms. Keeping weight within a healthy BMI range, and/or focusing on losing pregnancy weight, can also help with bladder control.
• Special exercises. Kegels strengthen the pelvic floor, giving more control over urinary urges. Visit our Kegel Corner to learn more.
• Physical therapy. Pelvic floor physical therapy can also help build muscle memory and strength. The abdominal muscles, hip muscles and pelvic floor muscles work together when a woman performs strengthening exercises like Kegels. Physical therapists identify areas of weakness in those muscle groups to help a woman build a strong core and pelvic floor.
• Bladder training. The bladder is a muscle that should be regularly strengthened. Scheduling urination times and then gradually increasing the amount of time in between urination can increase bladder strength.
• Percutaneous tibial nerve stimulation (PTNS). PTNS is a nonsurgical treatment for overactive bladder and a form of neuromodulation therapy. During PTNS treatments, a doctor places a slim needle in the ankle where the tibial nerve is located. The needle delivers electrical impulses to the tibial nerve, which sends signals to the sacral nerves in the spine that control bladder and pelvic floor function. Over time, these pulses block nerve signals that are not working properly to lessen urinary incontinence symptoms.
• Evaluating lifestyle factors. Excessive coughing due to smoking or being overweight can put unnecessary strain on the pelvic floor muscles. Certain drugs such as antidepressants and antihistamines can also have an impact on urinary incontinence.
• Pessary. A pessary is a device inserted into the vagina to provide support for vaginal tissues, in turn, aiding in bladder incontinence.
• Surgical treatments. Surgical treatment options can help support the pelvic floor and may be recommended for women who have completed childbearing and have not had success with conservative therapy.

  View all incontinence treatments at the bottom of our Urinary Incontinence page.

Resolving incontinence

In many cases, women with postpartum incontinence see significant improvement after implementing a doctor’s recommended lifestyle changes. Women may also see their symptoms completely resolve by maintaining a healthy routine and losing any extra post-pregnancy weight.

The important thing for women to know is that incontinence after childbirth does not need to be a daily part of their lives as moms. There are attainable solutions, and all they often require is taking the first step of asking for help.