Leaking Urine After Birth: Is it Normal and What Should be Done About It?

Leaking urine is one of the most common complaints new moms have after giving birth to their babies. In fact, it’s so common that it has been normalized by much of society and generations past. However, not being able to control your urine flow is not normal, and pelvic floor physical therapists are shouting this from the rooftops. If you are leaking urine after birth, you need to see a pelvic floor physical therapist. 

Many women who have never been to pelvic floor therapy are a bit apprehensive because they don’t know what it entails or what to expect. When you’re leaking urine after birth and having a hard time controlling bodily functions, here are the top 4 things we assess and treat at our Waukesha-based pelvic floor physical therapy clinic to help moms stay dry and confident:

Pelvic Bone Positioning

During pregnancy our bones move to accommodate for a growing baby, and the ones that move the most are, arguably, the pelvic bones. Then when we get to labor, the bones move again, and they move a lot. If we had a successful vaginal birth, we will see the following bone changes:

• Ischial tuberosities (aka sitz bones) splay out to the side

• Sacrum lifts backwards

• Tailbone is displaced to the side

  
  

All of these changes make space for baby to come out, and we call this an open birthing pattern. Problems can arise when the bones don’t return back to their original position. Our pelvic floor muscles are attached to all of these pelvic bones, and stretched out muscles don’t work well. This rapidly leads to pelvic floor problems.

If you didn’t have a vaginal birth, your pelvic bones still experienced changes during pregnancy and any labor that you did experience. While we may not find a textbook open birth pattern in a mom who has had a c-section, it is always worth assessing whether your pelvic bones are positioned well and move well since we know they were impacted. 

It’s been my clinical experience that treating the pelvic bones creates rapid, positive changes in women’s ability to control their bladder better postpartum because it puts the muscles back into optimal position for optimal function. 

Perineal Scars

Perineal scars are another contributing factor to leaking urine after birth. This is because the scar tissue on the perineum, which is typically sustained during a vaginal delivery, directly impacts the pelvic floor muscles in this area. There are different degrees of tissue damage that can occur when a woman tears or has an episiotomy. Even the smallest scars can have a big pelvic floor impact as scars tend to bind down, or tighten. This binding down places the muscles at a disadvantage. Tightened scar tissue can pull on all of the pelvic floor muscles and tissues in the vaginal canal, making it harder for them to do their job of controlling urine. 

Pelvic floor physical therapists utilize internal vaginal manual therapy to treat these scars, help them to loosen, release, and function well so the muscles of the pelvic floor can better function. 

Pelvic Floor Weakness

Birth is a major stress to the pelvic floor. While the pelvic floor was designed to handle the strain of pregnancy and the stress of delivery, there are some cases where women find their pelvic floors too weak to respond well when we need to control our urine. Common reasons for pelvic floor weakness after baby are:

• Perineal scars

• Muscle avulsion (aka becoming detached)

• Nerve damage

• Altered breathing mechanics

• Abdominal weakness

• Hip weakness

  
  

Seeing a pelvic floor physical therapist for a thorough assessment will help you to determine if pelvic floor weakness is your problem and what is causing it. The treatment often involves a combination of manual therapy, both intravaginal and external, and targeted exercises. 

Pelvic Floor Tension

Believe it or not, not all pelvic floors that leak urine are weak. Some are simply too tense to respond when you cough, sneeze, exercise, or feel the urge to urinate. It’s been my clinical experience that this is more common to find in women than it is to find true pelvic floor weakness. Or sometimes I’ll find that the pelvic floor is weak because of the tension it's holding! The most common reasons a pelvic floor will hold tension after birth are: 

• Open birth patterns in the pelvis

• Perineal scars

• Glute weakness

• Abdominal weakness

• Altered breathing mechanics

• Back muscle tension

• Altered posture 

• C-section scars

• Strong negative emotions related to birth, parenting, or relationships

  
  

The pelvic floor will often take over the job of supporting the body when other muscles are not showing up through the hips and abdomen. It also is placed at a significant disadvantage when the ribs are not stacked properly over the pelvis, and it will often tense up to provide support that the body is not getting from elsewhere. This is why “doing your Kegels” can be detrimental advice- if you are already tense, adding more tension isn’t the answer. A pelvic floor physical therapist will help your muscles to release and relax while helping the rest of the muscles in the body start doing their jobs better again. 

Leaking urine is never normal, no matter what your grandmother/mother/sister/aunt/neighbor may claim. It does not have to be your norm after having a baby, there is help for it. That help is pelvic floor physical therapy. 

Looking for a pelvic floor physical therapist who will take a whole-body approach to helping you master leaking urine after birth? Foundation Physical Therapy in Waukesha, WI is currently accepting new patients. We would love to help you live pain free, move well, and thrive. 

Click here for more information and to schedule an appointment online, or give us a call at 262-627-0425. 

Treatment of the sacrum to correct an open birth pattern to help the pelvic floor function optimally

FAQ

What is pelvic floor physical therapy? 

Pelvic floor physical therapy is a specialty within the field of physical therapy that specifically addresses concerns related to or that involve the pelvic floor. Pelvic floor PTs are trained in internal vaginal assessments and can treat the pelvic floor from the inside and outside.

When should I start physical therapy after having a baby?

Women should be starting rehab and physical therapy within 2-3 weeks of giving birth. These first appointments never involve intravaginal work, as the uterus is still healing and infection risk is high. These first appointments are targeted at the pelvic bones, re-establishing proper breathing mechanics, core activation, and can also help with positioning and posture challenges for baby wearing and nursing. Intravaginal work can start at 6 weeks postpartum or with midwife/physician clearance. 

Will my leaking get better if I just take it easy?

That depends on how far postpartum you are. Moms in the first week or two postpartum can expect some minor leaking, and taking it easy is exactly what they should be doing. However, if the leaking isn’t improving, or it’s getting worse past this point, just taking it easy isn’t guaranteed to be the answer. Having an assessment with a pelvic floor physical therapist is the best way to help with leaking urine after birth. 

Dr. Sabrina Thorpe is a Doctor of Physical Therapy with a decade of clinic experience. She specializes in treating pregnant and postpartum women and their infants at Foundation Physical Therapy in Waukesha, WI.