Bringing a new baby into the world comes with countless joys – and a few unwelcome surprises. One surprise many new mums discover is leaking urine after childbirth. Maybe you’ve noticed a little dribble when you cough, laugh, sneeze, or try to exercise. If this sounds familiar, first know that you are not alone – postpartum urinary incontinence (peeing when you don’t mean to) is incredibly common, affecting roughly a third of women in the months after having a baby. But here’s something every woman should hear loud and clear: common does not mean normal, and you don’t have to live with it. Incontinence after childbirth is treatable and often curable with the right help. At Dyer Street Clinic in Cirencester, our women’s health physiotherapy services are geared towards helping new (and not-so-new) mums resolve these “leaking” issues and restore confidence in their bodies. Let’s talk about why postpartum leaking happens and what we can do to fix it.
Why Does Leaking Happen After Childbirth?
The type of leaking most women experience after having a baby is called stress urinary incontinence. “Stress” in this context refers to physical pressure or effort – it’s when an action like coughing or jumping puts pressure on the bladder, and urine leaks out because the usual support mechanisms aren’t strong enough to hold it in.
Several factors related to pregnancy and birth contribute to postpartum incontinence:
- Pelvic Floor Muscle Weakness: The pelvic floor is a sling of muscles that stretches across the bottom of your pelvis, supporting your bladder, uterus, and bowel. Pregnancy itself, with the weight of the baby pressing down for months, can weaken these muscles. Then, during a vaginal delivery, the pelvic floor stretches up to 3 times its normal length – it’s like an elastic that’s been pulled too far. It may not snap back to full strength immediately (or without targeted exercise). If these muscles are weak or damaged, they can’t squeeze the urethra (the tube from the bladder) as effectively to prevent leaks when pressure increases. Think of it like a trampoline – if it’s lost its tension, anything bouncing on it (like a full bladder under pressure) will push right through.
- Nerve or Tissue Damage: The act of childbirth can sometimes strain or even injure the nerves that control the bladder and pelvic floor. It can also lead to minor injuries of the urethra or bladder support. For instance, prolonged pushing or a very fast second stage of labor might bruise those areas. This can disrupt communication to muscles or the closure mechanism of the bladder in the short term.
- Episiotomy or Tearing: If you had a significant tear or an episiotomy (a cut to help deliver the baby), especially if it involved pelvic floor muscles, it may take time to heal and regain strength. Scar tissue can also cause the muscles to not work in sync as well initially.
- Instrumental Delivery: Using instruments like forceps or vacuum can increase the chance of pelvic floor trauma (though they are often lifesaving interventions for the baby’s delivery). Forceps in particular have been associated with higher incidence of postpartum pelvic floor issues, including incontinence, because they create more stretch/damage in that area.
- Hormonal Changes: Right after birth, and while breastfeeding, your body has low levels of estrogen. This can cause the tissues down below (like the vagina and urethra) to be a bit thinner and drier. This might not directly cause leaks, but it can contribute to symptoms like urgency or slight irritation. Low estrogen can also affect pelvic muscle tone somewhat. (The good news is this is temporary – hormone levels normalize after you stop breastfeeding or as more time passes postpartum).
- Bladder Changes: Pregnancy can also change your bladder’s behavior. Some women find their bladder becomes a bit “irritable” – meaning you might feel like you have to go more often (this is called urge incontinence if leaks happen with a strong urge). Others might have a harder time fully emptying (especially right after birth when everything is swollen), which can lead to overflowing a bit later.
Typically, stress incontinence (leak with cough/sneeze) in new mums is due to that combo of weakened pelvic floor and the stretched-out support for the bladder/urethra. During pregnancy, the pressure inside the bladder can overcome the closure strength of the urethra because the pelvic floor isn’t giving its usual back-up support. After birth, the pelvic floor might not automatically regain tone without some work – hence leaks continue.
You’re Not Alone: How Common is Postnatal Incontinence?
Urinary incontinence after childbirth is incredibly common – but it often feels like a secret problem because people don’t talk about it openly. Here are some eye-opening stats and facts:
- One in three women experiences some urinary incontinence in the first year after having a baby. That’s a lot of new mums! If you attend any baby group or antenatal class reunion, chances are multiple women there are going through the same thing, even if no one mentions it.
- A study cited by the NCT (National Childbirth Trust) found about a third of women had incontinence at 3 months postpartum. Many were embarrassed to talk about it – even with partners or friends. Nearly 38% felt self-conscious even discussing it with healthcare professionals, which means many suffered in silence.
- Without effective treatment, the problem can persist. Research highlighted by the NHS shows that up to 75% of women who experience incontinence in the first year after birth still have it 12 years later if left unaddressed. That’s a huge portion continuing to deal with leaks for over a decade! This statistic underscores that while some women do recover naturally, many don’t fully, and it’s not something that always just “goes away” on its own.
- First-time mothers are more often affected, but having multiple children can increase risk as well. Also, big babies, long labors, or deliveries with instruments like forceps can raise the likelihood of postpartum leaks.
- It’s not just vaginal births – even women who have C-sections can experience incontinence after childbirth, though the rates are a bit lower than with vaginal deliveries. Pregnancy itself (plus any laboring before an unplanned C-section) still impacts the pelvic floor.
The take-home message is that postpartum leaking is very common, and you have no reason to feel ashamed or alone in it. It’s a physical issue, not a personal failing. And just like we treat other postpartum issues (like helping a C-section scar heal or treating postpartum depression), we can treat this too.
Why You Shouldn’t Ignore It (It’s Treatable!)
Some women tolerate postpartum incontinence because they think it’s a normal part of being a mum – their mum or grandma might have joked about crossing their legs when sneezing, so they assume it’s just hereditary or inevitable. Others put off seeking help because they’re too busy or embarrassed. But here’s why you shouldn’t ignore it:
- Quality of Life: Leaking can affect your day-to-day activities and enjoyment. You might avoid exercise (maybe you’re scared to go for a run or do a Zumba class because of leaks), or you might feel anxious about long outings where toilet access is uncertain. Some women even shy away from playing actively with their kids for fear of an accident. This sucks the fun out of things you deserve to enjoy. Life with a baby or toddler is challenging enough without an extra worry every time you laugh or sneeze.
- It Can Get Better (or Worse): Urinary incontinence isn’t likely to magically resolve if it’s still going on months after birth, unless you do something about it. In fact, if left, it could worsen during certain times – like during your next pregnancy, or as you approach menopause (when lower estrogen can again weaken tissues). The sooner you tackle it, the better your pelvic floor will be for future stresses. Think of it as reinforcing the foundation of a house; do it before more weight (like another pregnancy or aging) is added.
- Prevent Other Issues: The pelvic floor supports more than just the bladder. If it’s weak, you could also be at risk for other pelvic floor problems such as pelvic organ prolapse (where organs sag down) or fecal incontinence (difficulty controlling wind or bowel movements). Strengthening your pelvic floor now will help protect against these issues too.
- Mental Well-being and Confidence: Constantly worrying about smelling of urine or having to pack extra pads “just in case” can take a mental toll. It might make you less confident in intimate situations with your partner, affecting your relationship. Many women feel a loss of self-esteem, like their body has betrayed them. But reclaiming control can be incredibly empowering. And truly – you can get control back. We’ve seen women go from wearing pads daily to not needing any, and the smile and relief that brings is priceless.
- It’s Not “Just How It Is”: There’s a saying, “Incontinence is common, not normal”. The NHS and health organizations emphasize that women shouldn’t just accept leaking – because effective treatments exist. In fact, a quote from an NHS resource states, “Incontinence is curable but only if you get help from a midwife, GP or health visitor”. In other words, don’t stay silent – speak up and get the ball rolling for treatment.
How Physiotherapy Can Stop the Leaks
The first-line treatment for stress urinary incontinence in women, including after childbirth, is pelvic floor muscle training (PFMT) – basically, physiotherapist-guided Kegel exercises. According to NICE guidelines, women with stress incontinence should be offered a supervised pelvic floor muscle training program for at least 3 months. That’s exactly what we do at Dyer Street Clinic.
Here’s how we approach it:
- Pelvic Floor Assessment: It often starts with ensuring you know how to contract (squeeze) your pelvic floor correctly. Many women aren’t sure if they’re doing it right, and about half of women when first trying actually do it incorrectly (some bear down instead of lift up). A women’s health physio can assess your pelvic floor. This might involve an internal examination (with consent), where we actually feel the muscle contraction, or using biofeedback devices or an ultrasound to see the muscle move. Don’t worry, we create a comfortable, private environment for this. Getting that feedback is super helpful – once you know what a correct contraction feels like, you can practice effectively.
- Pelvic Floor Exercises: We’ll create an exercise plan. Typically, this involves doing a set of pelvic floor squeezes every day. We train both endurance (holding a contraction) and quick flicks (short, strong squeezes) because you need both types of muscle fibers – endurance for holding during a jog, and quick response for that sudden sneeze. For example, we might have you do something like: 10 slow squeezes held for 5 seconds each, and 10 quick squeezes. And you’d do that maybe 3 times a day. Everyone’s plan is tailored though – if your muscles are very weak, we start gentle. If you have some strength but poor coordination, we adjust accordingly.
- Progressive Load: Just like any muscle training, as you get stronger, we make it a bit harder. We might use resistance exercises to strengthen the pelvic floor. Or we change positions – maybe you start doing exercises lying down (easier) then progress to sitting and standing (harder because you’re working against gravity). We track your improvement – perhaps at first you can only hold a squeeze 3 seconds, a few weeks later it’s 6 seconds, and so on.
- Bladder Training (if needed): If you also have urgency (like suddenly needing the loo and struggling to hold it), we incorporate bladder training techniques. This might involve scheduled voiding (timing your loo trips) and strategies to suppress urge (like pelvic floor squeezes or distraction techniques when you feel an urge, to retrain the bladder). We teach you that it’s okay to not run to the toilet at the first hint of needing to pee – we build up your bladder’s tolerance gradually.
- Lifestyle Factors: We’ll talk about things like fluid intake (drinking enough but not excessively), and avoiding bladder irritants if urgency is an issue (like too much caffeine can irritate some bladders). We also address constipation if it’s present – chronic straining on the loo can weaken pelvic floor muscles, so managing bowel health is important.
- Other Therapies: In some cases, we use additional therapies. Biofeedback machines can give visual or audio feedback as you do exercises, which some women find motivating. Electrical stimulation is another option if a woman has very weak or no detectable pelvic floor contraction; a small device can deliver a gentle electrical impulse to make the muscles contract and help you learn the feeling. However, many postpartum women won’t need this if they can engage the muscles themselves. We might also incorporate core stability exercises (like Pilates-type exercise) because the core and pelvic floor work together.
- Education and Habits: We educate you on engaging your pelvic floor during activities that trigger leaks. For example, we teach the “knack” – that’s squeezing your pelvic floor before and during a cough or sneeze. It’s been shown to reduce leakage if done consistently. Eventually, this becomes automatic. We basically re-train your body’s reaction to those “stress” events.
- Use of Pessaries (sometimes): While typically more for prolapse, a vaginal pessary (a device placed in the vagina to support pelvic organs) can also help with incontinence in some cases by giving a little lift to the bladder neck. If appropriate, we might refer you to a specialist who can fit one. But for most postpartum stress incontinence cases, pelvic floor training suffices.
It’s worth emphasizing: Pelvic floor physiotherapy works. Numerous studies have found that women doing these exercises properly have significantly less leakage. Some are completely cured; others might still have an occasional small leak but not enough to bother them or require pads. It’s not an overnight fix – it takes weeks to months of consistent work (muscles don’t strengthen in a day, unfortunately!). But improvements often start to be noticed within a few weeks: maybe you can hold out longer without rushing to the loo, or you notice you didn’t leak during that one surprise sneeze.
Our role is also cheerleader and coach – keeping you accountable and encouraging you, adjusting the program if needed, and troubleshooting any difficulties. For instance, if you’re finding it hard to remember the exercises, we’ll come up with cues (like do them when feeding the baby, or after you go to the toilet each time). If you’re not seeing progress, we’ll re-evaluate technique or try a different approach.
In some cases, physiotherapy plus lifestyle changes still might not fully solve it – there are other medical options down the line (like pelvic floor injections or surgery) but these are usually only considered if physio doesn’t help after a solid trial. Most women won’t need to go to that – physio will do the trick, especially when started early.
Regain Confidence: Help in Cirencester for New Mums
Leaking after childbirth can make you feel older than your years, or insecure about doing the activities you love. But imagine reversing that: laughing with friends without a second thought, joining that exercise class or trampoline park with your kids without fear, coughing freely during cold season without crossing your legs – essentially, having control back. That is absolutely possible, and we’ve seen it happen for many women.
At Dyer Street Clinic in Cirencester, we provide a supportive, private environment for women to tackle these issues. We know it can be a sensitive topic – rest assured, your concerns will be met with understanding and professionalism. Women’s health physio is one of those things that once people discover it, they often say, “Why didn’t I do this sooner?!”
We work closely with local GPs and midwives. You might have been told at your postnatal check to “do your pelvic floor exercises” – but if you’re not sure you’re doing them right, or it’s not improving your symptoms, that’s where we come in. You can usually self-refer to physio or come directly to us; you don’t need to struggle until a GP explicitly sends you (though you can certainly ask them for a referral too, especially if going via NHS route).
Remember, even if you’re reading this and it’s been a couple of years since you had a baby – it’s not too late! We treat women with incontinence even decades after childbirth. Improvement can be achieved years later, so don’t feel you missed the window. That said, the earlier the better, both for your quality of life and to prevent habits (like avoiding activities) from taking hold.
In Cirencester and the surrounding Gloucestershire area, there’s a growing awareness of pelvic health. Let’s keep that momentum. Talk to your mum friends – you might be surprised how many are in the same boat. Sharing info about pelvic physio can be a game-changer for someone quietly suffering.
Call to action: If you’re dealing with postpartum leaking – whether it’s been 3 months or 3 years since your baby – get in touch with us at Dyer Street Clinic. Our women’s health physiotherapist can assess your situation and craft a plan to get you dry and confident. We do one-on-one sessions, and you’ll have a customized exercise plan. You’ll be supported every step of the way.
Motherhood is challenging enough; you shouldn’t have to worry about little leaks on top of it all. Let’s fix the leaks and focus on the laughs (and sneezes and jumps) without fear. After all, taking care of yourself is one of the best things you can do for your family – a happy, confident mum means a happier household. We’re here to help make that a reality for you.
References: Prevalence of postpartum urinary incontinence (one third of women)nct.org.uk; NHS England statistic on long-term persistence if not treated (up to 75% over 12 years)england.nhs.uk; NICE guideline recommendation for supervised pelvic floor training for stress incontinencenice.org.uk; NHS quoted advice that incontinence is curable with proper helpnct.org.uk.