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Incontinence in pregnancy and after childbirth

We discuss urinary incontinence in women including causes of incontinence and treatment for stress incontinence.

Urinary incontinence is the ‘involuntary loss of urine’. The most common form is stress urinary incontinence, which is leaking urine because of physical exertion, like doing sport, or coughing, laughing or sneezing.

What causes pregnancy incontinence?

The most common cause of pregnancy-related urinary incontinence is weak pelvic floor muscles. Pelvic floor muscles span the bottom of your pelvis. They support the uterus and help control the bladder and bowel. The increasing weight of your baby, followed by giving birth, may weaken these muscles.

Having weaker pelvic floor muscles makes it harder for you to control your bowel and bladder, which can lead to trouble controlling when you need to use the toilet. You may leak wee when you cough, sneeze, laugh or move quickly. Lifting things can also make you wee.

You're more likely to have stress incontinence if you had problems with controlling your bladder in pregnancy, particularly in the first or second trimesters.  If it took a long time to push your baby out, and you needed forceps to help, it may mean you are more likely to have problems with leaking.

If you had an epidural or a spinal block, the nerves controlling the feeling in and around your bladder may feel numb. In the first few days after birth you may not be able to tell when you need to wee. Your nurse or midwife will remind you when it's time to go to the loo soon after you've had your baby.

If you had an epidural, the catheter that was inserted into your bladder may make it harder for you to control when you wee. But this should get better within a few days.

Is incontinence after birth common?

Yes – almost half of all women experience urinary incontinence after childbirth.  Unfortunately, despite incontinence being something that many new mums suffer from, it remains a taboo subject.

Our research found that a third (33%) of women who developed urinary incontinence after childbirth were embarrassed to discuss it with their partner, and almost half (46%) were uncomfortable talking about it with friends. 

Most worrying of all, almost 4 in 10 (38%) of women said they were self-conscious speaking about the problem with a health professional.

No woman should suffer in silence as pregnancy incontinence can be treated without drugs or surgery through exercises that improve the strength of your pelvic floor muscles.  If you have any concerns about incontinence and bladder problems, speak to your GP, midwife or health visitor.

How long will incontinence after childbirth last?

This will depend on how you gave birth, what happened during labour and whether you had incontinence problems during pregnancy. For some, the problem goes away within a few weeks of giving birth. For others, it can continue for months, or become a long-term problem.

If you're still experiencing leaks when you have your postnatal check at about six weeks to eight weeks after your baby is born, tell your midwife, doctor or health visitor. While stress incontinence is common; it isn’t something you just have to ‘live with’. There is support available to help you regain bladder control.

What can I do to regain bladder control after birth?

The best treatment for stress incontinence is to make your pelvic floor muscles stronger by exercising them. Find out how to do your pelvic floor exercises here.

If you continue to have problems, ask your GP for a referral to a women’s health physiotherapist. If you suffer with incontinence, the National Institute for Health and Care Excellence (NICE) guidelines recommend that you should receive at least three months of supervised pelvic floor muscle training as a first-line treatment of the condition.

Even if you don’t experience urinary incontinence, the guidelines recommend women complete regular pelvic floor exercises in their first and subsequent pregnancies to reduce the risk of the condition developing.

Watch this video from the Chartered Society of Physiotherapy (CSP) where a mum, physio and midwife talk about how pelvic floor exercises can maintain muscle strength following pregnancy and birth.

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When can I start exercising my pelvic floor muscles after a vaginal birth?

Resuming pelvic floor muscle exercises as soon as possible after giving birth will help to reduce any swelling and speed up the healing process. If you had stitches you may wish to start the exercises lying down and work your way up to doing them whilst sitting.

Start with gentle, short, pelvic floor muscle squeezes, within 24 hours of having your baby. Although you might be worried that it will hurt, most women find that it's not as sore as they expect.

As you feel more confident and more comfortable, you can squeeze a little harder and add in your long squeezes again. Gradually build up how many squeezes you do, and how long you hold. Try to do this four to five times per day. Once your baby is feeding well you may find that this is a good time to practice your exercises.

When can I start exercising my pelvic floor muscles after a birth with ventouse or forceps, or by caesarean?

Start your pelvic floor muscle exercises once any urinary catheter has been removed, and you are passing urine normally.

Don't assume that you don't have to do these exercises if you've had a caesarean. Just being pregnant can weaken your pelvic floor muscles. You are still at risk of bladder and bowel problems.

How else can I regain control of my bladder?

As well as doing your pelvic floor exercises, you can:

  • Try to prepare for coughing, sneezing or any exertion, such as getting up out of a chair by tightening your pelvic floor muscles first (see our article about exercises to find out more).
  • Drink plenty of non-caffeinated drinks. You may think that if you drink less, you'll need the toilet less. In fact, you need to drink a lot, especially if you're breastfeeding, which can make you feel thirsty.
  • Try and avoid too many caffeinated drinks like tea, coffee, hot chocolate and fizzy drinks, as caffeine can irritate the bladder.
  • Eat a healthy, balanced diet to avoid constipation – straining to empty the bowel will weaken the pelvic floor muscles.

What if I have a urinary tract infection (UTI)?

Sometimes, having no control over the flow of your urine is caused by a urinary tract infection (UTI). If you have a UTI, you may also:

  • feel pain when you wee,
  • pass cloudy wee,
  • pass unpleasant-smelling wee,
  • have a fever and
  • need to wee more frequently.

Contact your doctor or midwife immediately if you have any of these symptoms. You may need antibiotics to clear up the infection.

Breaking the taboo

The consequences of not seeking help for incontinence problems can be devastating. It can leave women feeling lonely and isolated, affect relationships and careers, and prevent them exercising or having sex.

All women should know that they are not alone and that treatment is available – incontinence is not something they need to shy away from talking about.

Further information

The Chartered Society of Physiotherapy (CSP) has lots of useful information about pregnancy-related incontinence.

You can also use the CSP’s Physio2U service to find a local practitioner or contact the Pelvic Obstetric and Gynaecological Physiotherapy group.

Read more about the evidence around incontinence.

NHS Choices has helpful information about urinary incontinence including symptoms and treatment.