Bladder weakness (incontinence) after birth

Urinary incontinence is accidental loss of urine (wee) from the bladder. It can range in severity from a small leak to a complete loss of bladder control.

Leaking urine after childbirth is very common. Around 1 in 3 females who have had a baby may experience leakage at some point. The more times you give birth, the more likely you are to have bladder problems. You can also develop bladder problems during pregnancy.

There are different types of urinary incontinence. The type that can be caused by pregnancy and childbirth is known as stress incontinence.

You may leak urine when you:

• laugh
• sneeze
• cough
• lift something heavy
• exercise

You might also pass wind without intending to.

When you are pregnant, your body makes hormones that stretch your muscles and the tissues that support the bladder, the bowel and the uterus. This group of muscles and tissues is called the pelvic floor. The weight of your uterus also presses on your pelvic floor and makes it weaker.

When your baby moves down through your vagina to be born, your pelvic floor stretches and it remains stretched for some time.

This means the muscles that control your bladder are weakened. This can lead to accidental leak of urine.

If you are experiencing urine leakage, you can talk to your doctor or a women's health physiotherapist. It's important to seek help if your symptoms continue for longer than 6 months after giving birth.

See your doctor if:

• you have a heavy or dragging feeling in your vagina
• you experience pain or other problems during sexual intercourse
• you have pain when you pass urine
• your bladder problems are affecting your daily activities

Your doctor or physiotherapist will ask you about your symptoms and examine you. It can be helpful to keep a bladder diary, where you record your symptoms and how much fluid you drink.

Your doctor might refer you for a urodynamic study (a test of your bladder function).

Urine leakage after childbirth might get better by itself, as the stretched muscles and tissues recover. This can take up to 6 months. If your symptoms don't improve, there are treatments that can help.

Lifestyle changes

Simple lifestyle changes can help reduce urine leakage:

• Maintain a healthy weight.
• Eat foods rich in fibre to prevent constipation.
• Drink plenty of water.
• Avoid caffeine, as it can irritate your bladder.
• Quit smoking.
• Avoid lifting and high impact exercise.
• Only go to the toilet when you need to, not 'just in case'.

Pelvic floor exercises

You can exercise, tone and train the muscles around the bladder, bowel and uterus just like any other muscle in the body. Doing pelvic floor exercises can improve your symptoms. You can do them in any place and at any time.

Here's how you do pelvic floor exercises:

1. Relax your muscles.
2. Pull the muscles around your vagina and anus up and in, as though you are trying to stop yourself from urinating (weeing).
3. Hold the squeeze for 8 seconds, or as long as you can manage, while breathing normally.
4. Relax your muscles and wait 8 seconds.
5. Repeat the squeeze and release. Try to do this 8 to 12 times.
6. Do this exercise 3 times a day.

Continence Health Australia has a video on how to do pelvic floor exercises.

Urinary incontinence can sometimes become a long-term problem. Here are some tips that may help if you are living with it:

• Use continence pads — these are made for urine leakage.
• Take a change of underwear or set of clothes when you go out.
• Know where toilets are located so you can find them quickly. There are smartphone apps to help you do this, or use the National Public Toilet Map.
• Cross your legs when sneezing or laughing.
• Adapt your exercise routine to avoid high impact exercises, such as jumping.

A weak pelvic floor can lead to pelvic organ prolapse.

Vaginal weakness and trauma from birth can lead to sexual problems, such as pain with intercourse.

Urinary incontinence can affect your emotional health and general wellbeing. Help is available, but some people feel too embarrassed to ask for it. This can lead to distress.

Doing pelvic floor exercises during and after pregnancy will help prevent urinary incontinence after the birth of your baby.

Straight after birth, you will need to give the pelvic floor time to recover. Ice the perineal area for the first few days and have plenty of rest.

Later, you can start with gentle pelvic floor exercises while you are lying down. Hold for one second and rest for 3 seconds. Try to do 6 repetitions, twice a day. Try to build up longer holds when you can. Talk to a physiotherapist for guidance.

There are some other steps you can take to help prevent incontinence:

• Eat a high fibre diet with 2 pieces of fruit and 5 serves of vegetables per day.
• Maintain a healthy weight.
• Sit properly on the toilet, resting your forearms on your thighs.
• Avoid constipation, as this strains your pelvic floor muscles.
• Don't go to the toilet 'just in case'.

It's also important to exercise safely while you are pregnant and after the birth to avoid incontinence. To protect your pelvic floor, avoid:

• heavy weights
• high impact activities such as running
• bouncing

• Keep a bladder diary — this is a record of the fluids you drink and how much urine you passed or leaked during the day and overnight. Your health professional will use this information as part of your continence assessment to develop your plan for treatment or management.
• Read more on surgery for bladder control problems at Continence Health Australia.

For more information and support:

• Speak to your doctor or midwife.
• Call the National Continence Helpline on 1800 33 00 66 to talk to a nurse continence specialist.
• Visit the Australian Physiotherapy Association to find a pelvic health physiotherapist.

Looking for information for Aboriginal and/or Torres Strait Islander people?

Continence Health Australia offers resources on bladder problems and pelvic floor exercises for Aboriginal and/or Torres Strait Islander people. Read more on leaking urine (wee) after having a baby.